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Latex allergies update.

Many of the readers of Exceptional Parent have learned of latex allergy and sensitivities, either from a personal experience or perhaps from reading "Later Allergy Alert" (Exceptional Parent, October 1997). Unfortunately, many parents, caregivers, and healthcare providers are not aware of the serious and widespread nature of latex allergies and sensitivities. This month's "Ask the Doctor" by Robert W. McKane, CRNA, describes some of the severe consequences that may occur if medical caregivers (or the patient), are not aware of a latex allergy. Unfortunately, this problem probably only get worse due to the abundance of common products that contain latex.

At any surgical center, the staff works diligently to maintain a steady flow of patients. Each area, from Admitting through Pre-OR Operating Room, and Recovery Room, runs only as smoothly as the one preceding it. This all comes to a halt when a patient suddenly remembers to mention that they are allergic to latex.

We have all heard of the person who dies because of an overwhelming anaphylactic reaction to a bee sting, yet we do not associate this kind of an event with a latex allergy. This can be a fatal mistake. Even healthcare providers have told me that they get skin rashes on their hands after wearing latex gloves but, "it is not a problem." Although an initial reaction to latex may be present as only a few small blisters or a brief rash, any sensitivity can progress to an anaphylactic reaction without warning.

The history of latex sensitivity

Although rubber gloves have been used in medical practice for many years, universal precautions were not instituted until the AIDS (Aquired Immune Deficiency Syndrome) epidemic reared its ugly head. The illness led to an explosive demand for latex gloves, and we began to see a sudden increase in the occurrence of latex reactions. Soon, reports began to emerge that implicated other medical and household products containing latex rubber. Severe anaphylactic reactions were reported, first in the healthcare setting, and later in dental offices and glove manufacturing facilities.

Latex allergies manifest as urticaria (hives), angioedema (swelling of the tissues beneath the skin or mucous membranes), upper and lower respiratory system symptoms (difficulty breathing), and cardiovascular involvement. Direct skin contact may give rise to localized or generalized urticaria so slight that it can be mistaken for dry, irritated skin, or even an insect bite. At this point, simply washing the hands could end the exposure. Unfortunately, people tend to rub their faces, noses, and eyes, spreading soluble latex proteins. Once these mucous membranes are exposed, the proteins may be inhaled, leading to serious consequences, beginning with inflammation of the nasal passages, eyelid linings, and angioedema of the mouth--progressing to wheezing and difficulty in breathing and often a life-threatening anaphylactic reaction.

Who is at risk?

Only 0.08 percent of the general population react to latex. Several groups have a higher risk for reactions to latex. Healthcare workers in hospitals (1.3 percent), workers in the rubber industry (10 percent), and dental practice personnel (13.7 percent) are among the occupational risk groups. Patients with spina bifida have an incidence of 18 to 40 percent. Any person with a congenital urologic abnormality is also at risk and generally has a history of allergic reactions to common latex products, such as toy balloons and rubber bands. People with allergic reactions to foods such as avocado, celery, kiwi, passion fruit, and bananas are also at risk for latex reactions.

What can be done to lessen the risk of a reaction in the medical setting?

EDUCATION + PLANNING + VIGILANCE = SAFETY.

Planning: Most institutions now have formal protocols and are well equipped to handle latex sensitivity.

Education: Publications, community healthcare forums, and television programs are vital in educating the public about the dangers of latex sensitivity. Informed consumers spur healthcare facilities to develop institutional guidelines and protocols for dealing with latex allergies.

Vigilance: If you are in the high-risk group, or you think you have a problem with latex, get the facts from your primary healthcare provider or an allergist. If you have a latex sensitivity or allergy, stay alert for hidden sources of latex in your environment. Make sure your healthcare practitioners and facilities have a protocol in place and that they adhere to it. If there is any doubt, ask questions. If you are not convinced, go somewhere else!

Vigilance is also the responsibility of the healthcare institution. Patients should be interviewed about risk factors before undergoing any treatment.

Safety: All latex-free procedures are scheduled at the beginning of the day. The night before treatment, we remove or replace all latex gloves and other known latex devices. The room is sealed and marked "Latex-Free." Normal overnight oxygen circulation clears all contaminants from the air. Any other treatment area that the patient will enter must also be latex-free.

Many manufacturers of medical supplies, aware of the problems with latex, are working to make their lines completely latex-free. Until this is accomplished, education, planning, and vigilance must be priorities to ensure the safety of the consumer and healthcare professional.

RELATED ARTICLE: Screening for Latex Sensitivity

Dr. Hirsch uses this questionnaire (Weido and Sim, Postgraduate Medicine, vol. 98, no.3, Sept. 1995) to screen his patients for latex sensitivity.

A. Allergies

1. Do you have a history of hay fever (sneezing, runny nose, itchy eyes)? If so,

a. Does it come and go with the season? or

b. Does it cause problems year-round?

2. Do you have a history of

a. Asthma?

b. Nighttime cough or shortness of breath?

c. Tightness in your chest or cough with exercise?

3. Do you have a history of

a. Atopic dermatitis or eczema?

b. Recurring hives or welts?

4. Do you have a history of allergic reactions (rash, swelling, itching, or wheezing), after you ingest certain foods or beverages?

5. Do you have a history of allergic reactions after taking certain drugs?

B. Risk factors for latex allergy

6. Do you have spina bifida (myelomeningocele)?

7. Do you have a urinary tract problem necessitating frequent catheterization?

8. Have you had three or more operations?

9. Are you around latex products (e.g., surgical gloves) at work?

10. Have you ever had a job in a latex-product manufacturing plant?

C. Job-related symptoms

11. Do you think you are having an allergic response to something in your work environment?

12. Do you use latex products for work or hobbies? If so, have you noticed any of the following whenever you are around latex?

a. Itching?

b. Sneezing?

c. Runny nose?

d. Itchy eyes?

e. Cough?

f. Shortness of breath?

g. Trouble breathing later that day or at night?

h. A rash anywhere on your body?

13 Has a rash ever developed on your hands after you have worn latex gloves? If so,

a. How long after putting on the gloves did the rash develop?

b. What did the rash look like?

D. Hidden reactions to latex

14. Has a rash, swelling, shortness of breath, cough, wheezing, runny nose, sneezing, or itchy eyes ever developed while you were using household cleaning gloves, balloons, condoms, diaphragms, or any other latex-containing product?

15. Have you ever had an allergic reaction of unknown cause?

16. Has a doctor ever said you had an allergic reaction or problem of unknown cause during surgery or hospitalization?

17. Have you ever had a reaction of unknown cause during a dental procedure?

Spina Bifida Association of America 4590 MacArthur Blvd. NW #250 Washington, DC 20007-4226 (800) 621-3141 or (202) 944-3285 202-944-3295 (fax); e-mail: spinabifda@aol.com

Robert W. McKane is a Certified Registered Nurse Anesthetist (CRNA), and Chief Nurse Anesthetist at the HEALTHSOUTH Surgery Center, Lancaster, PA. He is marriage and the parent of three children, one of whom has Down syndrome.

For more information on Nurse Anesthesia, contact the American Association of Nurse Anesthetists at (800) 543-2262. Or contact:

Latex Allergy Information Service 176 Roosevelt Avenue Torrington, CT 06790 (806)482-6869 fax: (860) 482-7640
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Title Annotation:Ask the Doctor
Author:McKane, Robert W.
Publication:The Exceptional Parent
Date:Oct 1, 1998
Words:1324
Previous Article:We can survive.
Next Article:Association for the Care of Children's Health: humanizing healthcare for children & families.
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