Latex allergy prevention

Townsend Letter for Doctors and Patients, May, 2006 by Jule Klotter

Frequent exposure to natural rubber latex products is known to cause sensitization and allergic reactions. Health care workers, food service workers, and infants who undergo multiple surgeries (i.e., those with spina bifida) have the highest risk. Estimates of latex sensitization among health care workers range from ten percent to 17%. Between 35% and 70% of spina bifida patients acquire latex sensitization, which is blamed for 70% of the anaphylactic reactions that occur in these children. People with a history of allergic reactions (including asthma, eczema, and rhinitis) have an increased risk of becoming latex-sensitive. Cross reactivity between latex proteins and some foods (e.g., banana, avocado, chestnut, and kiwi) also occurs. Powdered latex gloves are credited with inciting much of the latex sensitivity. The powder carries latex proteins into the environment. Studies have shown that health care personnel who use powdered latex gloves are more likely to become latex-sensitive than those using powder-free gloves.

Three types of reactions occur in latex-sensitive people, and these reactions can exist at the same time. The most frequent reaction is irritation, a contact dermatitis characterized by dry, crusty, hard bumps, sores, and itching. A delayed hypersensitivity reaction, mediated by T-cells, is the next most common. It usually manifests as itching, erythema (redness), swelling, pimples, blisters, and other skin lesions. The reaction appears 18 to 24 hours after exposure, peaking at about 48 hours. It usually resolves within three or four days. Immediate hypersensitivity, a systemic IgE-mediated response to latex proteins, is the third reaction. In this case, symptoms appear within minutes of exposure and include local swelling, redness, edema, itching, and systemic reactions, such as bronchospasm, asthma, angioedema, and anaphylaxis. The most severe reactions tend to occur when latex proteins contact internal tissues during invasive procedures and when they touch mucous membranes of the mouth, vagina, urethra, or rectum. Because it is impossible to predict when a latex-sensitized person will react with severity, guidelines from the Association of periOperative Registered Nurses (AORN) state that "all individuals presenting with natural rubber latex sensitivity should be treated as if they are allergic." Anyone who experiences itching, swelling, or other signs of irritation after contact with latex gloves, condoms, or balloons should be evaluated by a qualified health care practitioner.

Because increased exposure leads to greater sensitization, many US health care facilities are choosing to become "latex-safe" environments. They use powder-free, low-protein latex gloves and latex-free items when available. Latex gloves are not the only source of natural rubber latex proteins. Syringes, IV tubing, tourniquets, tape, underpads, catheters, feeding tubes, bulb syringes, even anesthesia breathing bags may contain the protein. In the everyday environment, chewing gum, zippered plastic storage bags, diapers, feeding nipples, and lottery scratch tickets are other sources. People with latex sensitivity should use latex-free items only. AORN has suggestions for creating a latex-free cart for clinical use. The Spina Bifida Association of America lists items that frequently contain latex as well as latex-free alternatives that are available.

Association of periOperative Registered Nurses. AORN Latex Guideline--2004 standards, recommended practices, and guidelines. Available at www.aorn.org/about/positions/pdf/7c-latex-2004.pdf. Accessed February 3, 2006.

Spina Bifida Association of America. Latex list. Available at www.sbaa.org/site/DocServer/Latex_List_2005.pdf?docID=2561. Accessed February 3, 2006.