eMedicine Specialties > Emergency Medicine > Allergy & Immunology

Latex Allergy: Follow-up

Author: Amy J Behrman, MD, Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine
Coauthor(s): Marilyn Howarth, MD, Director, Occupational and Environmental Consultation Service, Clinical Assistant Professor, Department of Emergency Medicine, University of Pennsylvania
Contributor Information and Disclosures

Updated: Aug 7, 2008

Follow-up

Further Inpatient Care

  • Patients with major latex allergies who are admitted for allergic complications or unrelated conditions must be moved to latex-safe rooms with clear warnings on doors and charts.
  • All examinations and care must be done without use of latex-containing devices or equipment.
  • All providers should be educated to avoid inadvertent exposure.
  • Latex is the second most common cause of intraoperative anaphylaxis, which can be difficult to diagnose because of infrequent cutaneous signs and patients' inability to express symptoms. Known latex allergy or a history suggestive of major latex allergy should trigger the use of latex-free operating rooms and postoperative care.

Further Outpatient Care

  • Patients and their families should be educated to identify and avoid latex in home, work, and medical/dental settings.
  • Patients should be referred to an allergist or primary care provider for follow-up.
  • Patients should be aware of the life-threatening complications of anaphylaxis, bronchospasm, and laryngospasm.
  • Patients with type I hypersensitivity should carry subcutaneous epinephrine kits at all times.
  • Patients should obtain and wear a MedicAlert-type bracelet identifying their allergy.
  • Patients should be aware of the risk of cross-reacting fruit allergies.

Inpatient & Outpatient Medications

  • See articles on Anaphylaxis, Angioedema, and Asthma for inpatient and outpatient medications.
  • All patients with type I latex allergy should carry a subcutaneous epinephrine kit at all times.

Deterrence/Prevention

  • Hospitals should make policy and purchasing decisions to minimize latex exposure in the institution, with the goal being to protect sensitized patients and employees as well as to reduce the risk of primary sensitization. Several cost analyses have found that becoming latex-safe is cost-effective for health care facilities.
    • Minimally, this requires reducing or eliminating powdered latex examination gloves and substituting less allergenic latex gloves or, ideally, high-quality nonlatex gloves. This strategy has been shown to reduce natural rubber latex aeroallergen, sensitization of exposed HCWs, and incidence of asthma in HCWs. Follow-up studies of latex allergic HCWs have shown a reduction in latex-specific IgE antibodies after latex use is substantially reduced in the health care workplace.
    • It also requires clear guidelines for the safe treatment of sensitized patients and for the accommodation of sensitized employees.
    • Multidisciplinary hospital committees can be effective in accomplishing these goals.
    • Federal guidelines to reduce latex exposure will have an impact on all hospitals in the near future.

Complications

  • Respiratory compromise
  • Anaphylaxis

Prognosis

  • Most latex-allergic patients can function normally by avoiding significant latex exposure at home, at work, and in medical/dental situations.
  • Some patients will become more sensitized and have greater difficulty functioning.
  • A small percentage of patients with IgE-mediated allergy become so sensitized that inadvertent exposure to minute amounts of latex, either by contact or inhalation, causes frequent life-threatening episodes.
  • In the absence of effective immunomodulatory therapy, avoidance of latex and excellent ED care must be the patients' mainstays.

Patient Education

  • Patients can and should be referred to local or national support groups to stay abreast of new developments in latex-free devices that may make their lives safer and more convenient.
  • These groups frequently maintain lists of latex-safe medical and dental practices; many track regulatory and legislative developments.

Miscellaneous

Medicolegal Pitfalls

  • All EDs eventually treat patients with severe latex allergies. Inadvertent latex exposure to such a patient in the ED may result in adverse outcomes and litigation.
  • Failure to maintain latex-safe equipment in the ED may result in adverse outcomes and litigation.
  • Failure to obtain a history suggestive of recognized or unrecognized latex allergy may result in adverse outcomes and litigation.
  • Discharge without appropriate patient education may result in adverse outcomes and litigation.
  • Failure to comply with evolving federal regulations to decrease latex exposure to HCWs and patients may incur liability for an institution.
  • Institutional failure to accommodate latex-sensitized HCWs may lead to litigation.
 


More on Latex Allergy

Overview: Latex Allergy
Differential Diagnoses & Workup: Latex Allergy
Treatment & Medication: Latex Allergy
Follow-up: Latex Allergy
References
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References

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  4. Allmers H, Brehler R, Chen Z, et al. Reduction of latex aeroallergens and latex-specific IgE antibodies in sensitized workers after removal of powdered natural rubber latex gloves in a hospital. J Allergy Clin Immunol. Nov 1998;102(5):841-6. [Medline].

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Further Reading

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Keywords

natural rubber latex, allergy to latex, latex gloves, irritant dermatitis, latex-induced skin rashes, delayed (type IV) hypersensitivity reaction, contact dermatitis, type I hypersensitivity, immediate (type I) hypersensitivity

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Contributor Information and Disclosures

Author

Amy J Behrman, MD, Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine
Amy J Behrman, MD is a member of the following medical societies: American College of Occupational and Environmental Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Marilyn Howarth, MD, Director, Occupational and Environmental Consultation Service, Clinical Assistant Professor, Department of Emergency Medicine, University of Pennsylvania
Marilyn Howarth, MD is a member of the following medical societies: American College of Occupational and Environmental Medicine
Disclosure: Nothing to disclose.

Medical Editor

Mark Louden, MD, FACEP, Assistant Medical Director, Emergency Department, Duke Raleigh Hospital
Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Matthew M Rice, MD, JD, Vice President, Chief Medical Officer, Northwest Emergency Physicians, Assistant Clinical Professor of Medicine, University of Washington at Seattle; Assistant Clinical Professor, Uniformed Services University of Health Sciences
Matthew M Rice, MD, JD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Team Health  Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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