1. Lois Schick MN, MBA, RN, CPAN, CAPA
Latex Allergy
Lois Schick MN, MBA, RN, CPAN, CAPA

2. Latex Sensitivity
Review the development diagnosis and current treatment of latex allergies
Describe each of the 3 types of human reactions to natural rubber/latex containing products
Identify currently available diagnostic tests and medical treatment options

3. NIOSH National Institute for Occupational Safety and Health
Established under the Occupational Safety and Health Act
A division of the Centers fro Disease Control and Prevention (CDC)
Not OSHA
In Ireland and Great Britain it is the NHS

4. NIOSH Recommendations
June 1997 released-prevention oriented
Use the appropriate glove for the task at hand
Summarizes employer and worker info
Targeted towards hospitals, day care facilities, food service industry, environmental services

5. June 1997 was too late for nurse Cheryl Maree Mohrbacker
Cheryl was a 41 year old RN in Oregon
Worked 3-11 Shift
Cheri never came home from work one night
Her Story:
Visiting father in hospital and she develops a severe allergic reaction which required 3 days on a ventilator
Carpets were being cleaned at hospital and her reaction was attributed to a reaction to the cleaning chemicals
Had a second bout again when carpets were being cleaned at a hospital where she was employed

6. Cheri’s story
Cheri realized she was only having reactions when wearing Latex gloves
In 1994, Cheri was tested for and diagnosed with a latex allergy.
She switched to hypoallergenic gloves which are meant for those who suffer from dermatitis.
Some hypoallergenic gloves have been found to have 3000 times the latex protein as regular latex gloves making them more dangerous to latex sensitive nurses
Eventually she got latex-free gloves.

7. Cheri’s story June 10, 1996 Cheri had a severe attack while at work.
She was rushed to the ED and told the staff there that she was latex sensitive.
At one point Cheri grabbed one nurse by the arm so hard that she left bruises and her last words to this nurse were:
“You’re just going to let me die. I’m not going to make it this time.”
Cheri was right – she did die in the ED that night.

8. Natural Rubber Latex (NRL)
Milky fluid derived from the rubber tree (Hevea Brasiliensis)
Two methods of treatment prior to use
Coagulate to solidify
Dry natural rubber i.e. tires, shoe soles
Ammonionate to prevent coagulation
Gloves, condoms
Proteins can cause range of allergic reactions

9. Latex Allergy 18-73% sensitization rate in children with Spina Bifida
Latex allergy affects 18 million Americans
Increasing rates of sensitization
18-73% sensitization rate in children with Spina Bifida
33% sensitization rate in those having 3 or more surgeries
15% sensitization rate in RN’s

10. Latex Allergy
17% sensitization rate in ALL health care workers (2% have occupational asthma)
Increased sensitivity in operating room personnel from 2.95% to 15% in less than 10 years
Increased rates in dental personnel from 13.7% to 38% in 4 years

11. Suspected populations at risk
Congenital neural tube disorders
Urologic disorders requiring catheterizations
3 or more surgeries
History of systemic reactions to balloons, latex gloves, condoms, cosmetics, rocket handlers, Poinsettas

12. Suspected populations at risk
History of allergy to fruits with cross reactive proteins
Hay fever, asthma, contact dermatitis
Food allergies to:
bananas, avocados, passion fruit, kiwis, chestnuts, tomato, Celery, melon,

13. Manifestations of Latex Allergy
Delayed hypersensitivity
Contact pruritus, erythema, uriticaria, eczema
Immediate hypersensitivity
Rhinorrhea, conjuctival pruritis & edema, wheezing, bronchospasm, angina, tachycardia & progressively severe hypotension

14. Onset & Symptoms Type I: Immediate Hypersensitivity
Progresses in minutes
Resolves spontaneously over 1-2 hours
Immediate, local and generalized uriticaria, feeling faint, feeling of impending doom, angioedema, nausea, vomiting, abdominal cramps, bronchospasm, anaphylaxis

15. Onset & Symptoms Type I: Immediate Hypersensitivity
Anaphylaxis:
Typically within 30 minutes after exposure
Cutaneous, GI, CV, Respiratory
Laryngeal edema and CV collapse most common cause of death
Immunoglobulin & mediated systemic reaction to the latex proteins that if untreated lead to fatality

16. Onset & Symptoms Type IV: Delayed Hypersensitivity
Contact Dermatitis
Appears in hours
Resolves in hours
Redness & inflammation over exposed sites
Blister formation
Allergic Dermatitis
T-cell mediated delayed localized reaction to chemicals used in manufacture of gloves

17. More prolonged the latent period between antigen exposure and the onset of symptoms, the more benign the reaction

18. Equipment Issues act as a vector for patient sensitization
GLOVES
act as a vector for patient sensitization
Workers are at risk as a population from multiple exposures
5-6 million workers wear gloves regularly
117 million pairs of latex gloves were supplied to NHS in 1992
NHS – National Health Services

20. Equipment Issues itching, hives, vesicles, erythema, and eczema
Latex gloves can cause contact allergic reactions
itching, hives, vesicles, erythema, and eczema
Usually a delayed hypersensitivity reaction
Workers may have concurrent chemical sensitivities to additives in latex

21. Equipment Issues
40,000 consumer products that contain latex in their composition.
Makes it difficult to completely delete latex

22. Environmental Issues
Latex particles are suspended in indoor air in health care settings
Powder in gloves is the vehicle for latex particle aerosolization
Aeroallergens are higher in areas where workers frequently apply and discard gloves
When latex particles are inhaled, workers become sensitized

23. Sources of Latex - Hospital
Gloves - sterile and exam
Catheters
IV injection ports
Medication vials with needle access
Ventilator, anesthesia, and respiratory therapy equipment
Latex tipped enemas, endoscopy parts
Mattresses on stretchers
Stethoscopes & blood pressure cuff tubing

24. Source of Latex - Home Environment
Household gloves
Diapers, bottle nipples, pacifiers
Household insulation material, carpet backing
Newsprint, coupons, and magazines dusted with latex coating
Feminine sanitary pads, adult diapers, condoms, diaphragms
Clothing including elastic on underwear

25. Methods of Exposure Cutaneous & Mucosa Inhalants IV & Parenteral
Gloves, dental equipment, surgical procedures, food prepared by people wearing latex gloves, toys, clothing, sports equip.
Inhalants
Anesthesia machines, powder from latex gloves, balloons, car tires
IV & Parenteral
IV ports, tubing, burettes, bottles and syringes

26. Clinical Management of systemic reactions
Antihistamines - oral, IM, IV
Chlorphenamine
Diphenhydramine
Steroids - inhaled, oral, IV
Bronchodilators - inhaled, oral, IV
Epinephrine - SQ & IV

27. Clinical Management Latex-safe preoperative and patient rooms
Latex-safe OR, PACU and anesthesia equipment
Latex-safe neonatal resuscitation equipment
Drugs must not be administered through latex ports, nor dwell in syringes with latex plungers

28. Clinical Management Operating Room
Schedule latex - safe cases first of the day to allow settling of latex dust overnight
Latex-safe anesthesia equipment
Latex-safe respiratory equipment
Latex-safe IV delivery systems
Recognition of inadvertent latex exposure

29. Clinical Management Emergency Department
Latex-safe intubation & ventilation equipment
Latex-safe IV equipment
Latex-safe gloves and monitoring equipment
Laminar air flow available for the “exquisitely” sensitized

30. Latex Allergy Identification
Screening criteria and diagnosis of latex allergy
Methods of allergy testing
RAST – RIA (invitro test IgE) with variable sensitivity
AlaSTAT – ELISA testing ( IgE testing)
Skin Prick - Most sensitive but carries risk of anaphylaxis

31. Management of the Latex sensitive individual
Non latex gloves for the employee
Non latex for co-workers (Preferred) or powder free
Medications ( epi-pen, antihistamines, inhalers, steroids)
Education of co-workers
Complete removal of latex sources from work place

32. Environmental Preparation
Remove latex sources from room
Dust and vacuum with HEPA filters
Mop all surfaces
Label room with a “Latex Allergy”Sign
Obtain non-latex medical equipment (Cart)
Reverse laminar air flow room if possible

33. Equipment Concerns Non-latex exam and sterile gloves. NO Exceptions !
neolon, nitrile, & butadene-styrene
Latex-Free respiratory support equipment
Non-latex ambu bag, ETT, cannulas, & masks readily available
Non latex anesthesia machine components (Ohmeda, North American Draeger & Anesthesia Associates retrofits

34. Latex-Free IV Equipment
Clave ( ICU Medical), Interlink ( Baxter), IVAC & Braun needleless IV tubings
Protective Plus (Johnson & Johnson) Insyte (Critikon), Abbocath, Clear-cath
Central lines-check with Arrow & Bard
Heparin Locks - B. Braun and Abbot

35. Medications & Specialty Procedures
Use needleless systems with latex free syringes or prefills
Abboject for most emergency drugs
Approved Wyeth-Ayerst blunt tip or tubex drugs only
Latex-free syringes - Terumo, Norm-ject ( Air-tite) & Becton Dickinson
DeRoyal Procedure Packs

36. Personnel Specifics
Nursing, Laboratory, Pharmacy, Housekeeping & Food Service staff don fresh gowns when entering a latex-allergic person’s room to prevent latex glove residue on clothing from being introduced. All personnel wear non-latex gloves
Food prep done with non-latex gloves

37. Items that have caused Anaphylaxis and Fatalities
Latex gloves
Meds injected through latex topped vials into latex IV ports
Latex tipped enema catheters, urinary catheters
Respiratory and resuscitation equipment

38. Nursing Research Sample of 79 Type I allergic response to latex
49% RNs
Qualitative - Fears, Lifestyle changes, Job and family impact
Findings in a nutshell
Almost all respondents fear needing EMS and Medical care
Denial of symptoms often results in worsening

39. 10 Latex Precaution Interventions
1. Identify those at risk as well as those who have had reactions.
2. Communicate information about the patient to all departments who have contact with the patient. Latex Precaution checklist
3. Admit patient to environment that reduces exposure to latex

40. 10 Latex Precaution Interventions
4. Call for Latex Precautions cart.
5. Use Latex-free gloves for any patient contact. Sterile & nonsterile.
6. Schedule surgeries/procedures as first case of the day.
7. Protect patient from direct contact.
8. Follow physicians orders for pre and/or post anaphylaxis medications. BE Prepared!

41. 10 Latex Precaution Interventions
9. If appropriate, maintain a unit specific Latex Free “Tool Box”.
10. Educate the patient and the family-Refer cases to appropriate medical care, contact latex information networks.
LISTEN TO THE PATIENT!!!

42. Summary Obtain latex free equipment before it is needed
Suspect every patient and any employee with symptoms
Resources:
Elastic -
Latex Cart Products List - Journal of Emergency Nursing 1998; 24L58-61

43. Foot to the Pedal

44. Resources: Elastic - www.latexallergyhelp.com
Latex Cart Products List - Journal of Emergency Nursing 1998; 24:58-61
AANA:
American college of Allergy Asthma immunology:

45. See YOU in Seattle, WA. USA
April 3-7, 2011

46. Thank YOU Lois Schick MN, MBA, RN, CPAN, CAPA 12823 W. 3rd Place
Lakewood, CO USA
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