Latex Allergy: A Guideline for Perioperative Nurses

[Latex allergy in a paediatric hospital. Characteristics and risk factors]

INTRODUCTION

The prevalence of latex sensitisation varies according to the population studied. There are various risk factors that increase latex sensitisation, such as genetic risk, atopy, and multiple surgeries.

OBJECTIVE

To characterise patients referred to an Immunology Unit with suspected latex allergy, and to analyse their clinical features and risk factors.

PATIENTS AND METHOD

A retrospective, descriptive study was conducted on children suspected of latex allergy. Their medical records were reviewed in order to assess symptoms with contact or exposure to latex materials. Known risk factors to latex sensitisation, such as pathologies requiring repeated surgery (spina bifida, myelomeningocele, scoliosis and nephro-urological alterations), atopy (rhinitis, asthma, atopic dermatitis) were investigated. A prick test and/or specific IgE to latex were also performed. A multivariate logistic regression model was performed to find associations between symptoms triggered by exposure to latex with underlying diseases and other risk conditions.

RESULTS

A total of 106 patients were enrolled in the study, of whom 50 were evaluable. At diagnosis 96% of patients were older than five years. Most of the risk factors described were observable in these patients, such as multiple surgeries, neurological and nephro-urological malformations, surgery before one year-old, and repeated bladder catheterisation. After latex exposure, mucous cutaneous manifestations were the most common (52%), followed by respiratory symptoms (36%). All patients were sensitised and allergic to latex.

CONCLUSION

Latex allergy is a significant problem in children with risk factors. The results shown in this study raise important challenges for preventive measures and awareness.

Perioperative latex hypersensitivity reactions: an integrative literature review

This article characterizes hypersensitivity reactions during anesthetic-surgical procedures. This integrative literature review was conducted in the LILACS, CINAHL, COCHRANE and MEDLINE databases including papers published from 1966 to September 2011. A total of 17 case reports, two prevalence studies and one cohort study were identified. Latex reactions were mainly type III and the primary source of intraoperative reaction was latex gloves. The average time for clinical manifestation was 59.8 minutes after anesthetic induction; 44.4% of patients reported a reaction to latex at the pre-anesthetic evaluation. It was determined that the history of allergic reactions to latex obtained in the pre-anesthetic evaluation does not ensure the safety of patients if the staff is inattentive to the severity of the issue. There is also a tendency to initially attribute the anaphylactic event to the anesthetic drugs.

Latex allergy in clinical practice

A continuous exposure or contact to latex products may sensitize the human body by causing mild to fatal reactions. Despite the availability of the literature, medical personnel are still unaware of the implications of the use of latex materials. The increased awareness to prevent the transmission of infectious blood borne pathogens has lead to increased usage of medical gloves among health care workers. This increased usage of medical gloves, along with improved methods in diagnosing latex allergy, has been the reason for the rise in the number of reported cases. This has lead to recognition of latex allergy as a serious medical concern. Patients in high-risk groups must be assessed carefully, so that appropriate protocols can be used to protect them from contact with latex.

Anaphylactic reactions during surgical and medical procedures

The most common agents that are responsible for intraoperative anaphylaxis are muscle relaxants. However, latex accounts for a significant number of these reactions, and the incidence of intraoperative anaphylaxis caused by latex is increasing. It is now probably the second most important cause of intraoperative anaphylaxis. Following muscle relaxants and latex are probably antibiotics and anesthesia induction agents. Other agents that are responsible include colloids, opioids, and radiocontrast material. However, they account for less than 10% of all reactions. The clinical manifestations of intraoperative reactions differ from those of anaphylactic reactions outside of anesthesia. Cutaneous manifestations are far less common; cardiovascular collapse may be more common. The diagnosis can be made more difficult because patients cannot express symptoms. There is a paucity of cutaneous findings; the patient is draped, and concomitantly administered drugs may alter the manifestations. These additional drugs can also complicate therapy. There are populations who are at-risk for anaphylaxis to latex during surgical procedures: individuals with a genetic predisposition (atopic individuals), individuals with increased previous exposure to latex (eg, anyone who requires chronic bladder care with repeated insertion of latex catheters or chronic indwelling catheters), health care workers who are exposed to latex mainly by inhalation, and possibly patients who have undergone multiple surgical procedures and therefore have been exposed to latex intravascularly and by catheterization on a number of occasions. It has been shown that pretreatment with antihistamines and corticosteroids that are used successfully for the prevention of reactions to radiocontrast material are not as effective in the prevention of anaphylactic reactions to latex. Therefore, the major emphasis has been on prevention. The key elements of prevention include an adequate history, testing for latex allergy in high-risk patients, preadmission measures, and the establishment of a "latex-free environment" while the individual is hospitalized. This is particularly important in the operating and recovery rooms.

Latex allergy: how to identify it and the people at risk

Some patients and staff are more at risk to latex allergy than others. This paper identifies those people and the ways in which their allergy can be confirmed. Recommendations are made for their care and to prevent sensitization occurring.

Latex sensitivity: a public health care challenge

Latex sensitivity is becoming epidemic in the health care arena. Providers of health care need to be aware of the signs and symptoms, the treatments, and the consequences of latex sensitive reactions. In this article, I will provide information about latex sensitivities that will enable health care workers and their patients to have a better understanding of the phenomena. Resource information is provided for the latest information pertaining to latex sensitivities to aid in the education of health care providers and their patients.

Latex allergy: what it could mean for you

With the increase in infectious disease epidemics and the need to protect health-care workers, the use of rubber gloves has increased twofold. Recent reports have noted an increase also in the prevalence of natural rubber latex allergy among some of these workers. A newly emerging problem, the allergy has potentially life-threatening consequences for those affected, a fact which has far-reaching ramifications for all those working in contact with latex, critical care nurses in particular. Indeed, the allergy has had a major impact on one such nurse, to the extent that she has had to relinquish her career and make significant changes to her lifestyle. Latex allergy was first recognised in 1927 but has become more prevalent in the last few years. There are two types of reactions, type I and type IV, with symptoms varying from a mild itch to anaphylaxis. Diagnosis is made via a blood or skin test, as well as a patient history. Treatment is to medicate for symptoms, while avoidance is the only way to prevent occurrences. The case study which follows reveals the impact that this allergy can have on a critical care nurse.

Latex allergy in patients with myelomeningocele presenting for imaging studies of the urinary tract

OBJECTIVE

We prospectively surveyed patients with myelomeningocele who presented in our department over a 3-month period to determine the frequency of latex allergy in this population.

MATERIALS AND METHODS

A questionnaire assessed history of allergy to latex and attitudes toward and use or avoidance of latex-containing products in both medical and nonmedical environments.

RESULTS

Surveys were completed by 118 patients (56 boys, 62 girls; mean age 10.4 years, range 0.6-30.9 years). Seventy-two (61%) had heard of latex allergy and 25 (21%) reported being allergic to latex. Most allergic patients were performing intermittent self-catheterization (92%) and tended to be slightly older (mean age 12.7 years) than those not reporting allergy (mean age 9.8 years). Although most reactions were limited to rashes and mucosal irritation, two patients experienced anaphylaxis with severe respiratory symptoms or hypotension or both. No reactions had occurred in the Department of Radiology. While 84% of patients with previous allergic reactions reported trying to avoid further exposure to latex in the hospital, at home, or in school, only 14% of non-allergic patients took any special precautions.

CONCLUSION

Allergy to latex is common in patients with myelomeningocele who are examined in our department. We have developed a policy designed to prevent exposure of such patients to latex during imaging studies.

Barrier protection and latex allergy associated with surgical gloves

Latex continues to be the material of choice for surgical gloves because it is resealable and flexible, and it maintains the wearer's tactile sensitivity. The use of latex gloves for barrier protection may need to be reevaluated in light of the increasing number of individuals who are sensitive to latex. Hospital personnel can use low-allergen gloves or nonlatex gloves when caring for patients with known sensitivity to latex; however, only nonlatex gloves may be effectives at reducing or preventing anaphylactic reaction. Health care facilities must develop policies and procedures for dealing with latex-sensitive patients and health care workers.

Latex anaphylaxis: report of occurrence in two pediatric surgical patients and review of the literature

This report describes two cases of intraoperative anaphylaxis in children sensitized to latex. Both children were undergoing nonurological procedures and, despite numerous previous operations, neither had a history of unusual reaction or anaphylaxis during surgery. The problem of latex allergy is discussed with review of the current literature and suggestions for management.

Latex sensitivity among perioperative nurses

To estimate the prevalence, risk factors, and clinical spectrum of adverse reactions to natural rubber latex-containing products among a national sample of perioperative nurses, the investigators administered a self-reporting questionnaire to a convenience sample of 2,200 members of the Association of Operating Room Nurses, Inc. Of the 1,738 nurses who responded, 369 (21%) reported latex reactions. Multivariate analysis identified a history of allergies to cosmetic powders, other allergies, chronic illnesses, and regular use of latex gloves as independent risk factors for reactions to latex-containing products. Localized reactions, such as contact dermatitis, were the reactions reported most commonly, although severe systemic reactions also were described.