Latex Allergy Follow-up

  • Author: Amy J Behrman, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Nov 30, 2011
 

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.[7] Known latex allergy or a history suggestive of major latex allergy should trigger the use of latex-free operating rooms and postoperative care.
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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.
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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.
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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.[18, 19]
    • 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.[20, 21] 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.[22, 23]
    • 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.
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Complications

  • Respiratory compromise
  • Anaphylaxis
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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.
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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.
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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Matthew M Rice, MD, JD, FACEP  Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians of TeamHealth; Assistant Clinical Professor of Medicine, University of Washington School of Medicine

Matthew M Rice, MD, JD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Washington State Medical Association

Disclosure: Nothing to disclose.

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

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

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  3. Feng C, Wang H. Natural rubber latex allergy among health care workers. J Allergy Clin Immunol. Jun 2007;119(6):1561; author reply 1561. [Medline].

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  14. Hamilton RG, Peterson EL, Ownby DR. Clinical and laboratory-based methods in the diagnosis of natural rubber latex allergy. J Allergy Clin Immunol. Aug 2002;110(2 Suppl):S47-56. [Medline].

  15. Blanco C, Carrillo T, Ortega N, et al. Comparison of skin-prick test and specific serum IgE determination for the diagnosis of latex allergy. Clin Exp Allergy. Aug 1998;28(8):971-6. [Medline].

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  17. Food and Drug Administration. Natural rubber containing medical devices: user labeling.[Docket No. 96N-0119]. 21 CFR Part 801 Fed. Regist. 1997;62:51021-51030.

  18. Korniewicz DM, Chookaew N, El-Masri M, Mudd K, Bollinger ME. Conversion to low-protein, powder-free surgical gloves: is it worth the cost?. AAOHN J. Sep 2005;53(9):388-93. [Medline].

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  20. 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].

  21. LaMontagne AD, Radi S, Elder DS, Abramson MJ, Sim M. Primary prevention of latex related sensitisation and occupational asthma: a systematic review. Occup Environ Med. May 2006;63(5):359-64. [Medline].

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