Life-threatening Reactions Occurring Less Than 1 Hour after Exposure to Latex

Type IV Reactions Occurring More Than 1 Hour After Exposure to Latex Protein

Discomfort reaction to additives such as thiurams and carbamates; eczema; irritation; redness

Client Will (Specify Time Frame)

• Identify clients at risk: those persons who are most likely to exhibit a sensitivity to NRL that may result in varying degrees of reactivity. Consider the following client groups:

• Take a thorough history of the client at risk. EB: A clinical history is essential for diagnosing latex allergy (Pollart, Warniment, & Takahiro, 2009). EB: The vast majority of the clients diagnosed with latex allergy are informed of their diagnosis when seeking medical care during which they would be exposed (Garcia, 2007).

• Question the client about associated symptoms of itching, swelling, and redness after contact with rubber products such as rubber gloves, balloons, and barrier contraceptives, or swelling of the tongue and lips after dental examinations. EB: Latex allergy is an IgE-mediated hypersensitivity to NRL, presenting a wide range of clinical symptoms such as angioedema, swelling, cough, asthma, and anaphylactic reactions (Deval et al, 2008).

• Consider the use of a provocation test (cutaneous, sublingual, mucous, conjunctival) for latex allergy diagnosis confirmation. EB: Latex allergy diagnosis was confirmed by specific provocation tests (Nucera, Schiavino, & Pollastrini, 2006). EB: The nasal provocation test is a more sensitive testing method as compared to the glove use test (Unsel et al, 2009).

• Consider a blood test to measure serum IgE levels. EB: Because skin prick testing is not available in the United States, measurement of latex-specific serum IgE levels is the best option (Pollart, Warniment, & Takahiro, 2009). EB: In theory, allergy blood testing may be safer, because it does not expose the client to any allergens (Siles & Hsieh, 2011).

• All latex-sensitive clients are treated as if they have NRL allergy. EB: The primary treatment for suspected latex allergy is avoidance of exposure to the latex protein (Gawchik, 2011). EB: Recent studies have demonstrated that adopting latex-free strategies in health care facilities has reduced the prevalence of latex sensitization and allergy in children with spina bifida (26.7% to 4.5%), myelomeningocele (4% to 1.2%), and a history of multiple surgeries (42% to 7%) (Venkata & Lerman, 2011).

• Clients with spina bifida and others with a positive history of NRL sensitivity or NRL allergy should have all medical/surgical/dental procedures performed in a latex-controlled environment. EB: The management strategy recommended by the American Society of Anesthesiology consists of a complete medical history and questionnaire (from the parents), application for a medical alert bracelet, a latex-free cart, a list of latex-free devices and alternatives, signage on the client’s medical records that highlights his/her latex allergy, and “Latex Allergy” signs in the perioperative area (Venkata & Lerman, 2011). EB: A latex-controlled environment is defined as one in which no latex gloves are used in the room or surgical suite and no latex accessories (catheters, adhesives, tourniquets, and anesthesia equipment) come in contact with the client (Joint Task Force on Practice Parameters, 2010). EB: Clients who are latex allergic should have a surgical procedure performed as the first case in the morning, when the levels of latex aeroallergens in the environment are the lowest (Cleveland Clinic, 2011).

• In select high-risk atopic individuals, a specific immunotherapy regimen should be discussed with their health care provider. EB: Current subcutaneous and sublingual immunotherapy schedules have been tested for treatment of latex allergy with evidence of efficacy, but the risks of adverse events are high (Rolland & O’Hehir, 2008). EB: Sublingual immunotherapy represents an efficient therapeutic tool for the management of latex allergic clients (Nucera et al, 2008).

 The most effective approach to preventing NRL anaphylaxis is complete latex avoidance. EB: Symptoms of latex allergy resolve quickly with avoidance. However, elevated IgE levels can remain detectable more than 5 years after exposure, suggesting that long-term avoidance of latex should be recommended for clients with known latex allergy (Pollart, Warniment, & Takahiro, 2009). EB: The use of no-latex gloves is the best choice from the preventive point of view (Filon & Cerchi, 2008).

 Materials and items that contain NRL must be identified and latex-free alternatives must be found. EB: Effective in September 1998, all medical devices were required to be labeled regarding their latex content (Hubbard, 1997). EB: Latex-free synthetic rubber such as neoprene, nitrile, styrene butadiene rubber (SBR), butyl, and Viton are polymers that are available as alternatives to natural rubber (Deval et al, 2008).

 In health care settings, general use of latex gloves having negligible allergen content, powder-free latex gloves, and nonlatex gloves and medical articles should be considered in an effort to minimize exposure to latex allergen. EB: The use of low-protein, low-allergenic, powder-free gloves is associated with a significant decrease in the prevalence of type I allergic reactions to NRL among health care workers (Palosuo et al, 2011).

 If latex gloves are chosen for protection from blood or body fluids, a reduced-protein, powder-free glove should be selected. EB: Evidence within Europe demonstrates that the many benefits of NRL [gloves] can be retained by purchasing low-allergen, low-protein and powder-free gloves, thereby reducing the risk of type I and type IV sensitization as well as allergic reactions (Palosuo et al, 2011).

• See Box III-1 for examples of products that may contain NRL and safe alternatives that are available. EB: Clients who are known to be allergic should avoid any product that might contain latex until latex content is determined by contacting the manufacturer. Even products labeled “safe latex” (which indicates lower proportions of natural latex) cam cause latex allergy. There is no safe latex for latex allergy sufferers (Deval et al, 2008).