Approach Considerations

Treatment consists of oral immunotherapy with useful results, but subcutaneous immunotherapy appears to be more successful. Unfortunately, this only applies in case reports. It is also specific to patients who have rhinitis and conjunctivitis from latex. Avoidance is the mainstay of treatment for type I and type IV reactions. The extract that was used in some studies contained 5 HEP/mL manufactured by ALK. Average maximum tolerated dose was 11.1; this seems to be more effective.^[36]

In the presence of viral epidemics and pandemics such as Covid, wearing gloves has become an important barrier. Reactions due to latex and additives continue to be a challenge. Education, avoidance, and vigilance are important.^[38]

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 in all circumstances. 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, hospitals, and medical offices 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 non-latex intubation and ventilation equipment, IV tubing, syringes, tourniquets, electrode pads, gloves, masks, and medication vials.
Routine care of high-risk patients should use non-latex 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 non-latex 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.^[39]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. However, providers should be aware that package labeling for latex content may not be clear, and that latex-containing medications and devices can be mistaken for latex-free products in busy clinical settings.

Consultations

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

Medication

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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.