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.
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
- 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.[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.
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.
Gawchik SM. Latex allergy. Mt Sinai J Med. Sep-Oct 2011;78(5):759-72. [Medline].
Agarwal S, Gawkrodger DJ. Latex allergy: a health care problem of epidemic proportions. Eur J Dermatol. Jul-Aug 2002;12(4):311-5. [Medline].
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].
Palosuo T, Antoniadou I, Gottrup F, Phillips P. Latex medical gloves: time for a reappraisal. Int Arch Allergy Immunol. 2011;156(3):234-46. [Medline].
Ahmed SM, Aw TC, Adisesh A. Toxicological and immunological aspects of occupational latex allergy. Toxicol Rev. 2004;23(2):123-34. [Medline].
Jackson EM, Arnette JA, Martin ML, et al. A global inventory of hospitals using powder-free gloves: a search for principled medical leadership. J Emerg Med. Feb 2000;18(2):241-6. [Medline].
Thong BY, Yeow-Chan. Anaphylaxis during surgical and interventional procedures. Ann Allergy Asthma Immunol. Jun 2004;92(6):619-28. [Medline].
Ahmed DD, Sobczak SC, Yunginger JW. Occupational allergies caused by latex. Immunol Allergy Clin North Am. May 2003;23(2):205-19. [Medline].
Dorevitch S, Forst L. The occupational hazards of emergency physicians. Am J Emerg Med. May 2000;18(3):300-11. [Medline].
Fein JA, Selbst SM, Pawlowski NA. Latex allergy in pediatric emergency department personnel. Pediatr Emerg Care. Feb 1996;12(1):6-9. [Medline].
Galindo MJ, Quirce S, Garcia OL. Latex allergy in primary care providers. J Investig Allergol Clin Immunol. 2011;21(6):459-65. [Medline].
Liss GM, Sussman GL. Latex sensitization: occupational versus general population prevalence rates. Am J Ind Med. Feb 1999;35(2):196-200. [Medline].
Taylor JS, Erkek E. Latex allergy: diagnosis and management. Dermatol Ther. 2004;17(4):289-301. [Medline].
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].
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].
Bernardini R, Mistrello G, Pucci N, Roncarolo D, Lombardi E, Zanoni E. Diagnostic value of three different latex extracts. Int J Immunopathol Pharmacol. Apr-Jun 2007;20(2):393-400. [Medline].
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.
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].
Phillips VL, Goodrich MA, Sullivan TJ. Health care worker disability due to latex allergy and asthma: a cost analysis. Am J Public Health. Jul 1999;89(7):1024-8. [Medline].
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].
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].
Filon FL, Radman G. Latex allergy: a follow up study of 1040 healthcare workers. Occup Environ Med. Feb 2006;63(2):121-5. [Medline].
Yagami A, Suzuki K, Kano H, Matsunaga K. Follow-up study of latex-allergic health care workers in Japan. Allergol Int. Sep 2006;55(3):321-7. [Medline].
Biagini RE, MacKenzie BA, Sammons DL, Smith JP, Krieg EF, Robertson SA. Latex specific IgE: performance characteristics of the IMMULITE 2000 3gAllergy assay compared with skin testing. Ann Allergy Asthma Immunol. Aug 2006;97(2):196-202. [Medline].

