Other Patient Safety Information

Children with spina bifida and pediatric and adult patients who undergo multiple invasive procedures may suffer allergic reactions to medical devices and products made of natural rubber latex (NRL). Latex allergies produce a host of unpleasant symptoms ranging from sneezing; wheezing; itchy, watery eyes; and coughing; to a swelled windpipe and anaphylaxis, a condition characterized by breathing difficulties that can cause shock or even death. The following provides valuable information for latex-sensitive patients and those at risk of becoming sensitized to NRL.

• Facts about spina bifida: Spina bifida, the most common neural tube defect, occurs when a fetus’ spine fails to close properly during the first month of gestation. Babies born with spina bifida generally require surgery within 24 hours of birth to minimize infection and preserve existing spinal cord function. Additional surgeries and extensive care to prevent paralysis caused by damage to the spinal cord may be needed.
  
  Studies indicate that between 18 percent and 73 percent of pediatric patients with spina bifida develop a latex sensitivity. Children with spina bifida also may suffer from bladder and bowel complications and hydrocephalus, an accumulation of fluid on the brain.
  

• Other at-risk patients: Adults who undergo multiple invasive surgical, dental or gynecological procedures also may develop latex allergies.

• Types of allergies: Hypersensitive reactions to latex include non-allergic irritant contact dermatitis, type IV cell-mediated allergies and type I IgE-mediated allergies.
  
  Non-allergic irritant contact dermatitis, a skin rash, is the most common reaction affecting regular wearers of powdered and non-powdered latex gloves.
  
  Type IV cell-mediated allergies represent a delayed reaction to one or more of the 300-plus chemicals used to manufacture latex. The most common immune system reaction, type IV allergies produce a skin rash characterized by redness and swelling within 48 to 96 hours of exposure. Continued exposure puts individuals at risk of developing the antibodies that can trigger a type I latex allergy.
  
  Type I IgE-mediated allergies represent an immediate hypersensitivity to actual latex proteins. They include two subgroups that produce symptoms ranging from hives, runny nose and skin rashes to anaphylaxis.
  

• How patients develop latex allergies: Early, intense and constant exposure to NRL products during surgery, diagnostic tests, examinations, and bladder and bowel programs can cause latex allergies among spina bifida patients. Contact with skin or mucous membranes in the mouth, eyes, genitals, bladder or rectum also can trigger an allergy. Serious reactions occur when latex enters the bloodstream and severe reactions often follow the injection of medication through latex stoppers, IV ports or syringes. Visit the Spina Bifida Association of America Web site at www.sbaa.org for more information about this subject.
  

• Items made of latex: Latex can be found in over 40,000 consumer products including household items and children’s toys. It also can be found in medical products ranging from elastic bandages to ventilator hoses. See "Latex Allergy Protocol" published by the American Association of Nurse Anesthetists (AANA) in 1998 and included in this press kit for a complete list of medical devices, products and equipment containing latex.
  

• Allergic cross-reactions: Certain plant products contain the same allergy-producing proteins found in NRL. They include bananas, avocados, kiwis, plums, peaches, cherries, apricots, figs, papayas, tomatoes, potatoes and chestnuts. Latex-sensitive individuals should avoid the aforementioned fruits, vegetables and nuts because they may cause an allergic cross-reaction to occur. Genetically engineered fruits and vegetables contain the same DNA markers as latex and should be avoided as well.
  

• Steps to prevent spina bifida and at-risk patients from developing latex allergies:

• Avoid all items containing latex, especially in the operating room.

• Wear a Medic-Alert bracelet that identifies the NRL allergy.

• Carry a doctor-prescribed self-administering epinephrine device for emergency use.

• Inform healthcare providers, school, day care and camp staff of the latex allergy.

• Develop a therapeutic plan to treat related symptoms that develop.

 

• Precautions for healthcare workers who treat spina bifida patients: The following information includes guidelines from the U.S. Food and Drug Administration.

• When taking a spina bifida patient’s medical history, ask if they’ve experienced itching, rashes or wheezing after wearing gloves or inflating a balloon.

• Flag the chart of patients who exhibit NRL allergy symptoms.

• Recommend a test for patients predisposed to NRL allergies.

• Carry a self-administering epinephrine device and sterile non-latex gloves for use in case of an emergency.

• Keep a crash cart stocked with non-latex gloves, equipment and drugs to treat anaphylaxis nearby.

• See AANA’s "Latex Allergy Protocol" included in this press kit for information about latex avoidance precautions and patient care recommendations.

• Emergency response/management of latex-sensitive patients: The AANA’s "Latex Allergy Protocol" included in this press kit contains comprehensive information about the emergency response and management of latex-sensitive patients. It includes lists of secondary pharmacological treatments, non-pharmacological considerations, pre-medication agents, and common medical devices, products and equipment containing latex. The protocol also provides suggested reading materials and Web sites of manufacturers who offer latex-free healthcare products.
  

• Pediatric patients on home ventilation: A 2000 study published by American College of Chest Physicians reported "a significant incidence" of latex allergies among children who require home mechanical ventilation, including those with neuromuscular and chronic lung diseases. These children often become exposed to medical products containing latex during hospital stays, surgical procedures and multiple daily episodes of suctioning. The study advises clinicians to be on the lookout for latex allergies among children on home mechanical ventilation and speculates that screening these patients, particularly before elective surgery, would prevent reactions.
  

•  Latex screening methods: Skin prick, skin patch and radioallergosorbent (RAST) tests screen for latex allergies. Skin prick tests, which can induce anaphylactic shock, should be performed only under the supervision of an allergy specialist and with appropriate emergency back-up equipment available. The current unavailability of a standard by which to benchmark the skin prick, skin patch and RAST tests can produce inconclusive results, such as false positives and negatives, that require further testing or a diagnosis based on patient medical history.
  

•  Available treatments: Though no cure exists, non-allergic skin rashes can be treated with doctor-prescribed or over-the-counter ointments, creams or jellies. Those with type IV allergies can use the aforementioned treatments to relieve skin irritations and should avoid the latex source of the dermatitis. Sufferers with type I allergies must avoid exposure to NRL proteins altogether.

Latex Exposure Press Release

Talking Points About Latex Allergies

Fact Sheet

Creating a Latex-Safe School for Latex-Sensitive Children

Latex Allergy Protocol

This information is brought to you by the
American Association of Nurse Anesthetists
222 S. Prospect Avenue
Park Ridge, IL 60068-4001
847-692-7050
http://www.aana.com