eMedicine Specialties > Emergency Medicine > Allergy & Immunology

Latex Allergy: Treatment & Medication

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

Treatment

Prehospital Care

  • Prehospital providers should be aware of the risk of latex allergy in patients and providers.
  • Search for and read MedicAlert-type bracelets.
  • Note the patient's history of relevant allergies to medical devices or fruits.
  • To rule out latex allergy that could worsen with further medical exposure, review the patient's history of activities/exposures immediately preceding any systemic allergic reaction.
  • Use powder-free latex gloves or, ideally, high-quality nonlatex gloves to minimize risk to patients and providers. Latex-free resuscitation and intravenous (IV) access equipment should be available for high-risk patients. Do not give medication from rubber-topped multidose vials or through latex IV ports in latex-allergic patients.

Emergency Department Care

Patients with known or suspected latex allergy who seek care for unrelated medical conditions or injuries must be kept within a latex-safe environment to prevent serious complications. This includes all patients with spina bifida.

Patients presenting with frank symptoms of type I latex allergy are treated as any other patients with systemic allergic reactions, except they must be protected from further latex contact to avoid clinical deterioration. Many EDs represent very high-risk environments for latex-sensitive patients, particularly if powdered latex gloves are still in use.

  • Latex-free resuscitation equipment must be available. This frequently is accomplished with a mobile, latex-free cart carrying nonlatex intubation and ventilation equipment, IV tubing, syringes, tourniquets, electrode pads, gloves, masks, and medication vials.
  • Routine care of high-risk patients should use nonlatex supplies. Major reactions in sensitized patients have been precipitated with pelvic and rectal exams using latex gloves, urinary catheterization with latex catheters, IV medication given through latex ports, and inhalation of aerosolized latex glove powder.
  • Consultants must be aware of the need to completely avoid latex exposure to the patient during examinations and procedures.
  • Patients needing studies in other hospital areas, such as radiology, must be transported without risking latex exposure.
  • Identification of latex versus nonlatex medical devices traditionally has required laborious contacts with individual manufacturers. Since 1999, the US Food and Drug Administration has required all manufacturers to apply warning labels to medical devices containing natural rubber latex. This regulation has helped to facilitate safe care of patients who are allergic to latex. In addition, medical device manufacturers have developed many latex-free alternatives for routine care and invasive procedures.

Consultations

Consultants must be aware of the need to scrupulously avoid exposing the patient to latex during exams and procedures.

Medication

Latex allergies are best treated with patient education to avoid further exposure. Type I reactions are treated as any other systemic allergic reaction. The cornerstones of treatment are epinephrine and H1 antihistamines. Systemic corticosteroids and H2 blockers may be useful. Please see articles on Anaphylaxis, Angioedema, and Asthma for details of therapy. No specific immunotherapy has been shown to be effective.

Type IV reactions (localized contact dermatitis) are unlikely to require ED treatment. They can be treated with topical steroids and patient education to avoid further exposures.

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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  2. Ahmed DD, Sobczak SC, Yunginger JW. Occupational allergies caused by latex. Immunol Allergy Clin North Am. May 2003;23(2):205-19. [Medline].

  3. Ahmed SM, Aw TC, Adisesh A. Toxicological and immunological aspects of occupational latex allergy. Toxicol Rev. 2004;23(2):123-34. [Medline].

  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].

  5. 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].

  6. 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].

  7. 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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  12. 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.

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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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