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Latex Allergy Purpose The purpose of the Latex Allergy presentation is to introduce and provide information about latex allergies to healthcare providers.

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Presentation on theme: "Latex Allergy Purpose The purpose of the Latex Allergy presentation is to introduce and provide information about latex allergies to healthcare providers."— Presentation transcript:

1 Latex Allergy Purpose The purpose of the Latex Allergy presentation is to introduce and provide information about latex allergies to healthcare providers. The information may help either the healthcare provider with a latex sensitivity or the healthcare provider caring for the latex sensitive patient.

2 Objectives After successful completion of this course, you will be able to… 1. Account for the increase in people with latex sensitivities and allergies. 2. Explain why elimination of latex gloves is not the solution to the problem of increased latex allergies 3. Convey the signs, symptoms, onset, and recovery times of irritant contact dermatitis. 4. Discuss how healthcare professionals can reduce their risk of latex sensitivity in themselves and their patients. 5. List the steps for using latex gloves safely. 6. Compare and contrast the onset, symptoms, and treatment of: Latex sensitivity: allergic contact dermatitis and IgE-mediated sensitivity. Allergy Precursor: irritant contact dermatitis. 7. Define the limitations of commonly used non-latex gloves. 8. Identify the characteristics of people most at risk for latex allergy. 9. Summarize the steps required to safely care for surgical patients who are allergic to latex. 10. Discuss alternative management strategies to address latex sensitivity and the need for latex products in healthcare settings. 11. Compare the latex sensitivity tests currently available as well as their limitations. 12. Define an appropriate course of action for a person newly diagnosed with a latex allergy.

3 WHY ARE SO MANY PEOPLE DEVELOPING ALLERGIESTO LATEX ? Latex rubber gloves were first used in 1890 by a surgeon at Johns Hopkins University. His purpose in using the gloves was to protect his skin from the strong antiseptics used in surgery. Today, the extensive gloving required by current universal precaution standards and the predominant use of latex and latex-bearing powder in gloves has caused a dramatic increase in the incidence of irritant contact dermatitis and allergic reactions in healthcare professionals.

4 The incidence of latex allergy is on the rise.  Cited statistic estimates the prevalence of latex allergy in healthcare workers to be between ten and seventeen percent (Roy, 2000).  However, none of the studies used to develop this statistic clearly defined the criteria for a diagnosis of “latex allergy.”  As of 1997, the last year for which statistics are available, only 1000 “serious” allergy reactions had been reported to the Food and Drug Administration (FDA) (Carroll, 1999).  Despite the uncertainties in the incidence statistics, there is agreement that once a healthcare worker has begun to develop sensitivity, the signs and symptoms of latex sensitivity continue to escalate until the individual takes steps to prevent repeated exposure.  For this reason, the Occupational Safety and Health Administration (OSHA) recommends risk reduction strategies to reduce “potential development of allergy by reducing unnecessary exposure to NRL (natural rubber latex) products for all workers”(OSHA, 1999).

5 Response to increased incidence  In response to the increased incidence of allergic responses to latex in healthcare workers, many healthcare institutions are creating “latex-safe” environments by selecting gloves and medical supplies that are low in latex and powder-free.  These institutions are also using non-latex gloves in all situations where barrier protection is not required (AAAAI, 2004; ALAA, 2003).  In addition, the amount of latex protein in gloves has decreased significantly from a high of 5000 micrograms in 1992 to 1800 micrograms in 2002. Similar decreases were made in powder levels (Latex Allergy Recent Developments, 2003; Tomazic-Jezic, 2002).

6 Latex Allergy What is Latex? Latex is the naturally occurring milky sap of the commercial rubber tree, Hevea Brasiliensis. Trees are tapped for latex and a centrifuge is used to concentrate the product. It is then heated in the presence of sulfur (vulcanization) to make it heat- stable and elastic. Because latex is a mix of hundreds of proteins, it has been difficult to develop effective desensitization techniques or standard latex extracts for skin testing of suspected allergic individuals (Roy, 2000).

7 Latex Use  Latex use hit a previously unknown high in 1987 when the Centers for Disease Control (CDC) recommended universal precautions for healthcare workers and facilities.  These recommendations led to a dramatic increase in the demand for gloves.  To cope with this growing demand and the decreasing supply of pure latex, glove manufacturers had to make changes in the manufacturing process that lessened the purity of the latex found in gloves.  The use of latex with a higher percentage of impurities has put more healthcare professionals at risk for the development of latex allergy.  Other manufacturing changes designed to increase the speed of production led to latex gloves that are inadequately processed.  These gloves contain loosely-bound proteins that readily rub off or leach into sweat, then accumulate on glove wearers’ hands and easily transfer by touch to other persons and objects (ANA, 1997).

8 Hospital Products that may Containing Latex Products That May Contain Latex Hospital Items include: B/P cuffs stethoscopes gloves oral & nasal airways endotracheal tubes IV tubing syringes electrode pads hot water bottles condoms diaphragms balloons pacifiers baby bottle nipples (Latex Containing Products, 2003)

9 Household Items that may contain Latex: rubber bands Chewing gum erasersElastic bands in underwear, socks and bathing suits auto tires motorcycle or bike handgrips carpet swimming goggles racquet handles shoe soles expandable fabrics (waistbands) dishwashing gloves hot water bottles condoms diaphragms balloons pacifiers baby bottle nipples

10 Products containing Latex at Kaleida Health Products containing latex are labeled by the manufacturer on the outside wrapper More and more products are being made out of silicone or other non rubber materials Rubber products are being identified and are being replaced (when available) with non latex products Operating rooms at WCHOB for adults and children are being supplied with latex free products and latex free gloves

11 Who is at Risk? There are varying factors that make individuals susceptible to latex allergy. The type and severity of a reaction depends on: 1. The site(s) of exposure 2. The individuals’ level of sensitivity 3. The amount of allergen to which they are exposed

12 People Most at Risk for Latex Allergies People most at risk are those who are repeatedly exposed to latex: those who work in healthcare and the rubber industry, those who have undergone repeated and/or long surgeries or frequent bladder catheterization, especially early in life. NOTE: Some of the most severe reactions occur during surgery when latex gloves touch internal organs.

13 Types of Reactions when exposed to Latex Three types of reactions can occur in people exposed to products containing latex. These are: Irritant contact dermatitis Allergic contact dermatitis Latex Allergy

14 Irritant Contact Dermatitis Irritant contact dermatitis is the most common reaction to latex. Causes may include: sweating or rubbing under the gloves, or a soap or detergent residue left on the hands. Overaggressive scrubbing Inadequate drying of the hands, especially before donning gloves Use of abrasive or irritating hand soaps Abrasive effect of cornstarch in gloves Maceration from sweating while wearing gloves Pre-existing eczematous condition or tendency

15 Irritant Contact Dermatitis (ICD) Irritant contact dermatitis (ICD) is the most common precursor to latex allergy. It is a non-immune reaction, and it is not a true allergic response in that it is not a systemic reaction mediated through the immune system. Rather, it is a direct injury to the skin and NOT a reaction to latex. When the skin is broken, more latex particles can enter the body and increase the level of exposure to latex allergens. ICD most commonly occurs on the hands and presents with symptoms ranging from redness and chapping to overt dermatitis with vesicles (tiny water blisters), scaling, cracking, and finally, splitting of the skin. The onset is gradual.

16 Irritant Contact Dermatitis (ICD) Each preventive action is important, but since ICD is the most common precursor to latex allergy, preventing ICD is the single most important step that non-atopic (non-allergic) healthcare professionals can take to minimize their risk of latex sensitivity. If you develop ICD, treat it aggressively to minimize exposure to latex and bacteria. Remember that it is ICD that makes you most vulnerable to the development of a latex allergy. ICD can be cured by determining and removing the cause and by using proper care.

17 Symptoms of Contact Dermatitis Symptoms of contact dermatitis include red, dry, cracking hands, and a rash after wearing gloves

18 Reducing Symptoms You can reduce irritants of contact dermatitis by using non-petroleum based moisturizing creams and lotions, topical barrier products, or cotton glove liners.

19 Recommendations When Dermatitis Occurs Do not use latex gloves until the rash is completely healed. Ask your supervisor to assign you to patients whose care does not require maximum barrier protection from bloodborne pathogens (if possible). Do not use powdered gloves. Powders like cornstarch are a nutrient source for bacteria and can cause opportunistic infections on macerated skin. If you must glove for long procedures, use washable cotton glove liners to reduce the moisture on the skin. Some gloves and liners made of substances other than latex use elastic or other latex products in the cuffs. Be careful not to use gloves or liners with elastic cuffs to prevent exposure to latex in the wrist area.

20 Recommendations When Dermatitis Occurs Do not use gloves labeled “hypoallergenic.” The FDA has forbidden the use of the term “hypoallergenic latex gloves” for gloves manufactured after September 30, 1998. This term was used NOT to identify latex-free gloves, but rather to designate “pure” latex that contained a “low level of chemical additives.” Gloves labeled “hypoallergenic” may actually contain more latex proteins than regular latex gloves. Use water-based hand creams five to ten times during working hours to facilitate the restoration of skin integrity. Do not wear jewelry until the dermatitis is totally resolved. Use petroleum-based creams after work and especially before bedtime to promote healing (Roy, 2000; Hood, 2000).

21 Allergic Contact Dermatitis Allergic Contact Dermatitis is the third type of reaction to latex. It is a reaction to the chemicals added to the latex during processing

22 Skin Rash These chemicals can develop a skin rash that develops within 24 - 48 hours after contact and may have oozing skin blisters. The rash usually shows up on parts of the skin that have been touched by the latex but in some people may spread to other areas.

23 Washing Hands Washing your hands after contact with latex will help prevent allergic contact dermatitis

24 Latex Allergy Latex allergy occurs when the body’s immune system reacts to proteins in the natural rubber latex. In people with latex allergy, exposure to latex may cause immediate reactions such as coughing, swelling, sneezing, and wheezing

25 Latex Exposure Rarely, latex exposure may result in anaphylaxis. Anaphylaxis may be life threatening and include Symptoms such as severe trouble breathing or a drop in blood pressure. Latex allergens can become airborne resulting in respiratory complications. Latex allergens may adhere to the cornstarch powder used on gloves.As gloves are used the cornstarch particles and latex allergens become airborne where they may be inhaled or come into contact with the nose or eyes and may cause symptoms of an allergic reaction.

26 Patients with Latex Allergies This is important because patients who are allergic to latex may experience symptoms of an allergic reaction just by being in a room where latex gloves are used or have been used. The patient doesn’t need to personally touch the latex gloves or compounds.

27 Repeated Exposure to Latex In most cases, latex allergy develops when there is repeated exposure to latex Reactions upon exposure to latex allergens are generally acute and may mimic hay fever or asthma with symptoms such as nasal congestion, hives or difficulty breathing.

28 Anaphylaxis The most severe cases can result in anaphylaxis, a potentially fatal reaction that affects may parts of the body at once. Symptoms usually occur following contact with latex. They progress rapidly and may result in a dangerous drop in blood pressure, flushed skin and difficulty breathing.

29 Symptoms of Anaphylaxis Symptoms of anaphylaxis may include swelling of the throat, tongue, and nose, or a loss of consciousness. Tell your doctor about any changes in your symptoms due to latex exposure.

30 Causesof Latex Allergy The reason some individuals are allergic to latex while others are not is not clear. However, the potential to develop allergies is thought to be hereditary. Atopic individuals (i.e., persons with a tendency to develop allergic conditions, such as asthma, rhinitis, hay fever, and eczema) are at increased risk for developing latex allergy.

31 Latex Fruit syndrome “Latex fruit syndrome” is common to people with latex allergy with one study showing as many as 52% of latex allergic patients with allergies to various fruits and nuts. Systemic anaphylaxis occurred in 36% of study subjects with this syndrome (Frankland, 1999). Because of the high degree of correlation between fruit allergies and severe reactions to latex, it is of critical importance that these allergies are disclosed and noted on the charts of pre-operative patients. If you perform pre-operative patient assessments, you may want to specifically question patients about fruit allergies. The next slide shows different foods and their potential for the latex allergy patient reacting to them.

32 Allergens in Foods Associated with Natural Rubber Latex HighModerateLow or Undetermined bananasapplepearmango avocadocelerypeachrye chestnutpapayaplumwheat kiwicherrygrasses carrotsstrawberryragweed potatofigmugwort tomatograpehazelnut melonsapricotwalnut passion fruitsoybean nectarinespeanut

33 Atopic individuals Atopic eczema on the hands also predisposes individuals to latex allergy (Carroll, 1999; ACAAI, 2000). Atopic individuals are 24% more at risk of developing a latex allergy than are other healthcare workers (Sussman, 1995).

34 Prevalence of Latex Allergies 6% General Public 10% Healthcare Workers 50% Spina Bifida patients

35 Latex Allergy in Children Early in life, babies are exposed to rubber in significant amounts. Latex is used in the manufacture of baby bottle nipples, toys, and pacifiers. The most common symptom of latex allergy in babies is a rash where the child’s skin comes in contact with the latex.

36 Latex Balloons The introduction of balloons into a child’s life, coupled with their frequent use as toys, increases the risk of sensitization to latex. Both latex balloons and the powder used to keep them from hardening represent unnecessary exposure to latex. This exposure extends to any adult who inflates balloons. In many individuals, the latex in balloons can cause lip and facial swelling.

37 Latex Balloons Balloons are especially dangerous because of the potential of breakage and aspiration of pieces into the lungs, which would require surgical removal. Use and breakage of latex balloons also projects latex particles into the air, increasing the potential of latex sensitivity. “Epidemiological thinking today is that early life exposure to allergens is more likely to lead to sensitization than at any other time in life,” (Worth, 1999).

38 Latex Exposure Children who are exposed to latex through extensive medical and surgical procedures are most vulnerable to latex hypersensitivity, including anaphylaxis during surgery at some time during their lives. For example, children born with spina bifida, a birth defect in which the spinal neural tube fails to seal, are subject to a series of surgical procedures in the first few years of life. Estimates indicate that up to 67% of spina bifida patients develop sensitivities to latex at some time during their lives. This high rate of allergy is a result of multiple surgical procedures that put latex in contact with the internal organs of the body (Allergic Reaction, 2003).

39 USING LATEX GLOVES SAFELY TO PREVENT SENSITIZATION Latex provides the best currently available protection against bloodborne pathogens. Latex gloves currently offer the best fit and tactile dexterity, so IF you have NO signs and symptoms of sensitivity, latex gloves may still be your best choice in many patient care situations.

40 USING LATEX GLOVES SAFELY TO PREVENT SENSITIZATION When you do use latex gloves, there are simple choices you can make to reduce your own and your patients’ exposure to latex: Whenever possible, use “low protein” gloves. Per FDA labeling regulations, latex gloves must have no more than 50 mcg of latex protein per gram of rubber glove to be labeled “low protein.” As researchers have not yet determined how low the protein level must be to avoid sensitization, be cautious even in the use of these gloves.

41 USING LATEX GLOVES SAFELY TO PREVENT SENSITIZATION Whenever possible, use low powder or “powder-free” latex gloves. Low powder gloves create fewer airborne latex particles and reduced exposure to allergic sensitivity through inhalation of latex. Even“powder-free” latex gloves may contain up to 2 mg of latex powder per glove and still meet FDA standards. Studies have shown that sensitivity may progress even with low powder levels and that latex dust can remain airborne for up to two hours; contaminating lab coats, surgical scrubs, upholstered furniture, drapes, and carpet, and even traveling through a building’s ventilation systems

42 Knowledge is Power Before you glove for a task or procedure, exercise your right to know:  The kind of glove you are wearing  If the glove is appropriate in durability, barrier, and material for your task  The end use time, amount of torque, and twisting or instrumentation required for the task.  If the glove you are using poses a potential danger to you or your patients (Miller, 2000)

43 Wearing Latex products When wearing latex gloves do not touch your eyes, mouth or other mucous membranes. Sensitization can occur more easily through the mucus membranes (Chumman, 2002). Remove all gloves, even “powder-free” gloves slowly, turning them inside out as you pull them off your hand. Do not “snap” them as this propels powder into the air.

44 Cornstarch Powder Do not use gloves powdered with cornstarch. Cornstarch powder has been called “medicine’s deadly dust.” Cornstarch powder can act as an aerosol agent for latex; spreading it throughout hospitals, clinics, and offices through heating and cooling ducts. By being transported on the clothing of healthcare workers, it can even impact allergic family members.

45 Lotions Do not apply hand lotions immediately before donning gloves. Oil-based hand creams leach latex proteins out of the glove, increasing your skin exposure and your risk of developing a true allergy. Be sure to dry your hands thoroughly before putting on the latex gloves. Warm, wet skin absorbs more latex proteins than dry skin does.

46 Work Area Keep the surfaces in your work area clean and free from contamination with latex dust. In the event you have any type of skin break or rash, do not wear latex gloves. Any skin breakdown will allow more latex protein or chemical additives entry to your body, contributing to your risk of developing a true allergy.

47 Dry Hands Thoroughly Wash and dry your hands thoroughly after removing latex gloves (APIC, 2003). Hand washing after glove removal prevents transfer of latex proteins to surfaces such as door knobs, telephones, charts, and other instruments where they expose others, including latex sensitive individuals (Miller, 2000).

48 Operating Room If you work in the operating room or other environment where latex gloves are used extensively, change your scrubs before leaving the surgical area to minimize your own and others’ exposure to the aerosolized latex you may be “wearing.” WCHOB operating room has been using latex free gloves since 2001

49 Choose the best glove for the job (Brooks, 2004) TypeAdvantagesDisadvantages NRL (natural latex) Good viral barrierPenetrated by chemicals Degraded by oils. VinylPoor viral barrier Cracks easily after wearing for half an hour. Nitrile, neoprene, styrene, butyl Good viral & chemical barrier. May contain additives causing contact dermatitis Polyisoprene (artificial latex) Good viral barrier without allergenic potential of NRL Penetrated by chemicals. Degraded by oils.

50 To Protect Your Patients from Unnecessary Exposure to Latex While wearing latex gloves, touch patients ONLY when absolutely necessary. Never inflate gloves and use them as toys for pediatric patients. If balloons are still permitted, work with your manager to achieve a facility-wide “no rubber balloon” policy in which only balloons made of Mylar are permitted. WCHOB has become a latex free facility allowing only Mylar balloons for their patients.

51 The Surgical Patient who is at Risk for a Severe Reaction Current or former healthcare workers, especially operating room personnel and others who have had long-term, extensive occupational exposure to latex, have some of the most serious allergic reactions to latex in the surgical and post-operative settings.

52 The Surgical Patient who is at Risk for a Severe Reaction If your patient is:  a healthcare provider,  has recently retired from work in a healthcare facility (including in housekeeping or food service)  has worked in another industry with high exposure to latex, such as automotive repair, tire sales, etc., Be especially sensitive to their needs. They are at high risk for allergic reactions to latex materials or aerosolized latex from powder. If you are the patient, be certain to tell your physician/surgeon about your high risk status and confirm with your nurses that this has been documented on the chart.

53 Caring for Patients with Known or Suspected Latex Allergy Avoidance of latex is the only means to assure prevention of a latex allergy and protection from its symptoms in a person who has an active latex allergy.

54 Surgical Patients Upon Admission to a Kaleida Health Facility assist the patient or caregiver to complete a latex allergy questionnaire for review by attending physicians, the surgeon(s), and the anesthesiologist. Be certain that the allergic status is documented on paper and in computerized medical records and a “latex allergy” label is put on the chart cover. This questionnaire should elicit information about allergy-related disorders such as asthma, autoimmune disease, and drug or food reactions. It should also ask whether the patient has had frequent surgeries, extensive dental work, or recent occupational exposure to latex.

55 Latex Allergy Screening Tool The Latex Precaution Protocol will be implemented on all patients at risk for or diagnosed as having a latex allergy The primary care physician and/or admitting physician shall be notified when the Latex Allergy Screening Tool indicates the risk or actual allergy to latex in a patient with no previous documentation of risk or actual latex allergy. “Latex Precautions” alert signage shall be placed as per protocol. Patients having a diagnosed or documented latex allergy or patients at high risk (as revealed by the Latex Allergy Screening Tool) will have their need for a private room assessed by a physician upon admission. When a private room is requested by the physician but not available, than both patients in the room must receive a latex free environment.

56 Latex Allergy Screening Tool The Latex Precaution Protocol will be implemented on all patients at risk for or diagnosed as having a latex allergy 1. At the point of registration or admission to any inpatient or outpatient service: Patients who have a latex allergy or are suspected of having one shall be assessed for risk of or actual latex allergy using the Latex Allergy Screening Tool. The need for “Latex Precautions” shall be communicated to the admitting inpatient unit or outpatient services (e.g. diagnostic lab).

57 If any question in Section 1 is answered “YES,” the patient should be considered latex allergic. An orange latex allergy ID wrist band is applied and the patient is treated with latex precautions. Latex Allergy Screening Tool

58 If any question in Section 2 is answered “YES,” the patient should be considered high risk for latex allergy. An orange latex precaution allergy ID wrist band is applied and the patient is treated with latex precautions. Latex Allergy Screening Tool

59 Page 2 of the revised Adult Patient Screening Database now includes the screening criteria for Latex Allergies. If the patient meets criteria, the nurse is directed to complete the Latex Allergy Screening Tool (KH01186). Latex Allergy Screening Tool

60 The final portion of the form is a summary of findings, physician notification, and a check list of necessary actions taken. Latex Allergy Kits, in orange containers, will be provided to each site. Several will be housed in high risk areas (ED, OB, etc.), but the majority will be housed in Central Supply. Each kit has disposable latex-free equipment that should be used for latex precautions. Once the patient is discharged, the orange container is to be returned to Central Supply. Latex Allergy Screening Tool

61 If any 2 questions in Section 3 are answered “YES,” the patient should be considered high risk for latex allergy. An orange latex precaution allergy ID wrist band is applied and the patient is treated with latex precautions. Latex Allergy Screening Tool

62 Pre medicate The patient may be pre-medicated with antihistamines and corticosteroids to minimize their action to any inadvertent exposure to latex. Schedule the patient’s surgery as the first case of the day, in a room in which latex products have not been used for many hours. Ensure that glove powder is not used in other rooms within the surgical suite because of the risk of aerosolization (Fogg, 2004). Follow a latex-free surgical protocol, assuring that anyone in the operating room does not wear latex gloves or use any equipment or supplies containing latex.

63 Medical & Surgical Patients Prepare a private room, prior to admission if possible, to limit the risk of accidental exposure. Remove all natural latex rubber items. Replace sharps containers. Cover/wrap patient’s arms and BP tubing when using any BP devices so they will not be used in direct contact with the patient. Be sure that housekeeping wipes down the bed and all other patient and staff contact surfaces to remove residual glove powders. Place labels noting the patient’s latex status above the patient’s bed, on the room door, and on the patient’s armband.

64 Latex Allergy Patients During hospitalization, give ancillary departments adequate notice before sending the patient off the unit for diagnostic tests and procedures. Advise the patient or caregiver to inform all other personnel about the allergy. Alert the pharmacy about the patient’s status when forwarding medication orders. When preparing medications from vials, remove the rubber stopper so you do not core it when drawing up the medication. Use only latex-free syringe plungers. Keep a latex-safe cart in the room and use only those products on the patient. Be sensitive to“hidden” latex, such as latex in the balloons of most pulmonary artery catheters. Central venous pressure catheters are often made of latex, and if not, there may still be latex in the injection port caps. Silicone- coated latex catheters, e.g., Silastic, are NOT safe for latex sensitive patients (Peterson, 2000).

65 Caring for a Latex Sensitive Patient? In most cases wearing latex gloves with other patients is preferred per universal/standard precautions. Check your facility policy for how to handle this situation.

66 LATEX MANAGEMENT STRATEGIES Latex is everywhere in the healthcare setting including: rubber gurney bumpers, rubber stoppers on drug vials, BP cuffs, urinary catheters, IV tubing, etc. Currently, it is virtually impossible to create a latex- free environment. However, there are several public health approaches to protecting and promoting the safety of employees available to healthcare institutions: Primary prevention: Protecting those at risk, but not yet sensitized. Secondary prevention: Preventing escalation of symptoms in individuals already affected, crisis management of an acute anaphylactic event, or ongoing treatment.

67 Secondary Interventions Secondary interventions include: Treatment of symptoms Changes in work sites Accommodation of the allergic employee The creation of a “latex-safe” (also described as “latex-minimized” or “latex-reduced”) environment is an achievable goal which combines both approaches and benefits individuals with confirmed or diagnosed latex allergy, as well as asymptomatic individuals at risk for development of the allergy

68 Out with the Rubber Tree Plants! The sap of the commonly used decorative rubber tree plant, ficus elastica, cross-reacts with Hevea brasiliensis, the rubber used in latex gloves, to cause symptoms of allergic rhinitis and asthma. As the plant is known to be a strong sensitizer to latex allergy, it should not be used in medical offices, waiting rooms, or any place populated with at-risk individuals including their homes (Frankland, 1999). Potentially, poinsettia plants, also part of the rubber family carry the same risk.

69 Employer Responsibilities According to the American Nurses Association (1997), healthcare institutions have the following responsibilities to protect all employees from unnecessary sensitization, and allergic employees from latex: 1. OSHA’s “Right to Know” laws require employers to inform healthcare workers of potentially dangerous substances in the workplace on an annual basis. Ensure that latex allergy information appears in annual updates and on the agendas of joint labor-management health and safety committees and risk management committees. 2. Incorporate latex allergy information in employee orientation; conduct in-service education. 3. Establish a multi-disciplinary latex allergy task force to develop a comprehensive plan that provides latex-safe care for sensitized patients, reduces risk of sensitization for patients and staff, and ensures that sensitized staff can continue to work. 4. Make alternative products available in all work sites. –(The employer must provide alternative gloves, if needed, according to the OSHA Bloodborne Pathogens Standard.)

70 Establish guidelines for the following measures Eliminate the use of powdered gloves. Establish standards of care and administrative procedures to ensure safe patient care and protect nurses from negligence claims related to latex allergy. Protect latex-allergic nurses from being required to work in latex-contaminated areas. Remove latex contamination from the environment, including the ventilation system. Establish procedures to ensure that latex-sensitized nurses are informed of their legal rights and responsibilities concerning reasonable accommodations in the workplace, disability insurance, medical insurance, workers’ compensation, vocational rehabilitation, and Social Security disability.

71 Precautionary Steps If, because of other allergies or intensive exposure, you believe that you are at high risk to develop latex sensitivity, you may want to take the following precautionary actions: Create a latex-reduced home environment for yourself. Minimize your risk for cross-reactivity from foods.

72 Condoms If you use condoms for safe sex and/or contraception or a diaphragm for contraception, one option is to use natural skin condoms. Natural skin condoms do not contain latex and can also prevent pregnancy. However, they do NOT protect against viruses like HIV and some other sexually transmitted diseases (STDs). Synthetic rubber condoms, created to prevent both pregnancy and STDs including HIV, are now available.

73 “I THINK I’M BECOMING ALLERGIC TO LATEX” Warning Signs of Developing Sensitivity Do you develop symptoms at work – skin rash, runny nose, burning or watery eyes, or trouble breathing – which clear up when you get home and never develop on your day off? Have you ever experienced swelling, itching, hives, shortness of breath, or coughing after blowing up balloons, or using condoms or a diaphragm? Have you ever had a respiratory reaction from an unknown cause after having a vaginal, rectal, or dental exam with symptoms resolving shortly after the end of the visit?

74 The Limitations of Allergy Testing If you think you have experienced the initial symptoms of latex sensitivity, your first impulse – and a logical one - may be to obtain a diagnostic test. If you do and are given a negative result, do not become comfortable with that finding. The following chart (Carroll & Celia, 2000) explains why: NameMethod Outcome/Effectiveness Limitations Puncture Skin TestSkin prick. A drop of liquid latex is put on the skin and pricked with a needle. Currently the most sensitive diagnostic test. No FDA approval Available only as part of research projects Intradermal TestDiluted latex is injected under the skin. A sensitized person usually develops redness and swelling at the injection site. May provoke a serious reaction. Only be safely performed at centers that are familiar with immunologic testing and a full resuscitation team is available. Radioallergosorbent Test (RAST) Blood Test may yield a false negative in patients with weak latex allergy. Roughly 20% false negatives. A low level result may come out positive in only two of three tries, especially if the lab is using a “homemade” test, i.e., one prepared onsite rather than one purchased from a commercial vendor. Should be used for screening only; NOT for definitive diagnoses. Although there are three FDA-approved RAST kits, many labs create their own. Usually, they are not as sensitive or reliable.

75 Latex Allergy Tests Latex allergy tests can be useful but not always reliable because the latex extract used to test is not standardized (Reed, 2003). Some recently developed tests show improvements: The Basotest ®, a basophil activation test, complements IgE tests, skin prick tests and clinical histories in making a latex allergy diagnosis (AAAAI, 2004). A microarray-based test researched in Austria shows greater accuracy than IgE tests and measures risk for cross-reactivity in latex sensitive people (Moyer, 2005). Until these or other tests become widely available, the diagnosis of latex allergy continues to be based primarily on clinical history (Lenehan, 2002).

76 “I’M ALLERGIC” Persons with newly diagnosed latex sensitivities need to be aggressive in self-care measures: 1. Obtain and carry quick-acting oral antihistamines (liquid or rapidly dissolving) and auto-injectable epinephrine at all times. 2. Wear a “latex allergy” medical-alert bracelet. 3. Carry a wallet card informing emergency care workers of the latex allergy. 4. Ensure that your regular physician (if an allergist or dermatologist makes the diagnosis) is informed of the allergy. 5. Inform employer of the allergy and ask for any necessary accommodations to work safely.

77 Latex Sensitive or Allergic? You should have a MedicAlert bracelet or necklace and card. Contact www.medicalert.org or call 1.800.432.5378.

78 “Is This the End of My Career?” People vary a great deal in their latex allergy patterns. Latex allergy in most people is known to “wax and wane” over a lifetime. In some cases, latex allergies disappear completely if exposure to latex is eliminated or minimized. A 1999 report of research at the Johns Hopkins Hospital provided encouraging results to healthcare workers with latex allergy. It showed a marked decrease in sensitivity subsequent to the practice of strict latex avoidance, confirmed by both a decrease in allergic symptoms and in response to allergen skin prick tests. For most of the study subjects, several years of latex avoidance resulted in the total elimination of the sensitivity. For several others, however, sensitivity was lowered through elimination of the latex stimulus, but not entirely eliminated (Miller, 2000). Another possibility for lowering sensitivity is through sublingual desensitization, although clinical trials have yet to be duplicated in the U.S. (Patriarca, et al, 2002). If you have, or develop, a latex allergy, the bad news and the good news is that you are one of a growing number of healthcare workers with this sensitivity. Given the shortage of tenured, qualified nurses, most employers are developing strategies to deal with latex exposure in order to retain their latex-sensitive employees.

79 Latex Allergies Remember –Limit the use of latex gloves –Complete the latex screening tool upon admission of a patient. –Limit exposure of your self and your family members to latex proteins.


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