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.

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.^{[16, 14]}Known latex allergy or a history suggestive of major latex allergy should trigger the use of latex-free operating rooms and postoperative care.

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.^{[40, 41]}

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.^{[42, 43]}Follow-up studies of latex allergic HCWs have shown a reduction in latex-specific IgE antibodies after latex use is substantially reduced in the healthcare workplace.^{[44, 45, 46, 27]}

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.

Non-healthcare workplaces should address the risk of workplace anaphylaxis.^[47]

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Author

Constantine K Saadeh, MD President, Allergy ARTS, LLP; Principal Investigator, Amarillo Center for Clinical Research, Ltd

Constantine K Saadeh, MD is a member of the following medical societies: American Academy of Allergy, Asthma and Immunology, American College of Rheumatology, American Medical Association, Southern Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Nicole Davey-Ranasinghe, MD Rheumatologist, Allergy ARTS, LLP, Amarillo Center for Clinical Research, Ltd

Nicole Davey-Ranasinghe, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Pending Approval

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, Washington State Medical Association

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.

Additional Contributors

Amy J Behrman, MD, FACOEM, FACP Professor, Department of Emergency Medicine, Medical Director, Division of Occupational Medicine, Perelman School of Medicine at the University of Pennsylvania

Amy J Behrman, MD, FACOEM, FACP is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Physicians

Disclosure: Nothing to disclose.

Mark Louden, MD Assistant Professor of Clinical Medicine, Division of Emergency Medicine, Department of Medicine, University of Miami, Leonard M Miller School of Medicine

Mark Louden, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Jarrod D Matthei, MD, MPH Resident Physician in Occupational Medicine, Hospital of the University of Pennsylvania

Disclosure: Nothing to disclose.

Acknowledgements

Marilyn Howarth, MD Center for Excellence in Environmental Toxicology, 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.