Transcript LATEX ALLERGY GAIL AUGDAHL, RN, BSN, CNOR

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
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
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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
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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
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
TYPE 1 ANAPHYLAXIS REACTION
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Immediate (Within 5 – 30 minutes of exposure)
True allergy to natural rubber latex
Systemic reaction
Pathways- Skin, mucous, inhalation, internal organs
Symptoms:
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Hives
Eyelid/ Facial swelling/ Edema
Swelling of throat, nasal passages, bronchi
Difficulty breathing/ Wheezing/ Bronchospasms
Anaphylaxis/ Death
AORN Standards and Recommended Practices 2012
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 avocado, banana, kiwi,
papaya, chestnut, potato and tomato
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AORN Standards and Recommended Practices, 2012
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)
Big Deal!
1988- FDA required warning statement
on latex products
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Goals
◦ Prevent reaction in latex-sensitized
individual
◦ Prevent initial sensitization
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
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
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Create a latex-safe environment
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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
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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!!