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Latex Allergy

Latex Allergy. Lois Schick MN, MBA, RN, CPAN, CAPA. Latex Sensitivity. Review the development diagnosis and current treatment of latex allergies Describe each of the 3 types of human reactions to natural rubber/latex containing products

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Latex Allergy

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  1. Latex Allergy Lois Schick MN, MBA, RN, CPAN, CAPA

  2. Latex Sensitivity • Review the development diagnosis and current treatment of latex allergies • Describe each of the 3 types of human reactions to natural rubber/latex containing products • Identify currently available diagnostic tests and medical treatment options

  3. NIOSH • National Institute for Occupational Safety and Health • Established under the 1970 Occupational Safety and Health Act • A division of the Centers fro Disease Control and Prevention (CDC) • Not OSHA • In Ireland and Great Britain it is the NHS

  4. NIOSH Recommendations • June 1997 released-prevention oriented • Use the appropriate glove for the task at hand • Summarizes employer and worker info • Targeted towards hospitals, day care facilities, food service industry, environmental services

  5. June 1997 was too late for nurse Cheryl MareeMohrbacker • Cheryl was a 41 year old RN in Oregon • Worked 3-11 Shift • Cheri never came home from work one night • Her Story: • Visiting father in hospital and she develops a severe allergic reaction which required 3 days on a ventilator • Carpets were being cleaned at hospital and her reaction was attributed to a reaction to the cleaning chemicals • Had a second bout again when carpets were being cleaned at a hospital where she was employed

  6. Cheri’s story • Cheri realized she was only having reactions when wearing Latex gloves • In 1994, Cheri was tested for and diagnosed with a latex allergy. • She switched to hypoallergenic gloves which are meant for those who suffer from dermatitis. • Some hypoallergenic gloves have been found to have 3000 times the latex protein as regular latex gloves making them more dangerous to latex sensitive nurses • Eventually she got latex-free gloves.

  7. Cheri’s story • June 10, 1996 Cheri had a severe attack while at work. • She was rushed to the ED and told the staff there that she was latex sensitive. • At one point Cheri grabbed one nurse by the arm so hard that she left bruises and her last words to this nurse were: • “You’re just going to let me die. I’m not going to make it this time.” • Cheri was right – she did die in the ED that night.

  8. Natural Rubber Latex (NRL) • Milky fluid derived from the rubber tree (Hevea Brasiliensis) • Two methods of treatment prior to use • Coagulate to solidify • Dry natural rubber i.e. tires, shoe soles • Ammonionate to prevent coagulation • Gloves, condoms • Proteins can cause range of allergic reactions

  9. Latex Allergy • Latex allergy affects 18 million Americans • Increasing rates of sensitization • 18-73% sensitization rate in children with Spina Bifida • 33% sensitization rate in those having 3 or more surgeries • 15% sensitization rate in RN’s

  10. Latex Allergy • 17% sensitization rate in ALL health care workers (2% have occupational asthma) • Increased sensitivity in operating room personnel from 2.95% to 15% in less than 10 years • Increased rates in dental personnel from 13.7% to 38% in 4 years

  11. Suspected populations at risk • Congenital neural tube disorders • Urologic disorders requiring catheterizations • 3 or more surgeries • History of systemic reactions to balloons, latex gloves, condoms, cosmetics, rocket handlers, Poinsettas

  12. Suspected populations at risk • History of allergy to fruits with cross reactive proteins • Hay fever, asthma, contact dermatitis • Food allergies to: • bananas, avocados, passion fruit, kiwis, chestnuts, tomato, Celery, melon,

  13. Manifestations of Latex Allergy • Delayed hypersensitivity • Contact pruritus, erythema, uriticaria, eczema • Immediate hypersensitivity • Rhinorrhea, conjuctival pruritis & edema, wheezing, bronchospasm, angina, tachycardia & progressively severe hypotension

  14. Onset & Symptoms Type I: Immediate Hypersensitivity • Progresses in 15-20 minutes • Resolves spontaneously over 1-2 hours • Immediate, local and generalized uriticaria, feeling faint, feeling of impending doom, angioedema, nausea, vomiting, abdominal cramps, bronchospasm, anaphylaxis

  15. Onset & Symptoms Type I:Immediate Hypersensitivity • Anaphylaxis: • Typically within 30 minutes after exposure • Cutaneous, GI, CV, Respiratory • Laryngeal edema and CV collapse most common cause of death • Immunoglobulin & mediated systemic reaction to the latex proteins that if untreated lead to fatality

  16. Onset & Symptoms Type IV:Delayed Hypersensitivity • Contact Dermatitis • Appears in 18-24 hours • Resolves in 72-96 hours • Redness & inflammation over exposed sites • Blister formation • Allergic Dermatitis • T-cell mediated delayed localized reaction to chemicals used in manufacture of gloves

  17. More prolonged the latent period between antigen exposure and the onset of symptoms, the more benign the reaction

  18. Equipment Issues • GLOVES • act as a vector for patient sensitization • Workers are at risk as a population from multiple exposures • 5-6 million workers wear gloves regularly • 117 million pairs of latex gloves were supplied to NHS in 1992

  19. Equipment Issues • Latex gloves can cause contact allergic reactions • itching, hives, vesicles, erythema, and eczema • Usually a delayed hypersensitivity reaction • Workers may have concurrent chemical sensitivities to additives in latex

  20. Equipment Issues • 40,000 consumer products that contain latex in their composition. • Makes it difficult to completely delete latex

  21. Environmental Issues • Latex particles are suspended in indoor air in health care settings • Powder in gloves is the vehicle for latex particle aerosolization • Aeroallergens are higher in areas where workers frequently apply and discard gloves • When latex particles are inhaled, workers become sensitized

  22. Sources of Latex - Hospital • Gloves - sterile and exam • Catheters • IV injection ports • Medication vials with needle access • Ventilator, anesthesia, and respiratory therapy equipment • Latex tipped enemas, endoscopy parts • Mattresses on stretchers • Stethoscopes & blood pressure cuff tubing

  23. Source of Latex - Home Environment • Household gloves • Diapers, bottle nipples, pacifiers • Household insulation material, carpet backing • Newsprint, coupons, and magazines dusted with latex coating • Feminine sanitary pads, adult diapers, condoms, diaphragms • Clothing including elastic on underwear

  24. Methods of Exposure • Cutaneous & Mucosa • Gloves, dental equipment, surgical procedures, food prepared by people wearing latex gloves, toys, clothing, sports equip. • Inhalants • Anesthesia machines, powder from latex gloves, balloons, car tires • IV & Parenteral • IV ports, tubing, burettes, bottles and syringes

  25. Clinical Management of systemic reactions • Antihistamines - oral, IM, IV • Chlorphenamine • Diphenhydramine • Steroids - inhaled, oral, IV • Bronchodilators - inhaled, oral, IV • Epinephrine - SQ & IV

  26. Clinical Management • Latex-safe preoperative and patient rooms • Latex-safe OR, PACU and anesthesia equipment • Latex-safe neonatal resuscitation equipment • Drugs must not be administered through latex ports, nor dwell in syringes with latex plungers

  27. Clinical Management Operating Room • Schedule latex - safe cases first of the day to allow settling of latex dust overnight • Latex-safe anesthesia equipment • Latex-safe respiratory equipment • Latex-safe IV delivery systems • Recognition of inadvertent latex exposure

  28. Clinical ManagementEmergency Department • Latex-safe intubation & ventilation equipment • Latex-safe IV equipment • Latex-safe gloves and monitoring equipment • Laminar air flow available for the “exquisitely” sensitized

  29. Latex Allergy Identification • Screening criteria and diagnosis of latex allergy • Methods of allergy testing • RAST – RIA (invitro test IgE) with variable sensitivity • AlaSTAT – ELISA testing ( IgE testing) • Skin Prick - Most sensitive but carries risk of anaphylaxis

  30. Management of the Latex sensitive individual • Non latex gloves for the employee • Non latex for co-workers (Preferred) or powder free • Medications ( epi-pen, antihistamines, inhalers, steroids) • Education of co-workers • Complete removal of latex sources from work place

  31. Environmental Preparation • Remove latex sources from room • Dust and vacuum with HEPA filters • Mop all surfaces • Label room with a “Latex Allergy”Sign • Obtain non-latex medical equipment (Cart) • Reverse laminar air flow room if possible

  32. Equipment Concerns • Non-latex exam and sterile gloves. NO Exceptions ! • neolon, nitrile, & butadene-styrene • Latex-Free respiratory support equipment • Non-latex ambu bag, ETT, cannulas, & masks readily available • Non latex anesthesia machine components (Ohmeda, North American Draeger & Anesthesia Associates retrofits

  33. Latex-Free IV Equipment • Clave ( ICU Medical), Interlink ( Baxter), IVAC & Braun needleless IV tubings • Protective Plus (Johnson & Johnson) Insyte (Critikon), Abbocath, Clear-cath • Central lines-check with Arrow & Bard • Heparin Locks - B. Braun and Abbot

  34. Medications & Specialty Procedures • Use needleless systems with latex free syringes or prefills • Abboject for most emergency drugs • Approved Wyeth-Ayerst blunt tip or tubex drugs only • Latex-free syringes - Terumo, Norm-ject ( Air-tite) & Becton Dickinson • DeRoyal Procedure Packs

  35. Personnel Specifics • Nursing, Laboratory, Pharmacy, Housekeeping & Food Service staff don fresh gowns when entering a latex-allergic person’s room to prevent latex glove residue on clothing from being introduced. All personnel wear non-latex gloves • Food prep done with non-latex gloves

  36. Items that have caused Anaphylaxis and Fatalities • Latex gloves • Meds injected through latex topped vials into latex IV ports • Latex tipped enema catheters, urinary catheters • Respiratory and resuscitation equipment

  37. Nursing Research • Sample of 79 Type I allergic response to latex • 49% RNs • Qualitative - Fears, Lifestyle changes, Job and family impact • Findings in a nutshell • Almost all respondents fear needing EMS and Medical care • Denial of symptoms often results in worsening

  38. 10 Latex Precaution Interventions • 1. Identify those at risk as well as those who have had reactions. • 2. Communicate information about the patient to all departments who have contact with the patient. Latex Precaution checklist • 3. Admit patient to environment that reduces exposure to latex

  39. 10 Latex Precaution Interventions • 4. Call for Latex Precautions cart. • 5. Use Latex-free gloves for any patient contact. Sterile & nonsterile. • 6. Schedule surgeries/procedures as first case of the day. • 7. Protect patient from direct contact. • 8. Follow physicians orders for pre and/or post anaphylaxis medications. BE Prepared!

  40. 10 Latex Precaution Interventions • 9. If appropriate, maintain a unit specific Latex Free “Tool Box”. • 10. Educate the patient and the family-Refer cases to appropriate medical care, contact latex information networks. • LISTEN TO THE PATIENT!!!

  41. Summary • Obtain latex free equipment before it is needed • Suspect every patient and any employee with symptoms • Resources: • Elastic - www.latexallergyhelp.com • Latex Cart Products List - Journal of Emergency Nursing 1998; 24L58-61

  42. Foot to the Pedal

  43. Resources: • Elastic - www.latexallergyhelp.com • Latex Cart Products List - Journal of Emergency Nursing 1998; 24:58-61 • http://www.cdc.gov/niosh/latexalt.html • AANA: http://www.aana.com • http://www.immune.com/allergy • American college of Allergy Asthma immunology: http:// www.acaai.org

  44. See YOU in Seattle, WA. USA April 3-7, 2011

  45. Thank YOU • Lois Schick MN, MBA, RN, CPAN, CAPA • 12823 W. 3rd Place • Lakewood, CO USA 80228 • E- Mail: Schickles@aol.com • Home:303-989-2281 • Cell: 303-475-9854

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