Chapter 15. Latex Allergy

8/11/2019 Chapter 15. Latex Allergy

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Chapter 15

Latex AllergyConcern about latex allergy in the medical community has increased as health carepersonnel have seen an increase in reactions among both patients and themselves.

Latex is the second most common cause of i ntraoperative anaphylaxis, preceded

only by muscle relaxants (1).

Origin of Sensitivity

Natural latex is obtained from the sap of a rubber tree. During the manufacturing

process, many chemicals are added to the latex, depending on the design and

technical requirements of the f inished product. These substances may also be

allergenic. There may be as many as 240 potential ly allergenic substances in

processed latex products (2).

The increased incidence of latex allergy is b elieved to be due both to c hanges in

the manufacturing processes and increased use of latex-containing products.

Adoption of uni versal and stan da rd prec auti ons (Chapter 34) has greatly increased

latex exposure.

Latex sensit izat ion can occur as a result of contact via the skin or mucous

membranes, inhalation, ingestion, parenteral injection, or wound inoculation.

Latex-containing Products

Latex is ubiquitous in the home, workplace, and health care sett ing but is not

always obvious. In the operating room suite, i t is found in gloves; tracheal tubes;

Combitubes; face masks; mask straps; airways; wrappers on trays; laryngoscope

bulb gaskets; skin temperature monitors; rubber suction catheters; arm boards; bite

blocks; teeth protectors; breathing tubes; oxygen tubing; reservoir bags; v enti lator

hoses and bellows; resuscitat ion bags (black or blue, reusable); blood pressure

cuffs and tubing; stethoscope tubing; intravenous tubing injection ports;

tourniquets; s yringe plungers; rubber-shod c lamps; intravenous bag and tubing

ports; medication vial needle ports; tape and other adhesives (e.g., Esmarch

bandages, adhesive bandages); dental dams; elastic bandages (Ace wraps);

dressings (e.g., Coban, Moleskin, Micropore); rubber pads; protective sheets;

drains; electrode pads; rubber aprons; circulat ing f luid warming blankets; s ome cast

material; goggles; pulmonary artery catheter balloons; epidural catheter adapters;

intravenous (IV) medication pump cassettes; electrocardiogram (ECG) electrodes

and pads; f inger cots; ostomy bags; intest inal and stomach tubes; rubber bands;


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automobile tires; raincoats; computer mouse pads; earphones; household rubber

gloves; and carpet padding to name but a few (8,13).

Clinical Signs and SymptomsReactions to latex include a spectrum of non-immune and immune-mediated

responses. Signs and symptoms may be local or s ystemic and vary widely in

severity and the time of occurrence. Most adverse reactions to latex occur 30 to 60

minutes after induction (14 ,15 ). Symptoms can progress quickly from mild to

severe. In some cases, l i fe-threatening reactions a re the f irst to appear.

There are three types of reactions to latex: irr i tant contact dermatit is, Type IV

delayed hypersensit ivity, and Type 1 immediate hypersensit ivity (2,8,16 ).

I r r i t a n t Con t a c t De rma t i t i s

This is the most common type of glove-related reaction. I t results from the direct

act ion of latex and other irr i tant chemicals and consists of i tching, redness, scaling,

drying, and skin c racking. The rash is usually l imited to the exposed skin area.

Soaps, mechanical irr i tat ion from sc rubbing, and excessive sweating often

exacerbate it . While this is not a true allergy, disruption in skin integrity may

enhance absorption of latex allergens and accelerate the onset of allergic

reactions.

Type I V De l ay ed Hy pe r s en s i t i v i t y

Hypersensit ivity is an immune response that leads to tissue damage. Once

sensit ized, an individual's exposure to an antigen can cause a reaction. I t may take

several years for latex sensit ivity to develop. When it does, most develop as a Type

IV (delayed) reaction.

A Type IV rea cti on (all erg ic con tac t de rmati t is , de laye d hyp ersens i ti v ity) is a T-

cellmediated response characterized by a skin rash that appears up to 72 hours

after init ial contact and may p rogress to oozing skin b listers. Unlike irr i tant contact

dermatit is, al lergic contact dermatit is often spreads beyond the area of contact with

the allergen. Flushing, itching, rhinit is, di zziness, sinus s ymptoms, conjunctivit is,

and eyelid edema may also be present.

Not all individuals who develop Type IV hypersensit ivity progress to Type I, but

most individuals with Type I s ensit ivity have previously had Type IV symptoms

(2,16,17).

Type I Im m ed i a t e Hyp e r s en s i t i v i t y


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This is the most severe reaction and may lead to signif icant morbidity and mortality

(18). Symptoms usually appear short ly after exposure but can occur hours later.

They run the entire spectrum from mild (skin redness, hives, itching, rhinit is,

scratchy throat, i tchy or swollen eyes) to more severe (facial edema, faintness,

nausea, abdominal c ramps, diarrhea, cough, hoarse v oice, chest t ightness) to l i fe

threatening (laryngeal edema, bronchospasm, anaphylaxis). A survey of

anaphylaxis during anesthesia showed that cardiovascular symptoms, cutaneous

symptoms, and bronchospasm were the most common clinical features (19).

Anaphylax is is an imm ed ia te , severe , li fe -t hr eate ni ng al le rgic re spon se. Th ere are a

number of reports in the literature of anaphylactic reactions to latex

(1,2 ,4,7,20,21 ,22 ,23,24 ,25 ,26,27 ,28,29,30,31,32 ,33 ,34).

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Latex allergy should be high on the l ist of possibil i t ies when anaphylaxis occurs

during anesthesia and surgery. I t may not be apparent that latex is the causative

factor. I f medications have been injected in close proximity to the anaphylact ic

reaction, the anesthesia provider may suspect that medication caused the reaction

(32). Failure to recognize latex allergy can delay removal of latex-containing

products and delay effect ive treatment.

Individuals at Risk

Identifying patients at high risk for h aving an allergic latex reaction allows

preventive measures to be targeted (17 ). High-risk groups can be identif ied by

knowing the risk factors and appropriate questioning. Latex anaphylaxis may be

decreased by identifying at-r isk patients (19).

The reported prevalence of latex allergy varies greatly depending on the populat ion

studied and the methods used to detect sensit izat ion. Anyone with frequent

exposure to latex-containing materials is at increased risk of developing latex

allergy. The greater the exposure to latex in a populat ion, the greater the number of

sensit ized individuals. Extended or massive exposure in and of itself is neither

necessary nor suff icient to cause sensit izat ion if the person is not genetically

predisposed (35).

Children and younger adults are more l ikely to become latex s ensit ive than the

general population. Some but not all studies have found that women and members

of non-Caucasian races are more l ikely to have latex alle rgies (17,35 ,36 ,37,38 ).


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The majority of latex-sensit ive individuals have a history of atopy (predisposit ion to

mult iple allergic condit ions) or posit ive tests in atopy sc reening

(2,17,25,27,35,39 ,40 ,41,42 ,43 ). Many have a history of an anaphylactic reaction in

the past (8,36 ,43). Some studies have found a connection between an al lergy to an

anesthesia-related agent and latex (43 ,44).

Many patients with Type I latex allergy have a history of allergy to certain foods,

including bananas, mangoes, watermelons, avocados, peaches, figs, apples,

chestnuts, pineapples, kiwi, passion f ruit , apricots, nectarines, papaya, celery,

peanuts, cherries, strawberries, plums, potatoes, and tomatoes

(2,5 ,25 ,35,37,45,46). There may be cross sensit ivity between latex and f icus,

grasses, and ragweed (47). Patients with milk protein allergies may exhibit al lergic

reactions to latex products containing casein (48).

Individuals with hand dermatit is who wear latex gloves are at inc reased risk (35 ). A

history of glove-related symptoms does not reliably indicate latex allergy;

conversely, absence of symptoms does not rule out sensit izat ion (42 ).

Many latex-sensit ive individuals report swell ing or itching on the hands or other

areas after contact with rubber gloves, condoms, diaphragms, toys, or other rubber

products. Other symptoms include swell ing or i tching at the l ips or mouth from

blowing up balloons or after dental examinations (2).

Latex allergy incidence is highest for patients requiring mult iple operations along

with repetit ive urinary catheterizat ion. This includes patients with myelodysplasia,

congenital orthopedic defects, and congenital genitourinary tract abnormalit ies

(49). Spina bifida patients have a particularly high incidence. However, adults with

spinal cord injuries have a low risk of l atex sensit izat ion (50). Other high risk

groups include patients who undergo repeated esophageal d ilat ions, patients who

have frequent vaginal exams (part icularly those going through an in v itro

fert i l izat ion program) and are examined with a latex-covered ultrasound probe (51),

and patients undergoing barium enema procedures with a latex balloon t ip (17).

Other at-r isk patients for latex allergy include those who use gloves in their daily

act ivit ies: farmers, food-service workers, gardeners, painters, mortuary workers,

auto technicians, law enforcement personnel, waste removal workers, hairdressers,

individuals involved in the manufacture of latex products, and those with prior

reactions to l atex-containing devices.

Approx im ate ly 70 pe rc en t of ad verse ev ents to latex report ed to the Food and Drug

Admi ni stra t ion (FDA) in vol ve hea lth care wo rk ers . Withi n the medic al prof es sion ,

individuals who frequently use disposable gloves, including surgeons; anesthesia


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providers; operat ing room, postanesthesia care unit (PACU), and emergency room

personnel; dentists and dental assistants; and laboratory technicians are more

likely to become latex sensit ive t han other health care workers. Adult

anesthesiologists change gloves more often than pediatric anesthesiologists and

have an increased prevalence of latex sensit izat ion (52).

Diagnosing Latex Allergy

Latex allergy is diagnosed by his tory and confirmatory tests (53).

H i s t o r y

Standard questions to sc reen for latex allergy should be developed. There are

examples of screening tools for patients in the l i terature that can b e of assistance

in developing a questionnaire (46 ,54). The history should include the risk factors

and occupations where latex exposure is common, as discussed previously i n this

chapter.

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Con f i rma t o r y T e s t s

A patie nt wi th a hi story suspiciou s for latex al le rg y ma y be a cand ida te fo r

confirmatory test ing.

Immunologic test ing is not foolproof, part icularly in the case of latex, because of

the numerous dif ferent latex proteins. Testing requires a variety of latex antigens,

and there can be no c ertainty that a part icular antigen wil l be included in the test

solut ion (17). Because false negatives can occur, patients with a strong s uspicion

of latex allergy s hould be managed in a latex-safe environment even if immunologic

test ing indicates a negative reaction (17 ).

Skin-prick Test

The skin-prick test (SPT) is used to detect Type I latex allergy (38 ). A dilute

solut ion of latex allergen is placed on the skin, and the skin is pricked or scratched.

A wheal -an d-f lare react io n is considere d positiv e for latex sen si ti v i ty . Th is te st is

inexpensive and easy to administer and interpret. It offers reasonably good

sensit ivity and specif icity. Retrospective studies show that p atients with

intraoperative latex anaphylaxis are almost invariably latex-SPT posit ive (42).


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Drawbacks to the SPT include absence of an accepted test solut ion (2,5,9,17 ,55).

The risk of a s ystemic anaphylact ic reaction exists, but it is less than with

intradermal test ing.

Intradermal Test

With intradermal test ing, a small amount of a suspension or allergen is injected into

the skin. This method is more sensit ive than skin pricking, but the chance of

anaphylaxis is greater (17,56).

Patch Test

The patch test is available for diagnosis of Type IV delayed hypersensit ivity (8,38).

A sta ndard ize d patc h or a f ra gme nt of the la tex produc t is app lied to the sk in an d

checked over several days. A posit ive reaction includes i tching, redness, swell ing,

or blistering where the patch covers the sk in.

In Vitro Measurement of Antibodies

In vitro tests are used to measure specif ic antibodies against latex allergens in

blood samples (57). These tests are expensive, and the clinical signif icance of a

posit ive serologic test is unclear. Subjects with anti latex antibodies are termed

latex sensit ive , although many are n ot symptomatic and may never become so.

Challenge Tests

Challenge (provocation, use, wear) tests may be used if the results of other tests

are equivocal or if the person has a clinical history highly consistent with latex

allergy but results of other tests are negative (5,35 ,58). The potential ly allergic

person handles, wears, or inhales latex proteins and is observed for reactions.

However, there may be discrepancies in challenge test results, and no challenge

method has become broadly accepted by clinicians.

Preventing Reactions

Successful prevention of latex reactions requires a f acil i ty-wide s trategy. Healthcare facil i t ies should appoint a mult idisciplinary task force that includes

representatives from every professional component of the inst itut ion. I t should

include an allergist or i mmunologist as consultant. I t may be a good idea to have a

latex-sensit ive employee on the team (9). Among the duties of this task force

should be glove select ion, a mechanism for report ing latex reactions, formulat ing

policies and protocols for management of the latex-sensit ive patient, and health

care worker and educational programs (2 ,59 ,60).


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Medical products that contain latex wil l need to be identif ied and alternatives

established before an emergency arises. Manufacturers have made great str ides in

decreasing latex in a variety of products (57 ). I f i t is not possible to remove a latex

product, barriers should be placed between the l atex item and the patient.

Successful prevention of a llergic reactions wil l occur only when inst itut ions adopt

str ict policies to protect at-r isk patients from unnecessary latex exposure. At-r isk

children in a latex-containing environment are more l ikely to have an allergic

reaction than those in an environment where latex-containing articles have been

removed (3,61 ).

I t is impossible to totally eliminate latex exposure. The goal is to create a latex-

safe environment, that is, one in which the presence of latex antigens is minimized.

The need for education cannot be overemphasized. The majority of latex reactions

in a c enter with an established protocol were attr ibuted to human error (61).

Using powderless gloves should be a high priority (5 ,62 ,63 ). I t helps to minimize

reactions to latex at l i t t le added expense and decreases the amount of

aeroallergens i n the working environment. Oil-based hand creams or lot ions should

be avoided. They can break down latex and make the protein more l ikely to st ick to

the hands. When gloves are powdered, pull ing them on and off gently wil l minimize

aerosolizing the latex proteins.

Patients with known or suspected latex allergy should have their records f lagged

and wear l atex-allergy wristbands. Drug prophylaxis is sometimes undertaken (56 ).

Allerg ic re ac tio ns , inc lu ding anaphylax is, ma y occur even when prophylac tic agents

are used (3,64 ). While having these drugs already on board may lessen the

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severity of a reaction, they may mask the early signs of anaphylaxis, delaying

recognition and implementation of more aggressive treatment (17 ). Using H2

blockers may increase the risk of heart block for patients who develop anaphylaxis

(65).

I f pat ients requiring surgery have confirmed latex s ensit ivity or convincing histories

of latex reactions, avoiding latex-containing products is the only effect ive therapy.

This is not always easy, as latex allergens permeate the hospital. Even in the

absence of known latex allergy, some procedures involving patients with syndromes

such as spina bif ida should be performed in a latex-safe area (66 ). For high-risk

patient groups, avoiding latex products should begin at birth (67 ).


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The FDA requires that all medical products that contain latex that may direct ly or

indirect ly come into contact with the body during use to bear labels stat ing that the

product contains latex and that latex may cause allergic reactions in some

individuals (68) (Fig. 15.1). Governmental agencies in many other countries have

similar requirements (68). I f a product does not have this warning, it is l ikely that

the product is latex-free unless it is a pharmaceutical or is not regulated by the

FDA. Drug manufacturers are exempt from the labeling requirement ( 69).

Manufacturers frequently label devices as latex-free (Fig. 15.2).

The term hypoallergenicis no longer used for devices that contain latex. At

present, there is no test that can adequately determine the level of latex proteins in

a product, and there is no manufacturing process that can reduce the level below

the minimum required to produce a reaction in some people. Also, the total protein

content is not analogous to allergic r isk.

The latex-sensit ive patient should be scheduled as the f irst case of the day with al l

latex-containing materials removed the preceding night to minimize exposure to

airborne latex-laden part icles (2). No one should enter that operating room with

latex gloves without scrubbing after taking off latex gloves or while wearing clothing

from previous latex exposure.

View Figure

Figure 15.1Thermodilution catheter clearly marked ascontaining latex.


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Signs saying Latex Allergy or Latex Alert (fo r patients with signif icant r isk

factors for latex allergy but no overt signs or sy mptoms) should be posted inside

and outside the operating room as well as in perioperat ive care areas (Fig. 15.3).

View Figure

Figure 15.2Device labeled latex-free.

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View Figure

Figure 15.3A sign indicating possible latex allergy shouldbe placed outside the operating room door.


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Latex products should be l imited to situat ions where it is thought that they are

superior to nonlatex-containing products. Latex-free gloves with improved f it and

feel are available (70).

A ki t/ cart conta ini ng late x-free produc ts shou ld ac comp an y the pa tien t throughou t

his or her stay. Latex precaution st ickers should be placed on doctors' order sheets

and the l ike. Signs stat ing Latex Precautions or Latex Allergy should be placed

on the walls and doors of the patient's room. Any department that is to receive a

patient with latex allergy or sensit ivity should be notif ied prior to transfer to that

department.

Perioperat ive care areas where mult iple patients are managed in proximity (e.g.,

preoperative holding areas and PACUs) should be re-evaluated. If powdered gloves

are used in these areas, patients may be admitted directly to the operating room

and remain there during their recovery from anesthesia. If PACUs have isolation

rooms, they may be converted to latex-safe environments f or patients recovering

from surgery (71).

Some health care facil i t ies have established a specif ic operat ing room where all

latex-containing materials are banned. Signs should be posted on all entrances to

that operat ing room, reminding medical personnel of the s ituat ion (72 ). Traff ic in

the room should be kept to a minimum (2).

No latex-containing items (i.e., gowns, hats, boots, and compression stockings)

should be placed on the patient. Cords and tubes for al l monitoring devices should

be placed in stockinettes and secured with non-latex tape (73).

Latex-free intravenous s tart kits containing tourniquet, bandages, dressings, tapes,

and gloves are available. Intravenous tubing without latex inject ion ports should be

used or all latex inject ion ports should be taped to p revent inadvertent puncture.

Stopcocks or one-way valves should be used for push and piggyback medications.

Intravenous f luid or commercially prepared medication bags should be pierced

through the intravenous tubing port, not the latex injection port.

Al though reac tions to rub ber syri ng e pl un gers hav e bee n repo rt ed, no pro ble ms

have so far been described in medications freshly drawn and immediately

administered (74 ). I f latex-containing syringes are used, drugs should be freshly

prepared in the syringe immediately before use. Glass syringes offer an attract ive

alternative, and totally plast ic syringes and special needles are available

(75,76,77). I t is best to use medication from glass ampules, if available. Although it

has been advocated that the contents o f a vial should be drawn up after the rubber

stopper has been removed (17,47 ,78 ), this may not be beneficial and may result in


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increased microbial contamination and waste (79). Lyophil ized drugs in containers

with latex should be reconstituted by using a s yringe, not shaken in a mult idose vial

and withdrawn by using a f i l ter. Vials should be kept upright and not shaken (4).

A f i l te r shou ld be us ed at the bre ath in g sys te m pa t ie nt port to pro tec t agains t

airborne latex allergens (80,81).

I t may not be possible to entirely avoid some rubber-containing anesthetic

equipment-rubber bellows, diaphragms, valves, and tubings (82 ). However, when

these parts of equipment do not come into contact with the patient and have been

previously washed, no complicat ions have resulted (83 ).

Latex-free equipment including face masks, airways, mask straps, tracheal tubes,

bag-valve-mask units, reservoir bags, ECG electrodes and pads, s tethoscopes

(tubing or diaphragm), pulse oximetry sensors, esophageal stethoscopes,

nasogastric and suction tubes, tape, gas hoses, and breathing tubes should be

used. Unfortunately, some latex-free reservoir bags have such poor distensibil i ty

that their use may compromise patient safety (84).

I f an epidural catheter adaptor contains latex, it should be replaced with a blunt,

latex-free adaptor.

Latex-free reusable blood pressure instruments and accessories are available in a

variety of sizes and models. These include inf lat ing tubing, coiled tubing,

sphygmomanometers, and inflation bladders. Wrapping the area under the cuff with

soft cotton can prevent contact with any l atex in these devices.

In some cases, some improvising may be necessary, as with a pulmonary artery

catheter (85 ,86).

From the surgical point of v iew, using non-latex gloves, drains, and catheters is

mandatory. Special precautions should be undertaken to avoid latex-based

equipment such as i nstrument mats, rubber-shod clamps, vascular tags, bulb

syringes, rubber bands, and adhesive bandages. A non-latex glove can be used as

a

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Penrose drain, which can be a sou rce of latex hypersensit ivity (86A).

When latex-sensit ive patients or staff have been identif ied, it is i mportant to

provide latex-free items. These should be collected into a cart that can be called

into act ion as the need arises. The American Society of Anesthesiologists and

others have made recommendations for t he contents of a latex-safe cart (2,59,86).

Suggested items are listed in Table 15.1. Each item should give information on


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latex content and should be reviewed for this information prior to adding the item to

the latex-safe cart or before use.

TABLE 15.1 Suggested Contents of a Latex-safe Cart

Latex-free or glass syringesSyringe needlesIntravenous cathetersIntravenous tubing and extensions made from polyvinylchlorideStopcocks (in-line, three-way, and single)Latex-free heparin lock caps and T-pieces with side portAlcohol wipes in a new boxLatex-safe adhesive tape from a new box

Latex-free intravenous tourniquetsSterile gauze padsEsophageal thermometer

Disposable blood pressure cuffs of various sizesIsolation stethoscope

Sterile case paddingLatex-free disposable pulse oximetry finger sensors

Latex-free ECG electrodesLatex-free resuscitation bags sized for infants, children, and adults

Nasal oxygen cannulaOxygen extension tubing

Latex-free tracheal tubes, double-lumen tubes, and styletsLatex-free oral and nasal airways

Silicone supraglottic devicePlastic face masks and head straps (elastic strap may have latex)Medications for cardiac arrest and emergency situationsVinyl gloves for any size staffSterile nonlatex gloves, sizes 6 to 9Silicone urinary catheter in assorted sizesUrimeterEpidural and spinal traysPolyvinylchloride suction catheters, sizes 8 to 14 French

Anesthesia breathing circuits without latex componentsAnesthesia medications in vialsIn-line high efficiency particulate gas filterPolicy binder with all latex policies and protocolsReference guide for latex-containing materialsBrightly colored signs that warn of latex allergy

Treating Latex Reactions


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Heal t h Ca r e In s t i t u t i o n Respo ns i b i l i t i e s

Institutions should provide education programs and training materials about latex

allergy (71). This includes educating all staff members, not just p rofessional health

care providers. For example, environmental and nutrit ional service workers are

required to wear gloves; therefore, they should be knowledgeable about their glove

choices.

Staff should be encouraged to report al lergic symptoms and be periodically

screened for la tex-allergy symptoms. Detect ing symptoms early and protect ing

symptomatic workers from latex exposure are essential for preventing long-term

health effects. Prevention strategies should be re-evaluated whenever a worker is

diagnosed with latex allergy. Studies have s hown that economically feasible

interventions to reduce latex exposure can s uccessfully allow latex-allergic

individuals to continue working as well as decrease the number of new cases of

occupational latex allergy (5).

The use of powderless gloves (Fig. 15.4) should be encouraged. In a s tudy in which

health care workers used both powdered and powder-free gloves, the rate of

conversion to latex sensit ivity was the same i n each group, but the c onverters using

powdered gloves were s ymptomatic whereas the ones using powderless gloves

showed no symptoms (92 ).

Using non-latex gloves for act ivit ies that are not l ikely to involve contact with

infectious materials (food handling, housekeeping, transport) should be

encouraged. This can greatly reduce the levels of latex antigens in the

environment.

Wearing non-latex gloves or using some type of barrier between the latex gloves

and the skin should be encouraged. Non-latex gloves are usually more expensive

than gloves containing latex (97 ). I t is l ikely, however, that the price dif ferential can

be decreased if the facil i ty were to choose a single vendor of latex-free gloves. I f a

worker must move to another job to avoid latex-containing materials and the new

job pa ys les s, tha t wo rk er ma y be eligibl e fo r workers' compens ati on . It is also

possible that workers could become so sensit ized that employment is not possible.

Very low levels of permanent disabil i ty are needed to make the conversion to l atex-

free gloves cost effect ive (97).


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View Figure

Figure 15.4Gloves that are both powderless and latex-freewill help to prevent latex allergy.

Facilit ies should ensure that good housekeeping practices are performed to remove

latex-containing dust from the workplace. This can be accomplished by identifying

areas that a re contaminated with latex dust (carpets, upholstery, and venti lat ion

ducts) for frequent cleaning and changing venti lat ion f i l ters and vacuum bags

frequently.

Some health care institutions require that balloons that often accompany flower

arrangements be non-latex (98 ).

For sensit ized health care workers, the Americans with Disabil i t ies Act guarantees

workers reasonable modification of the workplace to accommodate the disability.

The Occupational Safety and Health Administrat ion (OSHA) rules state that in

addit ion to gloves that are normally provided, non-latex g loves, glove l iners,

powderless gloves, or other similar alternatives shall be readily accessible to those

employees who are allergic to l atex gloves (9).

Heal t h Ca r e Wo r ke r Respo ns i b i l i t i es

Workers in health care need to take advantage of latex allergy education and

training to become famil iar with ways to prevent l atex allergy and to learn to

recognize the s ymptoms.

Workers should protect themselves from latex exposure inside and outside the

workplace. Non-latex gloves should be used for act ivit ies that are not l ikely to

involve contact with infect ious materials. Intact skin is an effect ive barrier, and it is

important to maintain good hand care. Cuts and open sores should be covered with

a plast ic barrier dressing prior to wearing latex gloves (99). Oil-based hand creams


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or lot ions should be av oided, as they may enhance the release of latex proteins

from the gloves (54). After removing latex gloves, hands should be washed with a

mild soap and dried thoroughly. This wil l decrease the load of allergen.

Health care workers should avoid wearing work clothes (scrubs) home after working

in the operating room (99). Indirect exposures have caused latex allergy in children

and spouses.

If signs and s ymptoms of latex al lergy develop, the person should avoid contact

with latex-containing products unti l he or she can be seen by a physician who is

experienced in diagnosing and treating latex allergy. A diary of symptoms should be

kept. Delay and

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self-treatment can delay diagnosis, allowing the problem to become more serious.

The Hea l t h Ca r e Wo r ke r w i t h L a t e x Sens i t i v i t y

Depending on the severity of the reaction, latex sensit ivity in health care workers

can be an inconvenience or a l i fe-threatening hazard. I t can mean the end of a

career (100,101 ). Often, health care personnel are unaware of their sensit izat ion,

as the s ymptoms can be nonspecif ic (99 ). The only clue might be the temporal

relat ionship with working. Denial can be a problem.

Latex-allergic anesthesia providers should be counseled on the risks of continued

work in envi ronments with high latex use and on strategies to l imit exposure. They

should have proper allergy identif icat ion, including a medical alert device, and

should inform their health care providers ( including dentist and local hospital). They

may want to carry an allergy kit , including an epinephrine auto-injector device, non-

latex gloves to wear or give to others to wear if they must care for them, and a

complete l ist of medications taken. Friends and family should be given information

about latex allergy. The individual must be on the lookout for hidden latex.

Considerat ion should be giv en to avoiding foods that may contain proteins similar

to those in latex.

Once latex allergy is diagnosed, the only option is to av oid contact with latex and to

try to c ontrol the symptoms. Almost all the products that health care workers

encounter in their daily work can b e made latex-free. A latex-safe environment also

prevents exposure of other workers.

There are many non-latex gloves available, both steri le and nonsteri le. These

include vinyl, nitr i le, styrene butadiene, and neoprene (2,53 ,97 ,102). Unfortunately,


18/32

these may not match the physical characterist ics of la tex gloves such as high

elast icity, strength, f lexibil i ty, tear resistance, tact i le sensation, and barrier

integrity (5,53 ,10 3). Latex gloves are biodegradable and do not produce hazardous

and toxic emissions when incinerated, as do synthetic gloves. Non-latex glove

liners and latex gloves with integral non-latex layers are available (9). Co -workers

should wear powderless, low-latex allergen gloves. This reduces the exposure to

latex by those who are not yet sensit ized and may decrease symptoms in sensit ized

patients (2,10 ,12 ,16 ,96,10 4,105).

Health care workers with latex sensit ivity are not at increased risk when

incidentally exposed to dry, molded, or extruded rubber products in the health care

environment; however, i f direct contact with such objects is routine, exposure

should be minimized by covering the object or exposed body part (5).

Because of the many factors that disseminate latex allergens and because latex

allergens are so prevalent in some areas, it may not be possible to completely

isolate workers from these allergens. In this case, job reassignment may be

necessary. In the severely allergic worker, i t may not be possible to f ind an area in

the health care facil i ty that wil l be safe.

References

1. Hebl JR, Hall BA, Sprung J. Prolonged cardiovascular collapse due to

unrecognized latex anaphylaxis. Anesth Analg 2004;98:11241126.

[Fulltext Link]

[CrossRef]

[Medline Link]

2. Berry A. Natural rubber latex all ergy: considerat ions for anesthesiologists. Park

Ridge, IL: American Society of Anesthesio logists, 1999.

3. Holzman RS. Cl inical management of latex-allergic children. Anesth Analg

1997;85 :529533 .

[Fulltext Link]

[CrossRef]

[Medline Link]

4. Vassallo SA, Thurston TA, Kim SH, et al. Allergic reaction to latex from stopper

of a medicat ion via l . Anesth Analg 1995;80:10571058.

[Fulltext Link]

[CrossRef]

[Medline Link]


19/32

5. Ranta PM, Ownby DR. A review of natural-rubber latex allergy in health care

workers. Cl in Infect Dis 2004;38:252256.

[CrossRef]

[Medline Link]

6. Zehr BD, Gromelski S, Beezhold D. Reduction of antigenic protein levels in latex

gloves af ter gamma irradiat ion. Biomed Inst Tech 1994;8:481483.

7. Moneret-Vautrin DA, Laxenaire MC, Bavoux F. Allergic shock to latex and

ethylene oxide dur ing surgery for spine bi f ida. Anesthesiology 1990;73:556558.

[Fulltext Link]

[CrossRef]

[Medline Link]

8. National Inst itute for Occupational Safety and Health. NIOSH alert preventing

allergic reactions to natural rubber latex in the workplace (NIOSH Publicat ion No.

97-135) . Washington, DC: Author.

9. Anonymous. Latex sensit ivity among healthcare workers. Technol Anesth

1 994 ;1 4(10 ):1 7.

10. Berry AJ. Latex allergy: a problem for patients and personnel. APSF Newslett

1 999 ;14 :3 3.

11. Swanson MC, Bubak ME, Hunt LW, et al. Quantif ication of occupational latex

aeroal lergens in a medical center. J Al lergy Cl in Immunol 1994;94:445451.

[CrossRef]

[Medline Link]

12. Heilman DK, Jones RT, Swanson MC, et al. A prospective, controlled study

showing that rubber gloves are the major contributors to latex aeroallergen levels in

the operat ing room. J Al lergy Cl in Immunol 1996;98:325330.

[CrossRef]

[Medline Link]

13. Bernstein M. An overview of latex a llergy and its implicat ions for emergency

nurses. J Emerg Nurs 1996;22:2936.

[Fulltext Link]

[CrossRef]

[Medline Link]

14. Brock-Utne JG. Clinical manifestat ions of latex anaphylaxis during anesthesia

dif ferent from those not anesthesia/surgery-related. Anesth Analg 2003;97:1204.

[Fulltext Link]

[CrossRef]


20/32

[Medline Link]

15. Harper DL, Castells MC. Clinical manifestat ions of latex anaphylaxis during

anesthesia dif fer from those not anesthesia/surgery-related. Anesth Analg

2003;97 :12041205 .

[Fulltext Link]

[CrossRef]

[Medline Link]

16. Thomas LC, Skerman JH. L atex allergy: another complicat ion for

anesthesio logy. Part 1. ASA Newslett 1999;63:1517.

17. Dakin M, Yentis S. Latex allergy: a s trategy for management. Anaesthesia

1998;53 :774781 .

[Fulltext Link]

[CrossRef]

[Medline Link]

18. Hepner DL, Castells MC. Anaphylaxis during the perioperative period. Anesth

Analg 20 03 ;9 7:13 81 1 39 5.

[Fulltext Link]

[CrossRef]

[Medline Link]

19. Laxenaire MC, Mertes PM, Benabes B, et al. Anaphylaxis during anaesthesia:

results of a two-year survey in France. Br J Anaesth 2001;87:549558.

[Fulltext Link]

[CrossRef]

[Medline Link]

20. Fisher M. Latex allergy during anaesthesia: cautionary tales. Anaesth Intens

Care 1997;25 :302303 .

[Medline Link]

21. Gerber AC, Jorg W, Zbinden S, et al. Severe intraoperative anaphylaxis to

surgical gloves: latex allergy, an unfamiliar condit ion. Anesthesiology 1989;71:800

802.

[Fulltext Link]

[CrossRef]

[Medline Link]

22. Harding L, White JB. Another latex a l lergy. Anaesthesia 1994;49:926.

[CrossRef]

[Medline Link]


21/32

23. Hodgson CA, Andersen BD. Latex allergy: a n unfamiliar cause of intra-operative

cardiovascular col lapse. Anaesthesia 1994;49:507508.

[CrossRef]

[Medline Link]

24. Hepner DL. Sudden bronchospasm on intubation: latex anaphylaxis? J Clin

Anesth 2000;12 :1 62 1 66 .

25. Leynadier F, Pecquet C, Dry J. Anaphylaxis to latex during surgery.

Anaesth es ia 1989;44 :547 550.

[CrossRef]

[Medline Link]

26. McKinstry LJ, Fenton WJ, Barrett P. Anaesthesia and the patient with latex

al lergy. Can J Anaesth 1992;39:587589.

[Medline Link]

27. Nguyen DH, Burns MW, Shapiro GG, et al. Intraoperative cardiovascular

col lapse secondary to latex a l lergy. J Urol 1991;146:571574.

[Medline Link]

28. Pollard RJ, Layon AJ. Latex allergy in the operating room: case report and brief

review of the li terature. J Cl in Anesth 1996;8:161167.

[CrossRef]

[Medline Link]

29. Eckhout GVJ, Ayad S. Anaphylaxis due to airborne exposure to latex in a

pr imigravida. Anesthesio logy 2001;95:10341035.

[Fulltext Link]

[CrossRef]

[Medline Link]

30. Eckinger P, Ratner E, Brock-Utne J. Latex allergy: oh, what a surprise! Another

reason why all anesthesia equipment should be latex-free. Anesth Analg

2 004 ;99 :6 29 .

[Fulltext Link]

[CrossRef]

[Medline Link]

31. Phil ip JH. Low fresh gas f low and high desflurane vaporizer sett ing control vital

s ign changes dur ing induction. Anesthesio logy 1999;91:A1198.

32. Zucker-Pinchoff B, Chandler MJ. Latex a naphylaxis masquerading as fentanyl

anaphylaxis: retract ion of a case report. Anesthesiology 1993;79:11521153.

[CrossRef]


22/32

[Medline Link]

33. Zestos MM, Creighton R. Latex anaphylaxis during tissue expander insertion in

a healthy chi ld. Can J Anaesth 1997;44:12751277.

[Medline Link]

34. Spears FD, Lit t lewood KE, Liu WH. Anaesthesia for the patient with allergy to

latex. Anaesth Intens Care 1995;23:623625.

[Medline Link]

35. Brown RH, Schauble JF, Hamilton RG. Prevalence of latex allergy among

anesthesio logists. Anesthesio logy 1998;89:292299.

[Fulltext Link]

[CrossRef]

[Medline Link]

36. Akl M. Latex a l lergy. Resid Staf f Physician 1996;42:2126.

37. Lebenbom-Mansour M, Oesterle J, Ownby D, et al. The incidence of latex

sensit ivity in ambulatory surgical patients: a correlat ion of historical factors with

posit ive serum immunoglobin E levels. Anesth Analg 1997;85:4449.

[Fulltext Link]

[CrossRef]

[Medline Link]

38. Anonymous. Nebul izers. Technol Anesth 2002;22:10.

P.440

39. Bubak ME, Reed CE, Fransway AF, et al. Subspecialty cl inics: allergic

diseases. Mayo Cl in Proc 1992;67:10751079.

[Medline Link]

40. Konrad C, Fieber T, Gerber H, et al. The prevalence of latex sensit ivity among

anesthesio logy staf f . Anesth Analg 1997;84:629633.

[Fulltext Link]

[CrossRef]

[Medline Link]

41. Liss GM, Sussman GL, Deal K, et al. Latex allergy: epidemiological study of

1351 hospital workers. Occup Environ Med 1997;54:335342.

[Fulltext Link]

[Medline Link]


23/32

42. Arellano R, Bradley J , Sussman G. Prevalence of latex sensit izat ion among

hospital physicians occupationally exposed to latex gloves. Anesthesiology

1992;77 :905908 .

[Fulltext Link]

[CrossRef]

[Medline Link]

43. Tan BB, Lear JT , Watts J, et al. Perioperat ive collapse: prevalence of latex

allergy in patients sensit ive to anaesthetic agents. Contact Dermatit is 1997;36:47

50.

[CrossRef]

[Medline Link]

44. Watts J. Latex a l lergy. Anaesthesia 1997;52:1019.

[Fulltext Link]

[Medline Link]

45. Hamid RKA. Latex allergy. Diagnosis, management and safe equipment(ASA

Refresher Courses). At lanta: ASA, 1995.

46. Haeberle HA, Lupic D, Midoro-Horiut i T, et al. Role of cross-allergies to latex in

cl in ical rout ine of anesthesia. J Cl in Anaesth 2003;15:495504.

47. Kam PCA, Lee MSM, Thompson JF. Latex allergy: an emerging clinical and

occupat ional health problem. Anaesthesia 1997;52:570575.

[Fulltext Link]

[CrossRef]

[Medline Link]

48. Paskawicz J, Chatwani A. Latex allergy: a c oncern for anesthesia personnel.

Am J Anaes thesiol 20 01 ;28:43544 1.

49. Porri F, Pradal M, Lemiere C, et al. Associat ion between latex sensit izat ion and

repeated latex exposure in chi ldren. Anesthesio logy 1997;86:599602.

[Fulltext Link]

[CrossRef]

[Medline Link]

50. Merttes PM, Mouton C, Fremont S, et al. La tex hypersensit ivity in spinal cord

in jured adult pat ients. Anaesth Intens Care 2001;29:393399.

[Medline Link]

51. Ballantyne JC, Brown E. Latex anaphylaxis: another case, another cause.

Anesth Anal g 1995 ;81:13 031304 .

[Fulltext Link]


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[CrossRef]

[Medline Link]

52. Greenberg RS, Hamilton RG, Brown RH. Differential latex allergy prevalence in

anesthesio logy subspecia l ties. Anesthesiology 1999;90:1238.

[Fulltext Link]

[CrossRef]

[Medline Link]

53. Rinaldi PA. Perioperat ive management of the patient with la tex allergy (ASA

Refresher Course #532). Orlando: ASA, 1998.

54. Brown M-M, Hess R. Managing latex allergy in the cardiac surgical patient. Crit

Care Nurs Q 1998;21:815.

[Medline Link]

55. Beezhold DH, Sussman GL. Determining the allergenic potential of latex gloves.

Surg ica l Serv ices Mgt 1997;3 :3541.

56. Thomas LC, Skerman JH. L atex allergy: another complicat ion for

anesthesio logy. Part 2. ASA Newslett 1999;63:1720.

57. Hepner DL, Castells MC. Latex allergy: an update. Anesth Analg 2003;96:1219

1229.

[Fulltext Link]

[CrossRef]

[Medline Link]

58. Palczynski C, Walusiak J, Ruta U, et al. Occupational allergy to latex. Life

threatening reactions in health care workers: report of three cases. Int J Occup Med

Envi ron Hea l th 1997;10:297301.

[Medline Link]

59. Bailey DA, Reil ly ME, Atkins PM, et al. Implementing a system for care of

patients with latex allergy. Infect ion Control and Steri l izat ion Tech 1998;4:2736.

60. Senst BL, Johnson RA. Latex allergy. Am J Health-Syst Pharm 1997;54:1071

1075.

[Fulltext Link]

[Medline Link]

61. Birmingham PK, Dsida RM, Grayhack JJ, et al. Do latex precautions in children

with myelodysplasia reduce intraoperative allergic reactions. J Ped Orthopaedics

1996;16 :799802 .

62. Moser D. How our hospital tackled latex sensit ivity. Outpatient Surgery

Magazine 2001;11:6272.


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63. Lee J . What's new i n latex-and powder-free gloves. Outpatient Surgery

Magazine 2003;4 :5660.

64. Setlock MA, Cotter TP, Rosner D. Latex allergy: fai lure of prophylaxis to

prevent severe react ion. Anesth Analg 1993;76:650652.

[Fulltext Link]

[CrossRef]

[Medline Link]

65. Patterson LJ, Milne B. Latex anaphylaxis causing heart block: role of ranit idine.

Can J Anaesth 1999;46:776778.

[Medline Link]

66. Landwehr LP, Boguniewicz M. Current perspectives on latex all ergy. J

Ped iat r ics 1996;128:305312.

[Fulltext Link]

[CrossRef]

[Medline Link]

67. Swartz J, Leonard M. Prevention of la tex a l lergy. Anesth Analg 1993;77:1080.

[Fulltext Link]

[CrossRef]

[Medline Link]

68. Anonymous. FDA follows other governments requiring latex product labeling.

Biomed Safe Stand 1997;18:150151.

69. Royer K. Choosing latex-free supplies. Outpatient Surgery Magazine 2004;

5 (10) (supp l ):2224.

70. Wasek S. What's new in surgical gloves. Outpatient Surgery Magazine

2 006 ;7 (2 ): 727 6.

71. Shoup AJ. Guidelines for the management of latex allergies and safe use of

latex in per ioperat ive pract ice set t ings. AORN J 1997;66:726730.

[CrossRef]

[Medline Link]

72. Anonymous. FDA proposes new la beling regulat ion for latex-containing

products. Technol Anesth 1996;17:13.

73. Redmond MC. Latex allergy: recognition and perioperative management. J Post

Anesth Nu rs 19 96;11 :612 .

[Medline Link]

74. Armstrong TSH, Barr JM. Latex allergystrategies for management.

Anaesth es ia 1998;53 :1236 .


26/32


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83. Holzman RS. Latex a llergy: an emerging OR problem. Anesth Analg

1993;76 :635641 .

[Fulltext Link]

[CrossRef]

[Medline Link]

84. Blanshard HJ, Milne MR. Latex-free reservoir bags: exchanging one potential

hazard for another. Anaesthesia 2004;59:177179.

[Fulltext Link]

[CrossRef]

[Medline Link]

85. Wakakuwa JS, Shulman MS. Latex alle rgy and cardiac surgery. Anesth Analg

2 003 ;9 7:1 545 .

[Fulltext Link]

[CrossRef]

[Medline Link]

86. Bernstein ML. Latex-safe emergency cart products l ist . J Emerg Nurs

1 998 ;2 4:5 86 1.

[Fulltext Link]

[CrossRef]

[Medline Link]

86A. Bailey PD, Bastien JL. Intraoperative latex hypersensit ivity: do not overlook

Penrose drains. J Cl in Anesth 2005;17:485487.

[CrossRef]

[Medline Link]

87. Opsomer O, Van Boven M, Pendeville P, et al. An unusual presentation of latex

a l lergy. Can J Anaesth 1993;40:1000.

[Medline Link]

88. Patriarca G, Nucera E, Buonomo A, et al. Latex allergy desensitization by

exposure protocol; f ive case reports. Anesth Analg 2002;94:754758.

[Fulltext Link]

[CrossRef]

[Medline Link]

89. Patriarca G, Nucera E, Pollastrini E, et al. Sublingual desensit izat ion: a new

approach to latex a l lergy problem. Anesth Analg 2002;95:956960.

[Fulltext Link]

[CrossRef]


28/32

[Medline Link]

90. Heese A, Hintzenstern JV, Peters K-P, et al. Allergic and irr itant reactions to

rubber g loves in medical health services. J Am Acad Dermatol 1991;25:831839.

[Medline Link]

91. Hunt LW, F ransway AF, Reed CE, e t al. An epidemic of occupational allergy to

latex involving health care workers. JOEM 1995;37:12041209.

92. Sussman GL, Liss GM, Deal K, et al. Incidence of latex sensit izat ion among

latex g love users. J Al lergy Cl in Immumol 1998;101:171178.

93. Zucker-Pinchoff B. Latex allergy: a personal perspective. ASA Newslett

1 999 ;6 3:1 21 3.

94. Hack M. The prevalence of latex allergy in operating theatre staff . Anaesth

In tens Care 2001;29:4347.

[Medline Link]

95. Kaczmarek RG, Silverman BG, Gross TP, et al. P revalence of latex-specif ic IgE

ant ibodies in hospita l personnel. A l lergy Asthma Immunol 1996;76:5156.

96. Vandenplas O, Delwiche J-P, Sibil le Y. Occupational asthma due to latex in a

hospita l administ rat ive employee. Thorax 1996;51:452453.

[Fulltext Link]

[Medline Link]

97. Phil l ips VL, Goodrich MA, Sull ivan TJ. Health care worker disabil i ty due to latex

al lergy and asthma: a cost analysis. Am J Publ ic Health 1999;89:10241027.

[Medline Link]

98. Anonymous. Latex allergies: what you should k now. Same Day Surg

1 999 ;2 3:7 37 6.

99. Randel GI. Latex allergy: who is next? ASA Newslett 1997;61(5):1417.

100. Baur X, Ammon J, Chen Z, et al. Health risk in hospitals through airborne

allergens for patients pre-sensit ized to latex. Lancet 1993;342:11481149.

[CrossRef]

[Medline Link]

101. Lee J. Seven ways to tell i f your staff is a r isk for latex allergy. Outpatient

Surgery Magazine 2003;4 :6672.

102. Zucker-Pinchoff B. Latex-allergy organization recommends many new nonlatex

gloves as safety tools. APSF Newslet t 1999;14:49.

103. Olsen RJ, Lynch P, Coyle MB, et al. Examination gloves as barriers to hand

contaminat ion in cl in ical practice. JAMA 1993;270:350353.

[CrossRef]


29/32

[Medline Link]

104. Levy DA, Allouache S, Chabane MH, et al. Powder-free protein-poor natural

rubber latex g loves and latex sensit izat ion. JAMA 1999;281:988.

[CrossRef]

[Medline Link]

105. Hunt LW, Boone-Orke JL, Fransway AF, et al. A medical-center-wide

multidisciplinary approach to the problem of natural rubber latex allergy. JOEM

1 996 ;3 8: 7 6 57 70 .

P.441

QuestionsFor the following questions, answer

i f A, B, and C are correct

i f A and C a re correct

i f B and D a re correct

is D is correct

i f A, B, C, and D are correct.

1. What factors contribute to the increasing incidence of latex allergy?

A. Inc re as ed le ngth of surgi cal procedu res

B. Changes in the manufacturing process

C. Younger people entering the health care industry

D. Increased use of latex products because of univ ersal precautions

View Answer2. Which are likely routes of sensitization to latex?

A. Sk in contac t

B. Inhalat ion

C. Ingestion

D. Parenteral inject ion

View Answer3. Which item(s) listed below is unlikely to cause latex

allergy?

A. Whe elc hai r t ires

B. Washed venti lator bellows

C. Syringe plungers

D. Products steri l ized with ethylene oxide


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View Answer4. Powdered gloves pose a greater threat than those without

powder because

A. Latex pro tei ns bind to the po wd er

B. The powder contains all ergens

C. Powder may spray into the operating room when they are donned or removed

D. Filters in the venti lat ion system may become clogged

View Answer5. What are the symptoms of irritant contact dermatitis?

A. Sk in crac king

B. I tching

C. Scaling

D. Dryness

View Answer6. What are the characteristics of Type IV hypersensitivity?

A. De la yed hyp ers ens i t iv ity

B. Always stays within the area of the antigen

C. May be associated with d izziness

D. Skin rash is s een within 5 hours

View Answer7. Characteristics of Type I hypersensitivity include

A. Re ac tio ns ma y le ad to mo rta li ty o r mo rb id i ty

B. Symptoms can occur days later

C. Reactions range from mild to severe

D. They are mediated by IgF antibodies

View Answer8. Primary clinical features of Type I hypersensitivity

include

A. Bronc hospasm

B. Cutaneous s ymptoms

C. Cardiovascular s ymptoms

D. Neurologic sy mptoms

View Answer9. What are the important points to look for when taking a

history in an attempt to determine the presence of latex allergy?

A. Ha nd de rmati t is in conj un c ti on wi th weari ng late x g lo ves

B. Sensit ivity to ragweed

C. Food allergy to watermelons, pineapples, strawberries, and t omatoes

D. Predisposit ion to mult iple allergic c ondit ions

View Answer10. Which conditions are associated with a high incidence of

latex a llergy?

A. Genitourina ry tract abn orma l it ie s


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B. Congenital orthopedic defects

C. Esophageal str ictures

D. Spinal cord injuryView Answer11. Important features of the SPT include

A. High inc ide nce of an ap hylaxis

B. Reasonably good sensit ivity and specif icity

C. Availabil i ty of a good test solut ion

D. Patients with anaphylaxis during s urgery are almost invariably skin-prick posit ive

View Answer12. Preventive measures for latex allergy include

A. De termin in g th e products tha t con tain la tex

B. Using oil-based hand creams or lot ions

C. Using powderless gloves

D. Totally eliminating latex exposure

View Answer13. Considerations for drug prophylaxis include

A. H2 blockers may increase the risk f or patients with heart block

B. I t may mask the signs of anaphylaxis

C. I t may delay implementat ion of treatment, i f anaphylaxis occurs

D. I t wil l prevent anaphylaxis

View Answer14. Regarding labeling for latex content,

A. I f the la bel do es no t indic ate th at i t conta ins latex, it is latexf ree

B. Products not regulated by the FDA must be labeled if they contain latex

C. Drug manufacturers must label products regarding latex

D. The FDA requires that all medical products that may d irect ly or indirect ly contact

the body be labeled if they contain latex

View Answer15. Surgical precautions that need to be taken if a patient is

known to be latex sensitive include

A. No on e shou ld ente r the opera ting ro om we ari ng late x gl ov es

B. The case should be posted for the f irst case of the day

C. Clothes that have not been exposed to latex should be worn

D. Latex alert signs s hould be posted inside and outside the room

View Answer16. Which steps can be taken to limit the likelihood of latex

allergy resulting from intravenous or parenteral injec-tions?

A. Us ing medic ati on s supp li ed in ampules

B. Using glass s yringes

C. Preparing drugs just before use

D. Using rubber syringe plungers


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View AnswerP.442

17. Methods to treat irritant contact dermatitis include

A. Re duce ex pos ure to the irr i tan t

B. Use of a plast ic glove l iner

C. Topical c ort icosteroids

D. Protect ive hand cream

View Answer18. Steps that health care workers can take to protect

themselves against latex exposure include

A. Was hing hand s afte r latex glov es are remov ed

B. Using n on-latex gloves where infect ious material wil l not be encountered

C. Covering breaks in the skin with a plast ic barrier

D. Using oil-based creams or lot ions

View Answer

Chapter 15. Latex Allergy

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Transcript of Chapter 15. Latex Allergy