The following list of talking points answers many important questions about
the history, causes and symptoms of latex allergies and includes information
about ways to diagnose and prevent them. Latex allergies can adversely affect
healthcare workers and children with spina bifida. They also pose an
occupational health threat to individuals exposed to latex on a regular basis,
especially those who wear latex gloves.
What is
latex?
Discovered by the British in the mid-eighteenth century,
latex comes from the milky sap of the rubber tree, Hevea brasiliensis,
which grows in Africa, Asia and South America. A processed plant product,
latex should not be confused with synthetic rubber counterparts made of butyl
or petroleum.
What is a
latex allergy?
A latex allergy can be described as an antigenic
response to the complex compounds known as proteins found in natural rubber
latex (NRL). More than a dozen proteins identified in NRL can cause allergic
reactions, though which one(s) remains uncertain. Latex proteins react with
the body’s IgE antibodies, a group of structurally related human serum
proteins responsible for allergies, to produce a host of symptoms. These
include skin rashes, runny nose, sore throats, sneezing, wheezing, watery eyes
and anaphylaxis, a severe immune system reaction characterized by breathing
difficulties and low blood pressure that can cause shock or even death.
Are latex
allergies new?
The first reported case of a latex allergy in medical
literature occurred in 1979 to a British woman who developed a hypersensitive
reaction to her household rubber gloves. European medical journals recorded
about 50 cases of latex allergies between 1979 and 1988. In 1991, the U.S.
Food and Drug Administration (FDA) received over 1,000 reports of latex
allergies.
Why have
latex allergies increased so much in the past 20 years?
The introduction of universal precautions — especially
the use of latex gloves by healthcare workers to combat the spread of
bloodborne diseases, such as AIDS, HIV and hepatitis B — primarily caused
the rise in latex allergies observed after 1979. Increased awareness and
reporting of latex allergies also played a role.
Insufficient
washing during NRL glove manufacturing may have contributed to the rise in
latex allergies as well. In 1991, the FDA outlined to manufacturers a two-step
washing process, the first to occur during leaching and the second after
product completion, to better remove allergenic proteins from latex.
Are there
different types of latex allergies?
The three recognized 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. Symptoms
include dry, crusted patches in the glove area also caused by certain types of
cleaners, repeated hand washing and incomplete hand drying.
Type IV
cell-mediated allergies, the most common immune system reaction to latex,
affect 82 percent of individuals allergic to rubber products. A delayed
hypersensitivity to one or more of the 300-plus chemicals used to manufacture
latex, type IV allergies produce allergic contact dermatitis within 48 to 96
hours of exposure. Continued exposure puts individuals with a type IV allergy
at risk of developing the antibodies that trigger a type I latex allergy.
Type I
IgE-mediated allergies represent an immediate hypersensitivity to actual latex
proteins. Type I allergies include two subgroups. The first causes hives,
itchy and watery eyes, runny nose, sneezing, wheezing, asthma, abdominal pain,
nausea, diarrhea and skin rashes. The second, and more serious, causes
anaphylaxis.
What
causes latex allergies?
Contact with mucous membranes, regular glove wearing and
inhalation of aerosolized proteins represent the most common ways to contract
latex allergies. Ongoing exposure to products made from NRL or latex blends,
especially skin contact with gloves, cause most allergic reactions. Surgical
procedures cause some of the most severe reactions because latex comes into
direct contact with moist areas of the body and internal surfaces causing
faster, easier absorption of the allergen.
Airborne proteins,
which enter the eyes or mucous membranes, pose a serious health threat as
well. Latex proteins bind with the cornstarch powder lining some types of
gloves and become released into the air when wearers snap-off their gloves.
What
products contain latex?
Latex can be found in over 40,000 consumer products
ranging from household items to children’s toys. Examples include balls,
balloons, condoms, crepe-soled and athletic shoes, carpet backing, rubber
bands, erasers, elastic in clothing, exercise bands, feeding nipples, teething
rings and pacifiers. These products rarely cause reactions except among highly
sensitized individuals.
Latex abounds in
the healthcare setting, where it can be found in operating rooms and in
medical and dental offices. See "Latex Allergy
Protocol" published by the American Association of Nurse Anesthetists
(AANA) in 1998 for a complete list of medical devices, products and equipment
containing latex.
Who is at
risk of developing latex allergies?
The incidence of latex allergies among the general
public varies between 1 percent and 6 percent, but rises dramatically among
individuals who exhibit significant risk factors such as prolonged or repeated
exposure. Among healthcare workers exposed to latex products on a daily basis,
this figure rises to between 8 percent and 25 percent. Pediatric patients with
spina bifida, a congenital back deformity, run an 18 percent to 73 percent
chance of contracting latex allergies.
The following
lists some individuals and occupations predisposed to latex allergies.
-
Healthcare
workers, such as nurses, doctors, dentists, dental hygienists, paramedics
and technicians.
-
Pediatric
patients who undergo early or recurrent surgeries, such as children with
spina bifida or congenital urinary tract problems.
-
Adult patients
who undergo multiple invasive medical, dental or gynecological procedures.
-
Rubber and
tire industry workers.
-
Hairdressers.
-
Food service
workers.
-
Postal
workers.
-
Toll
collectors.
-
Individuals
with asthma, eczema or active skin conditions or with a family history of
allergies.
-
People with
food allergies.
Why do
certain foods cross-react with latex and cause allergic 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.
Can latex
allergies be prevented?
Individuals at risk for developing latex allergies can
minimize their exposure to products containing NRL. Food service employees can
practice good hygiene, such as hand washing, and avoid wearing latex gloves,
which contaminate food and spread NRL allergies to co-workers. Safety workers
and firefighters can select personal protective equipment such as respirators,
aprons, boots and gloves without NRL. Air filtration and ventilation systems,
which maintain a dust-free environment, help to prevent exposure to
aerosolized latex proteins.
How can
healthcare workers prevent latex allergies?
Considered at high-risk for developing latex allergies,
healthcare workers, especially nurses, can take the following steps to
minimize exposure to NRL proteins:
-
Wear
low-protein or powder-free gloves.
-
Reduce the
amount of time gloves are worn.
-
Wash hands
with a pH-balanced soap and dry thoroughly between glove use to remove
latex proteins and prevent skin irritations.
-
Avoid
oil-based hand creams and lotions, which deteriorate gloves and accelerate
the release of latex allergens.
-
Remove gloves
hourly to allow hands to air-dry.
-
Avoid
snapping-off gloves to prevent the release of airborne latex proteins.
-
Replace latex
gloves with appropriate substitutes such as vinyl gloves.
-
Note that
gloves labeled hypoallergenic are not latex-free.
-
See a doctor
who may prescribe topical treatments to relieve skin irritations caused by
latex gloves.
-
Wear glove
liners made of cotton or polymers, like hydrogel and silicone, under latex
gloves.
-
Double or
triple glove to reduce latex protein exposure to co-workers and patients.
To double glove, wear a non-latex glove over a latex glove. To triple
glove, wear a liner or vinyl glove under a latex glove and a vinyl glove
over the latex glove.
-
Remove
latex-containing dust from the workplace.
-
Enroll in
latex allergy training and education classes.
Can latex
allergies be treated?
Though no cure exists, non-allergic skin rashes can be
treated with doctor-prescribed or over-the-counter ointments, creams or
jellies. Patients should not use petroleum jelly and wear gloves at the same
time since petroleum products destroy the barrier of protection provided by
latex.
Patients with type
IV allergies can use the aforementioned treatments to relieve skin irritations
and should avoid the latex gloves or rubber products suspected of causing the
dermatitis. Type I allergic reactions can only be treated by strictly avoiding
latex exposure. This requires healthcare workers to wear vinyl or non-latex
gloves and work in areas that prohibit powdered gloves.
If latex
gloves cause allergic reactions, why do hospitals and healthcare workers
continue to use them?
Healthcare workers consider latex gloves the
"barrier of choice" against bloodborne pathogens like AIDS, HIV and
hepatitis B. Able to conform to the shape of the wearer’s hand, latex gloves
stretch to five times their original size without tearing. Latex gloves
don’t interfere with the sensitivity or fine manual dexterity required in
medical procedures and prove a better fit and more durable than their vinyl
counterparts which lose their barrier of effectiveness during the first 15
minutes of use.
In addition, many
in the healthcare industry believe that replacing latex gloves with non-latex
substitutes would be cost-prohibitive given the high price of synthetic rubber
gloves and the minority of healthcare workers and patients who develop latex
allergies. Research from the FDA indicates that synthetic rubber gloves exceed
by more than 105 percent the price of their latex counterparts. However, many
institutions, such as the Mayo Clinic in Rochester, Minn., and the Oakdale
Dental Clinic in Iowa City, Iowa, actually saved money and lowered worker
compensation claims by creating a latex-free environment.
What
should individuals do if they develop a work-related latex allergy?
Workers who exhibit symptoms related to latex allergies
should seek treatment immediately. The following outlines appropriate steps to
be taken:
-
Inform their
employer of NRL exposure.
-
Contact the
company occupational health and safety department or company nurse who may
prescribe a self-administering epinephrine device and antihistamine for
use in case of emergency.
-
Eliminate
products that contain NRL or find acceptable substitutes for them.
-
Check state
worker’s compensation laws to determine eligibility to receive medical
benefits.
-
Wear a
Medic-Alert bracelet that identifies the NRL allergy.
-
Avoid
beta-blockers that can trigger allergic reactions.
-
Arrange for
latex-safe medical and dental care.
-
Avoid foods
that cross-react with NRL.
-
Develop a
therapeutic plan to treat itching, swelling and respiratory symptoms.
Must
employers provide alternatives to latex gloves?
Yes. According to the 1991 bloodborne pathogens standard
issued by the U.S. Occupational Safety and Health Administration, "Glove
liners, powderless gloves, or other alternatives must be readily accessible to
employees who are allergic to the gloves normally provided."
How
should healthcare workers care for latex sensitive patients?
Healthcare workers need advance notice of a patient’s
latex sensitivity. Patients should wear a Medic-Alert bracelet and charts
should be clearly flagged. A crash cart stocked with latex-free gloves and
equipment, and drugs for treating anaphylaxis, should be on hand.
If a patient
experiences a severe latex reaction, healthcare workers should notify
supervisors and physicians, complete an incident report and document nursing
interventions taken. Healthcare workers should retain the product suspected of
causing the reaction and follow hospital procedures to comply with the Safe
Medical Devices Act.
See the AANA’s
"Latex
Allergy Protocol" included in this press kit for latex avoidance
precautions, patient care recommendations and emergency response and
management information. The protocol lists secondary pharmacological
treatments, non-pharmacological considerations, pre-medication agents, and
common medical devices, products and anesthesia equipment containing latex. It
also provides suggested reading materials and the Web sites of manufacturers
who offer latex-free healthcare products.
How can
latex allergies be detected?
Skin prick, skin patch and radioallergosorbent (RAST)
tests screen for latex allergies.
A small, diluted
amount of one or more of the latex proteins in question is injected under the
skin, to a scratch or a puncture on the patient’s arm or back during the
skin prick test. The proteins produce a small, raised area surrounded by
redness within 15 minutes in allergic patients. 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.
Skin patch tests
use the patient’s glove or latex product to screen for an immediate or
delayed hypersensitivity and to evaluate the cause of the skin irritation. Use
of the latex product in question helps to ensure an accurate diagnosis since
no standardized patch test exists.
The RAST test
identifies specific IgE antibodies to latex in the blood and confirms a NRL
allergy diagnosis. The diagnostic success of this test approaches 100 percent.
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. These inconsistencies may require further testing or a diagnosis
based on patient medical history. The FDA is expected to approve a serum for
standardized skin prick testing soon.
Latex Exposure Press Release
Talking Points
About Latex Allergies
Fact Sheet
Creating a
Latex-Safe School for Latex-Sensitive Children
Latex Allergy
Protocol
