A criterion-referenced measure of latex allergy knowledge

AORN Journal, Sept, 1998 by V.M. Kleinbeck, N.L. English, M.A. Sherley, J. Howes

The exponential increase in the use of latex products in hospitals, clinics, and dentistry has multiplied the incidence of patients' and health care workers' sensitization to natural latex rubber.(1) Prevalence rates of 10% have been reported among heavy glove users such as surgeons and OR nurses.(2) The predominant adverse reaction to natural rubber latex is contact dermatitis--a type IV delayed immunologic response commonly caused by chemicals required during the manufacture of latex products. A less frequent, yet more serious, type I allergic reaction occurs shortly after exposure; is stimulated by the latex protein, rather than irritants; involves immunoglobin E (IgE) antibodies; and may result in life-threatening anaphylactic shock (Table 1).(3) Professional nurses must recognize those patients who require latex precautions and implement appropriate nursing interventions to protect them from harm.

Table 1 GLOSSARY OF LATEX ALLERGY TERMS

Type IV reaction

Delayed immunologic response commonly caused by chemicals required during the manufacture of latex products. Not a true latex allergy, a type IV reaction is a reaction to chemicals in latex gloves.

Type I reaction

Allergic reaction occurring shortly after exposure to the proteins in natural latex rubber. This is a true latex allergy and can occur when latex proteins are touched, inhaled, or ingested.

Irritant reaction

Nonallergic skin damage caused by irritants (eg, detergents, cleansers, disinfectants, sterilizing agents).

Latex proteins

Natural building blocks within all natural latex products.

Although protocols establishing a plan of care for patients at risk for latex allergy response are available,(4) little is written about the knowledge nurses possess regarding latex allergy and patients' adverse reactions to exposure to the protein allergen.(5) Researchers posed the question: "What latex allergy information supported by empirical research should be included in a competency test for professional nurses?" The purpose of this study was to develop and test a set of items designed to measure professional nurses' knowledge in the following two domains:

* natural latex rubber allergic responses and

* nursing interventions appropriate for those at risk for latex allergy response.

LITERATURE REVIEW

Those allergic to latex may be exposed by touching, ingesting, or inhaling(6) the latex allergen anywhere, including at home (eg, balloons, toys) or when receiving care at health care facilities. Health care workers who wear powdered latex surgical gloves daily (eg, perioperative nurses) and patients who have a diagnosis that requires multiple surgeries (eg, spina bifida, genitourinary congenital defect) are at greatest risk for developing a sensitivity to latex.(7) Others at risk are those with atopic or genetic predisposition (eg, people who have multiple allergies). Newer mutes of sensitization include increased latex exposure in dentists' offices and condom use for safe sex practices. Although avoiding latex proteins is the best precaution for those at risk for sensitization, gloves containing latex remain the best barrier against blood-borne pathogens.

Factors influencing the severity of a latex allergy response are the individual's susceptibility; the route, duration, and frequency of exposure; and the type and amount of allergen present during the exposure. Allergic responses are much more likely in products, such as gloves, that are produced by dipping, than in molded products, such as syringe plungers or vial stoppers. The American College of Allergy, Asthma, and Immunology classifies allergic reactions in three categories.(8) The most common is an irritant reaction, which is nonallergic. Skin damaged by detergents, cleaners, defatting agents, disinfectants, sterilizing agents, or poor hand hygiene allows increased absorption of latex allergens. Management of nonallergic irritant reactions includes eliminating the irritant; improving hand hygiene (eg, drying hands thoroughly after scrubbing); and using powder-free, low allergen gloves.

Type IV allergic reactions are a cell-mediated response to chemical irritants used in the manufacture of surgical gloves.(9) Signs and symptoms generally appear up to 48 hours after exposure and include pruritis, edema, eczema, cracking of skin, and redness. The risk of type IV reactions can be managed by using low-allergen, powder-free gloves; avoiding offending chemical additives; and using nonlatex gloves.

Type I reaction is an IgE-mediated systemic reaction. The IgE antibodies gather around the mast cell and saturate it, causing the cell to change to a granulated state. Currently, there is no foolproof method to diagnose latex allergy; however, a skin prick test using latex protein allergens is the best available laboratory test for diagnosis. An accurate assessment of the patient's experiences, is crucial to identifying those at risk for a systematic reaction. For example, stories of unexplained, complicated anesthesia events or hives from blowing up a child's balloon are important. After exposure, signs and symptoms generally will appear within five to 20 minutes and include redness; edema; wheezing; asthma; hives; rhinitis; conjunctivitis; swelling of throat, nasal passages, and bronchi; and anaphylaxis. Management of systemic reactions includes latex protein avoidance, use of nonlatex products, creating a powder-free environment, and patient education.