Understanding Latex Allergy: Sensitivity vs. Allergy

1. LATEX ALLERGY

2. Latex Sensitivity vs Allergy Latex allergy is an IgE-mediated sensitization to naturally occurring latex proteins. Repeated exposure to proteins in NRL causes: • Sensitivity – the development of an immunologic memory (IgE) to a specific protein (i.e. latex) • Allergy – the demonstrated outward expression of the disease (hives, rhinitis, anaphylaxis, etc.) AORN Perioperative Standards and Recommended Practices, 2012

3. History of Latex Allergy Turn of Century, Latex gloves commonly used 1927- First recorded apparent allergic reaction to latex- Dental partial plate 1933 – Latex hypersensitivity to rubber gloves was reported 1979 – Immediate-type allergic reactions (Type1) reported with increasing frequency Since 1974- US FDA reports over 1,700 incidences of allergic reactions with 17 deaths AORN Perioperative Standards and Recommended Practices, 2012

4. Why Latex Allergy Became More Common • Probable Causes: • 1987 CDC implemented Universal Precautions • 1992 OSHA Mandated Universal Precautions • New and/ or inexperienced manufacturers • New routes of sensitization • Familiar with signs of hypersensitivity/ better reporting • AORN Perioperative Standards and Recommended Practices, 2012 • Latex Allergy, Christine Calson, Wild Iris Medical Education,Inc. 2011

5. Latex Sensitivity Prevalence Rates • General population range: 0.8-6.5% • Health Care Workers: 10 – 17% • Spina Bifida/Congenital Defects:35 – 70% AORN Perioperative Standards and Recommended Practices 2012

6. CLINICAL MANIFESTATIONS OF LATEX Delayed type contact dermatitis Reaction develops gradually over a day or weeks • Red, scaly, itchy skin • Climactic irritation, damage of skin • Not an allergic reaction Allergic contact reaction (Type IV) Symptoms within six – 48 hours • Previous exposure to latex- sensitized chemicals • Sneezing/runny nose, coughing/wheezing, watery eyes AORN Standards and Recommended Practices, 2012

7. CLINICAL MANIFESTATIONS TO LATEX TYPE 1 ANAPHYLAXIS REACTION • Immediate (Within 5 – 30 minutes of exposure) • True allergy to natural rubber latex • Systemic reaction • Pathways- Skin, mucous, inhalation, internal organs • Symptoms: • Hives • Eyelid/ Facial swelling/ Edema • Swelling of throat, nasal passages, bronchi • Difficulty breathing/ Wheezing/ Bronchospasms • Anaphylaxis/ Death AORN Standards and Recommended Practices 2012

8. GROUPS AT RISK FOR LATEX ALLERGY • Children with myelodysplasia (Spina Bifida)/ multiple surgeries since infancy • Occupational Exposure- Health care/Food service employees • Atopic individual w/ hx of eczema, rhinitis • History of Type 1 reaction to multiple environmental allergies including food allergies such as apple, avocado, banana, carrot, celery, chestnut, kiwi, melons, papaya, raw potato and tomato.

9. TRIGGERING LATEX PRODUCTS Just to name a few: Pacifiers/ bottle nipples Dental dams/ Orthodontic elastic Condoms/ Diaphragms Latex gloves/ powder Catheters- Urinary, Barium enema Nasogastric tubes Bandages/ Adhesives (Tapes)

10. Prevention Big Deal! 1988- FDA required warning statement on latex products • Goals • Prevent reaction in latex-sensitized individual • Prevent initial sensitization AORN Standards and Recommended Practices, 2012

11. PRE-OPERATIVE ASSESSMENT OF LATEX ALLERGY PATIENT Careful assessment of risk: Watch for patients that have problems with: Blowing up latex balloons Wearing rubber bands at wrist/ elastic underwear Dentist issues – dental dam Diaphragm / Condom Adhesive bandages/ tapes Fruits such as bananas, kiwi, etc Patient has latex allergy: In addition to above - Describe allergy and severity Check if filled out questionaire

12. MANAGEMENT OF LATEX- ALLERGIC PATIENT Create a latex-safe environment by: • Careful assessment of risk • Communicating risk to all care-givers • Schedule first case of day • All cases are set of using latex free gloves-routine! • ID band/ Flag chart/ Signs for OR & Patient bed • Educate patient/ family about plan • Latex-free environment - GLOVES/ CATHETERS/ANESTHESIA PRODUCTS Remove all latex gloves/ products from room • Monitor for reactions/ Assist with treatment - Trendelenberg, Epi, Benadryl, Albuterol, CPR Document laser-safe environment/ patient response Christine Calson, Wild Iris Medical Education, Inc, 2011

13. MANAGEMENT OF LATEX-ALLERGIC EMPLOYEE • Create a latex-safe environment • Provide latex free/ powder free gloves • Don’t use oil-based hand creams/lotions w/ latex gloves (causes deterioration of rubber) • Wash hands after wearing gloves • Educate self about latex allergy • Reduce exposure and seek medical advice if latex allergy is suspected • Recommend change of environment as necessary Christine Calson, Wild Iris Medical Education, Inc, 2011

14. Where are we today? • Considerable reduction in prevalence • Elimination of donning powder • Introduction of synthetic rubbers • Education of the public Resource for latex alternatives - American Latex Allergy Association Best and most effective treatment is AVOIDANCE!! • American Latex Allergy Association –latex alternatives