Be on the Lookout for Latex Allergies

June 1, 2003

Be on the Lookout for Latex Allergies

By Melba Rhodes, BSN, RN

Allergies are a serious problem and should be treated as such. Allergies canlead to impaired quality of life, including impaired sleep and learning ability,as well as missed school and work. Untreated allergies also result in otherchronic respiratory problems or dermatologic disorders such as asthma,sinusitis, eczema and urticaria. Some allergies, especially to foods, drugs orinsect stings, can even lead to a life-threatening reaction called anaphylaxis(which involves shock, swelling of the respiratory tract and other deadlychanges in the respiratory and circulatory systems).

Allergies are reactions to certain animal proteins, enzymes, flour, naturalrubber latex, certain chemicals, drugs, dust, latex rubber, etc. An allergicreaction occurs when the body's immune system overreacts to these substances,called allergens. Allergic responses range from watery eyes to itching,wheezing, rash, hives, swelling, and in severe cases, anaphylaxis. Theseresponses can occur when items touch the skin, mucous membranes, open areas orthe bloodstream (for example, during surgery) or are inhaled or ingested.

Latex allergy is a common serious hazard among healthcare workers (HCWs) andsome patients. Some people react to latex rubber balloons or to breathing thepowder inside latex gloves that is aerosolized when gloves are put on or takenoff. The Food and Drug Administration (FDA) has received more than 600 reportsof cases of serious reactions to latex and more than 16 deaths associated withreactions to rubber latex. Symptoms from glove allergy range from pain, itching,redness of hands after wearing latex gloves or contact with latex products toskin breakdown (papules, vesicles) to wheezing, respiratory difficulty andshock.

Latex is the sap from the Hevea brasiliensis tree. Rubber is produced whenchemicals to increase durability, elasticity and strength are added to latex.Latex is found in many products commonly used in the hospital, community orhome, including: IV tubing injection sites, balloons, "koosh balls,"gloves, pacifiers, urinary catheters, art supplies (gum erasers), condoms,adhesive tape, elastic bandages, artificial latex fruit and elastic on clothes.There are alternative or non-latex products for all of these items; usuallythese alternatives are made of plastic, vinyl or silicone.

While anyone could develop a latex allergy, certain groups have beenidentified as having a greater risk. These groups are comprised of individualswho have frequent exposure to latex, including: HCWs, people with spina bifidaand people with urologic abnormalities. It is not known exactly how this allergydevelops, but it is estimated 6 percent to 7 percent of surgical personnel and18 percent to 73 percent of children and adolescents with spina bifida aresensitive to latex as measured by history or blood test. Most, but not all, ofthe children who developed serious reactions during surgery were older than 11years and had multiple surgeries in the past. At least 7.7 million people areemployed in the healthcare industry in the United States. Once sensitized, HCWsmay go from contact dermatitis to true latex allergy. The National Institute ofOccupational Safety and Health (NIOSH) reports that 8 percent to 12 percent ofhealth-care workers regularly exposed to latex are sensitized, compared with 1percent to 6 percent of the general population. Workers at risk of latex allergyfrom ongoing latex exposure include physicians, nurses, aides, dentists, dentalhygienists, operating room employees, laboratory technicians and housekeepingpersonnel.

For individuals who are allergic to latex, the Spina Bifida Association (SBA)and NIOSH recommend avoiding all latex products. Substitute other kinds ofgloves, tape, pacifiers, etc. Allergies to certain food and nuts have beenassociated with an increased reaction to latex -- avocado, banana, kiwi, cherryor peach (stone, seedy and tropical fruits) or nuts (peanuts, hazelnuts, andchestnuts). These foods have similar DNA strains to latex. Anyone with latexsensitivity or other allergy should wear a medical identification bracelet ornecklace stating the allergy, avoid the allergen, and inform healthcareproviders before undergoing medical and dental procedures or exams. Talk withyour doctor about carrying an epinephrine kit.

There are three types or classifications of reactions HCWs experience. Themost common reaction to allergens or irritants is irritant contact dermatitis --the development of dry, itchy, irritated areas on the skin, usually the hands.This reaction is caused by irritation from wearing gloves and by exposure to thepowders added to them. Irritant contact dermatitis is not a true allergy and canbe caused by many things besides glove powder, including soaps and cold weather.These symptoms disappear shortly after the irritant is removed. Allergic contactdermatitis (sometimes called chemical sensitivity dermatitis) results from thechemicals added to latex during harvesting, processing or manufacturing and fromother allergens like poison ivy, soap and harsh chemicals. These chemicals cancause a skin rash similar to that of poison ivy. This rash can last from four toseven days after the irritant is removed. Neither irritant contact dermatitisnor chemical sensitivity dermatitis is a true allergy. The last is the trueallergy, immediate or Type I hypersensitivity. This ranges from mild reactionslike itchy, watery eyes to anaphylaxis and shock. Many other things, especiallyfood and drug allergies, can also cause true allergic reactions.

Probably the most important recommendation is to communicate about anyallergy to all healthcare providers. Teach yourself and the allergic individualto recognize and avoid the allergen (e.g., latex products). Sharing informationso that allergic individuals have minimal exposure to allergens (e.g., latex) inthe home, community and healthcare facility will help minimize the risk ofallergic reactions.

There are policies addressing identification and handling of personssuspected to be latex sensitive. Latex-free items are available for thetreatment and care of both employee and patients. Contact your employee healthnurse about the location of the policy for patients and employees.

Any suspected latex sensitivities in employees should be reported to employeehealth personnel. Any suspected latex sensitivities in patients should bereported to the appropriate personnel, the chart flagged, non-latex productsused on the patient and all latex products removed from the room.

The FDA recommends including questions about latex sensitivity in the generalhistory of all patients (i.e., itching, rash or wheezing) after wearinghousehold latex gloves for cleaning purposes or after blowing up latex balloons.Blood tests are available to help determine sensitivity.

Screening for allergies, including latex, should be done upon any admit(inpatient or outpatient) to any medical or dental facility. General questionsto be used to determine risk status are as follows:

1. Do you have allergies, asthma or rhinitis?

2. What has been your major exposure to natural rubber latex products?

Multiple surgeries?

Working where rubber latex products were manufactured?

Working with latex products (e.g., gloves)?

3. Have you ever had a work-related rash on your hands following glove usewhich lasted longer than one week?

4. Are you known to be allergic and/or do you have any adverse reactions whenyou ingest any of the following foods: avocado, banana, chestnut, kiwi,hazelnut, cherry, peach or other related fruits or nuts?

If any answers are suspicious, screen further with these specific questions:

1. Have you ever had swelling, itching or hives around your mouth afterblowing up a balloon?

2. Have you ever had swelling, itching or hives around your mouth during orafter a dental examination or procedure, or around your genital area after avaginal or rectal examination or after contact with a diaphragm or condom?

3. Have you ever had swelling or hives on your hands while wearing rubberlatex gloves or within an hour afterward?

4. Have you ever noticed that you had a runny nose, watery eyes or wheezingduring or immediately after contact with latex products or in an environmentwhere latex use is high (e.g., hospital or clinic)?

5. Have you ever been diagnosed as latex allergic by a physician?

6. Have you ever had a serious allergic reaction (e.g., anaphylaxis) or otherunexplained reaction during a medical exam or procedure where contact with latexwas involved?

Alternatives to latex exist in almost everything. Learn what items containlatex or the allergen you respond to and learn to avoid it. Latex-free items areavailable as an alternative to most latex products and the quality and quantityhave increased over the last 10 years. Good-grade non-latex gloves are equal tolatex gloves in protection value. Ask your central services director for glovetesting results and evaluation. Use of non-powdered latex or latex-free glovescan reduce the risk of latex sensitization in employees.

Asthma is a serious problem that may be caused by work-related allergy.Work-related asthma is linked to allergens such as latex, paper dust, harshchemicals and molds. Asthma can cause recurrent attacks of symptoms such aswheezing, chest tightness, shortness of breath and coughing. In severe cases,these symptoms can be disabling and possibly deadly. Fortunately, when potentialhazards are recognized, work-related allergies and asthma can often be preventedor their effects minimized. According to NIOSH reports based on a recentnational survey of the U.S. population, the hospital industry is associated withthe highest estimated asthma prevalence for nonsmokers --14.4 percent (95percent CI=8.1-20.7), or more than twice the estimated asthma prevalence amongnon-smokers overall -- 6.6 percent (95 percent CI=5.8-7.4).

For more information about latex allergy, contact the Spina BifidaAssociation of America at (800) 621-3141 or NIOSH at (800) 356-4674. A list oflatex in hospitals and communities can be found at http://www.sbaa.org/docs/latex2002.pdfICT

Melba Rhodes, RN, BSN, CIC, is an independent infection control consultant.

OBJECTIVES:1. Describe the three basic types or classifications of reactionshealthcare workers experience when in contact with irritants/allergens.

2. Describe symptoms of an allergic reaction.

3. State the persons most likely to be allergic to latex.

4. Describe work-related asthma.

TEST QUESTIONS: TRUE OR FALSETF
1. Spina bifida and healthcare workers are factors that indicate an increased risk for latex sensitivity.  
2. The FDA recommends including questions about latex sensitivity in the general history of all patients.  
3. Always tell your doctor or dentist if you suspect a latex sensitivity.  
4. Allergic contact dermatitis (sometimes called chemical sensitivity dermatitis) results from the chemicals added to latex during harvesting, processing or manufacturing.  
5. "True allergy" is defined as the development of dry, itchy irritated areas on the skin, usually the hands.  
6. Latex-free items are not available for the treatment and care of both employee and patients.  
7. Allergies to certain food and nuts have been associated with an increased reaction to latex.  
8. Studies indicate that 8 percent to 12 percent of healthcare workers regularly exposed to latex are sensitized.  
9. Allergic contact dermatitis causes a skin rash similar to that of poison ivy.  
10. Items that contain latex are IV tubing injection sites, balloons, "koosh balls," gloves, pacifiers, urinary catheters, art supplies (gum erasers), condoms, adhesive tape, elastic bandages, and elastic on clothes.  
11. Anaphylaxis is a life-threatening reaction involving swelling of the respiratory tract and other deadly changes in the respiratory and circulatory systems or shock.  
12. Gardening tools are capable of transferring sap to your hands up to six months after last use around poison ivy.  
13. To help prevent dermatitis, wash hands in hot water, which removes irritants more efficiently than tepid water.  
14. Latex gloves protect better than non-latex gloves.  
15. The hospital industry is associated with the highest estimated asthma prevalence for nonsmoke  

ANSWERS

1. T
2. T
3. T
4. T
5. F
6. F
7. T
8. T
9. T
10. T
11. T
12. F
13. F
14. F
15. T