Update on latex allergy among health care personnel - Home Study Program

AORN Journal,  Sept, 2003  by Deanna Reed

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The article "Update on latex allergy among health care personnel" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Sept 30, 2006.

Complete the examination answer sheet and learner evaluation found on pages 425-426 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on latex allergy among health care personnel, nurses will be able to

1. describe the historical development of latex allergy among health care personnel,

2. explain the types of reactions in populations at risk for developing latex allergy,

3. identify techniques currently available to diagnose latex allergy,

4. discuss methods that can be used to prevent the development of latex allergy, and

5. discuss the results of prominent research studies on latex allergy.

It is important to be aware of the seriousness of latex allergy and understand the risk factors leading to this devastating and potentially deadly allergy. Health care personnel must be well informed about the history of latex allergy and its implications in the health care field so they can protect their patients, latex-sensitized colleagues, and themselves. Latex allergies initially were identified in pediatric populations; however, with the implementation of standard precautions, latex allergy and sensitivity has become increasingly prevalent in health care personnel. (1) The main source of health care workplace exposure is the use of powdered gloves. (1) Currently, the only known treatment for latex allergy is cessation of exposure. (1)

This literature review examines research studies regarding the prevalence of latex allergy among health care personnel as a result of increased exposure to latex products. It identifies latex composition; types of latex allergy, including signs and symptoms; and populations at greatest risk. It also addresses diagnostic testing procedures and preventive measures.

BACKGROUND

Natural rubber latex is derived from the white, milky sap of rubber trees that are grown commercially in southeastern Asia, primarily Malaysia, and West Africa. Its use in the medical field is pervasive. Latex gloves are the latex product most frequently used in the health care field. They have excellent tactile properties, low penetration and leakage rates, durability, and low cost. When latex gloves are manufactured, chemicals, curing agents, and accelerators are added to give gloves these desired properties. The allergic response to latex generally is a reaction to the protein in latex or the chemicals used in the manufacturing process. (2) Studies have found more than 200 latex proteins exist on both the inside and outside of gloves. (3)

The most common cause of latex sensitization and allergic reactions is the use of powdered latex gloves, which historically contain the highest level of latex allergens. (4) Powdered latex gloves cause the majority of health risks because latex proteins bind to glove powder, become airborne when gloves are used or removed, and then are inhaled. (4) Latex sensitivity has become a major occupational health issue for health care personnel. The problem is linked most closely to the implementation of standard precautions and the dramatic increase in the use of latex gloves since the 1980s. (5) It is estimated that between 10% and 17% of medical personnel in Europe and the United States are sensitive to natural rubber latex. (6)

POPULATIONS AT RISK

The population at greatest risk of natural rubber latex allergy is health care personnel who wear powdered latex surgical gloves daily (eg, perioperative nurses) and people who have undergone multiple surgical procedures as a result of injury, disease, or chronic conditions (eg, spina bifida, gunitourinary congenital defect). Others at risk are individuals who have experienced a severe reaction to certain foods, such as banana, kiwi, avocado, and potatoes, or who are atopic. Atopic individuals have a wide variety of other unrelated allergies and tend to be more prone to developing new allergies. (7)

LATEX REACTIONS

The American College of Allergy, Asthma, and immunology classifies allergic reactions in three categories: type 1, type IV, and irritant reactions. (8) Type I reactions, also referred to as immunoglobulin E (IgE) reactions, are systemic, generally immediate, and possibly life threatening. They occur in response to skin contact or inhalation of latex proteins. Symptoms include facial flushing, rhinitis, vomiting or diarrhea, wheezing, dyspnea, facial or laryngeal edema, bronchospasm, and anaphylaxis. Although reactions are immediate, they diminish rapidly after contact with natural rubber latex is halted. Type TV reactions, or delayed hypersensitivity, are dermatological symptoms, which may not be seen for several days after initial exposure but may last for weeks and spread over the surface of the skin. Symptoms include pruritis, edema, erythema, and vesicles. Irritant reactions, the most common type of reaction, represent a nonallergenic condition the effects of which usually are reversible. Latex gloves may cause a dry, itchy rash