1. LATEX ALLERGY

2. Latex Sensitivity vs Allergy
Latex allergy is an IgE-mediated sensitization to naturally occurring latex proteins.
Repeated exposure to proteins in NRL causes:
Sensitivity – the development of an immunologic memory (IgE) to a specific protein (i.e. latex)
Allergy – the demonstrated outward expression of the disease (hives, rhinitis, anaphylaxis, etc.)
AORN Perioperative Standards and Recommended Practices, 2012
IgE is the protein antibody released as part of the body’s immune response to what it views as harmful. i.e. latex in this situation.
Sensitivity is more common than actual allergic reactions but anyone who has a reaction to latex has the potential to have a life threatening reaction.

3. History of Latex Allergy
Turn of Century, Latex gloves commonly used
1927- First recorded apparent allergic reaction to latex- Dental partial plate
1933 – Latex hypersensitivity to rubber gloves was reported
1979 – Immediate-type allergic reactions (Type1) reported with increasing frequency
Since US FDA reports over 1,700 incidences of allergic reactions with 17 deaths
AORN Perioperative Standards and Recommended Practices, 2012
Advantages to using rubber-based products in health care was recognized as early as 1834 when it was first used for surgical gloves and by 1900’s, surgical gloves were the standard to guard against the spread of disease. In A partial plate with a rubber base caused uticaria and oral angioedema in a patient.

4. Why Latex Allergy Became More Common
Probable Causes:
1987 CDC implemented Universal Precautions
1992 OSHA Mandated Universal Precautions
New and/ or inexperienced manufacturers
New routes of sensitization
Familiar with signs of hypersensitivity/ better
reporting
AORN Perioperative Standards and Recommended Practices, 2012
Latex Allergy, Christine Calson, Wild Iris Medical Education,Inc. 2011
Remember HIV scare…Blood exposure became scary and the use of latex items such as gloves and condoms increased tremendously. Shortage of gloves in the 80’s and 90’s was attributed to the increased demand due to Universal Precaution implementation. There was an estimated 20-fold increase in medical glove use ( in billions of pairs) since introduction of U.P.. The growing demand for latex gloves lead to manufacturers changing techniques for extracting rubber which contributed to leaving more water-soluble latex proteins in the gloves. Young Hevea brasiliensis (Hev b) trees in Africa and Southeast Asia were stimulated with chemicals to increase production as well as the use of shortened storage periods contributed to the production of more allergens in the latex. Sensitization increased with the combination of increased allergens in latex and transfer of these protein allergens into glove powder, which in turn aerosolized and became inhalation as well as cutaneous and mucous routes. In more recent years, individuals environmentally exposed to latex are more familiar with the signs of latex sensitiviy or a true allergy and reporting methods have improved.

5. Latex Sensitivity Prevalence Rates
General population range: %
Health Care Workers: 10 – 17%
Spina Bifida/Congenital Defects:35 – 70%
AORN Perioperative Standards and Recommended Practices 2012
By mid-1990’s, epidemic proportion of allergic incidence in healthcare workers. Numbers vary….

6. CLINICAL MANIFESTATIONS OF LATEX
Delayed type contact dermatitis
Reaction develops gradually over a day or weeks
Red, scaly, itchy skin
Climactic irritation, damage of skin
Not an allergic reaction
Allergic contact reaction (Type IV)
Symptoms within six – 48 hours
Previous exposure to latex- sensitized chemicals
Sneezing/runny nose, coughing/wheezing, watery eyes
AORN Standards and Recommended Practices, 2012
Contact dermatitis is generally caused from frequent hand washing, insufficient rinsing, use of antiseptics, dry Alaska climate and the powder in gloves.
Type IV is T cell-mediated and the result of exposure to chemicals used in latex harvesting, processing and manufacturing.

7. CLINICAL MANIFESTATIONS TO LATEX
TYPE 1 ANAPHYLAXIS REACTION
Immediate (Within 5 – 30 minutes of exposure)
True allergy to natural rubber latex
Systemic reaction
Pathways- Skin, mucous, inhalation, internal organs
Symptoms:
Hives
Eyelid/ Facial swelling/ Edema
Swelling of throat, nasal passages, bronchi
Difficulty breathing/ Wheezing/ Bronchospasms
Anaphylaxis/ Death
AORN Standards and Recommended Practices 2012
Results from latex protein exposure from gloves or proteins bound to powder suspended in the air, on objects or directly tranferred by touch.

8. GROUPS AT RISK FOR LATEX ALLERGY
Children with myelodysplasia (Spina Bifida)/ multiple surgeries since infancy
Occupational Exposure- Health care/Food service employees
Atopic individual w/ hx of eczema, rhinitis
History of Type 1 reaction to multiple environmental allergies including food allergies such as avocado, banana, kiwi, papaya, chestnut, potato and tomato
AORN Standards and Recommended Practices, 2012
Cross reactivity that exists between NRL and certain food allergens. Those with known latex allergy or are at high risk should be treated in a latex-safe environment.

9. TRIGGERING LATEX PRODUCTS
Just to name a few: Pacifiers/ bottle nipples Dental dams/ Orthodontic elastic Condoms/ Diaphragms Latex gloves/ powder Catheters- Urinary, Barium enema Nasogastric tubes Bandages/ Adhesives (Tapes)

10. Prevention
Big Deal!
1988- FDA required warning statement on latex products
Goals
Prevent reaction in latex-sensitized individual
Prevent initial sensitization
AORN Standards and Recommended Practices, 2012

11. PRE-OPERATIVE ASSESSMENT OF LATEX ALLERGY PATIENT
Careful assessment of risk:
Watch for patients that have problems with:
Blowing up latex balloons
Wearing rubber bands at wrist/ elastic underwear
Dentist issues – dental dam
Diaphragm / Condom
Adhesive bandages/ tapes
Fruits such as bananas, kiwi, etc
Patient has latex allergy: In addition to above -
Describe allergy and severity
Check if filled out questionaire

12. MANAGEMENT OF LATEX- ALLERGIC PATIENT
Create a latex-safe environment by:
Careful assessment of risk
Communicating risk to all care-givers
Schedule first case of day
All cases are set of using latex free gloves-routine!
ID band/ Flag chart/ Signs for OR & Patient bed
Educate patient/ family about plan
Latex-free environment -
GLOVES/ CATHETERS/ANESTHESIA PRODUCTS
Remove all latex gloves/ products from room
Monitor for reactions/ Assist with treatment -
Trendelenberg, Epi, Benadryl, Albuterol, CPR
Document laser-safe environment/ patient response
Christine Calson, Wild Iris Medical Education, Inc, 2011

13. MANAGEMENT OF LATEX-ALLERGIC EMPLOYEE
Create a latex-safe environment
Provide latex free/ powder free gloves
Don’t use oil-based hand creams/lotions w/ latex gloves (causes deterioration of rubber)
Wash hands after wearing gloves
Educate self about latex allergy
Reduce exposure and seek medical advice if latex allergy is suspected
Recommend change of environment as necessary
Christine Calson, Wild Iris Medical Education, Inc, 2011
Allergy band, flag chart, note on schedule. Improvement in Latex free gloves. Do not have to call all the manufacturers anymore. Each one complies with FDA requirement to clearly mark latex products.
Encourage employees to wear latex free gloves, wash hands after removing gloves.

14. Best and most effective treatment is AVOIDANCE!!
Where are we today?
Considerable reduction in prevalence
Elimination of donning powder
Introduction of synthetic rubbers
Education of the public
Resource for latex alternatives - American Latex Allergy Association
Best and most effective treatment is AVOIDANCE!!
American Latex Allergy Association –latex alternatives