In recent years, latex allergy has been recognized as a significant problem for both specific patient and provider populations. The incidence of latex allergy throughout the general population has been estimated between 1% and 6% while certain pediatric populations may experience an incidence as high as 73% (spina bifida and related pathologies). Healthcare workers who are regularly exposed to latex-containing devices and products maintain an incidence of allergic response that ranges from 8% to 17%.
Latex allergy is an immunologic reaction to natural rubber latex, processed from the Hevea Brasiliensis tree indigenous to Central and South America. Newer rubber medical supplies, particularly very soft "dipped" products, contain the greatest proportion of low molecular weight soluble proteins thought to be responsible for the allergic response.
The more recent appearance and recognition of latex allergy as a serious medical concern has resulted from the incorporation of increased barrier precautions in preventing the transmission of infectious bloodborne pathogens. The increase in the number of medical gloves imported to the United States increased awareness among providers. Improved methods in diagnosing latex allergy also accounts for the recent rise in the number of reported cases.
Immediate hypersensitivity reactions to latex vary from contact urticaria to systemic anaphylaxis and laryngeal edema that require lifesaving intervention. Allergic contact dermatitis can also occur and is a delayed hypersensitivity which mimics a poison ivy-type skin reaction. No immunotherapy or desensitization currently exists for latex allergy. Each systemic reaction occurs with less provocation and presentation of a greater magnitude.
Anaphylactic reactions have complicated a variety of common medical procedures including surgery (particularly of the genitourinary tract) and anesthesia, barium enemas, as well as oral, vaginal, and rectal examinations utilizing latex gloves. In most cases, there has been contact between latex products and mucous membranes. However, in some exquisitely sensitive individuals, exposure through inhalation of aerosolized latex or through intravenous administration has led to severe reactions. This type of reaction is similar to immediate drug reactions or stinging insect venom and may be associated with rapidly progressive anaphylaxis and death.
Populations at Risk for Developing Latex AllergyA complete and thorough medical history remains as the most reliable screening test to predict the likelihood of an anaphylactic reaction.
Individuals (particularly in the pediatric population) who are most likely to exhibit a sensitivity to latex that may result in varying degrees of reactivity include:
Individuals who have experienced a significant degree or repeated exposure to latex products are more likely to develop a latex allergy. These situations may include treatment that involves:
Latex Avoidance PrecautionsBy touching any latex object, the healthcare worker can transmit the allergen by hand to the patient. Caution should be taken to keep the powder from the gloves away from the patient, as the powder will act as a carrier for the latex protein. Therefore, in order to reduce the possibility of the latex protein becoming airborne, care must be taken not to snap gloves on and off.
Patients should be identified as being latex sensitive. The room should be labeled latex free to avoid personnel from bringing rubber products (wrist bands, chart labels, bed, room signs, etc.) into the room. A master list of latex free devices and products is readily available from several internet Web sites including:
Kendall's Healthcare Products
Search their Latex-Free Database
Latex-free respiratory care and anesthesia products
Establish a latex consultant in your institution; an allergist is recommended. Develop programs to educate healthcare workers in the care of latex-sensitive patients. Develop educational programs for patients and their families in the care and precautions that should be taken to prevent latex exposure. This should encompass a first aid protocol in the event a severe reaction should arise. Encourage latex-sensitive patients to obtain and carry with them, at all times, some type of identification such as a medical alert bracelet and to have an epinephrine auto-injection kit if warranted.
* Resource articles on latex allergy and a sample letter to manufacturers requesting latex information and resource articles are available in a Latex Packet from the Practice Department, American Association of Nurse Anesthetists, 222 South Prospect Avenue, Park Ridge, IL 60068-4001. Phone: (847) 692-7050, ext. 3016.
Recommendations for Patient Care
Patients with Latex Allergy or Latex Risk
Schedule latex-allergy and/or latex-risk patients as the first case(s) in the morning. This will allow later dust (from the previous day) to be removed overnight.
The Operating Room
Intravenous Line Preparation
Operating Room Patient Care
Signs and Symptoms of Allergic Reactions to LatexSymptoms usually occur within 30 minutes following anesthesia induction; however, the actual onset can range from 10-290 minutes.
Emergency Response and Management
Secondary Pharmacological Treatment may include the following:
Non-Pharmacological Considerations Should Include:
Postreaction stabilization should include appropriate monitoring by dedicated providers well-versed in managing post anaphylaxis patients. The pediatric, intensive or special care area should be used when appropriate.
Debate regarding the efficacy of premedication agents to treat patients with confirmed latex allergy remains somewhat controversial. Individual consideration for each patient undergoing elective operation or diagnostic and therapeutic procedures who has a known latex allergy should be initiated with the involvement of their primary care or allergy specialist provider. Premedication with steroids, antihistamines, and H2 blockers prior to general anesthesia or deep sedation may be preferred for children with a known and documented latex allergy. While these agents will not prevent an allergic reaction they may attenuate such a response by lessening the severity of a reaction. The patient's regular provider or specialist managing their allergy should consult to recommend appropriate pretreatment when warranted.
Latex Avoidance and Alternative Management Options
Common Latex Medical Devices Used in Perioperative Areas Include:
Anesthesia Equipment and Products Containing Latex Include:
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(2) Freeman GL, Co-occurrence of latex and fruit allergies. Allergy and Asthma Proceedings. March - April.1997:Vol.18, II.
(3) Holzman R. Latex-Free Environment Precautions for Patients with a Latex Allergy/Patients at High Risk for Latex Allergy. Boston: Boston Children’s Hospital (Departmental Policy). 1992.
(4) Kelly KJ, Kurup VP, Reijula KE, Fink, JN. The diagnosis of natural rubber latex allergy. J Allergy Clin Immunol. May 1994;93(5):813-816.
(5) Latex Allergies: Anesthesia Concerns. AANA NewsBulletin/Anesthesia Quality Plus. 1992; 46(9)(suppl):3.
(6) Pasquariello CA, Lowe DA, Schwartz RE. Intraoperative anaphylaxis to latex. Pediatrics. 1993; 91:983-986.
(7) Porri F, Pradal M, Lemiere C, et al. Association between latex sensitization and repeated latex exposure in children. Anesthesiology. 1997;86(3):599-602.
(8) Theissen U, Theissen JL, Mertes N, Brehler R. IgE-mediated hypersensitivity to latex in childhood. Allergy. 1997;52:655-669.
(9) Turjanmaa K, Alenius H, Makinen-Kiljunen S, Reunala T, Palosuo T. Natural rubber latex allergy. Allergy. 1996;51:593-602.(10) Vessey JA, McVay CJ, Holland CV, et al. Latex allergy: A threat to you and your patients? Pediatric Nursing. 1993;19:517-520.
Developed in 1993 by the Infection and Environmental Control Task Force. Revised by the Occupational Safety and Hazard Committee and approved by the AANA Board of Directors on July 31, 1998.
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