May Health Beat

By Mary Jane Dittmar
Fire Engineering/Fireengineering.com

Latex Allergies

Ongoing exposure to products made of natural rubber latex (NRL), including latex gloves, may pose occupational health hazards for healthcare workers, according to the American Association of Nurse Anesthetists (AANA). The AANA says that NRL allergies affect between 1 percent and 6 percent of the general population but between 8 percent to 25 percent of healthcare workers, who are regularly exposed to latex.

Allergies may manifest themselves as non-allergic irritant contact dermatitis, type IV cell-mediated allergies, or type I IgE-mediated allergies.

• Non-allergic irritant contact dermatitis, a skin rash, is the most common reaction regular wearers of powdered and non-powdered latex gloves experience.
• Type IV cell-mediated allergies, the most common immune system reaction, result from a delayed reaction to one or more of the 300-plus chemicals used to manufacture latex. This type of allergy is manifested by a skin rash characterized by redness and swelling within 48 to 96 hours of exposure. Continued exposure may cause individuals to develop the antibodies that can bring about a type I latex allergy.
• Type I IgE-mediated allergies represent an immediate hypersensitivity to latex proteins. This type of allergies includes two subgroups that produce symptoms ranging from hives, runny nose, and skin rashes to anaphylaxis.

An example of how severe a latex allergy can be is Chuck Mills, a certified registered nurse anesthetist, who now maintains a law practice specializing in medical legal consulting and risk management. Mills, a member of the International Association of Fire Fighters and AFL-CIO, developed a type I NRL allergy in 2000. He was forced to end his 20-year career as a rescue lieutenant for the City of Warwick (RI) Fire Department. Mills must wear shoes in his house because the latex backing of his wall-to-wall carpeting gives him chest pains and causes congestion. He cannot peel raw potatoes or eat tomato sauce. Mills says people need to be aware of how latex allergies can affect the quality of life. “I can’t go to my children’s birthday parties because the balloons give me chest pains, and I can’t shop in a costume store for Halloween. These are the little things that affect the quality of being a dad,” Mills explains.

Ongoing exposure to products made of NRL, especially direct skin contact with gloves, cause most allergic reactions. Airborne proteins released when powdered gloves are snapped off can enter the eyes or mucous membranes and also cause a reaction.

It is important for individuals with NRL allergies to realize that some plant products contain the same allergy-producing proteins. They include bananas, avocados, kiwis, plums, peaches, cherries, apricots, figs, papayas, tomatoes, potatoes, and chestnuts. Eating these foods may cause an allergic cross-reaction to occur. Also, genetically engineered fruits and vegetables contain the same DNA markers as latex and should be avoided as well.

The following will help to minimize the occupational risks of NRL exposure for frequent wearers of latex gloves:

• Wear low-protein, powder-free, or vinyl gloves, or wear glove liners made of cotton or polymers, such as hydrogel and silicone, under latex gloves. The “Personal Protective Equipment’ section of the U.S. Occupational Safety and Health Administration bloodborne pathogens standard states: “Glove liners, powderless gloves, or other alternatives must be readily accessible to employees who are allergic to the gloves normally provided.”
• 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 that deteriorate gloves and accelerate the release of latex allergens.
• Remove gloves hourly to allow hands to air dry.
• Do not snap off gloves; doing so releases airborne latex proteins.
• Replace latex gloves with appropriate substitutes such as vinyl gloves. Note that gloves labeled “hypoallergenic” are not latex-free.
• Double- or triple-glove to reduce latex protein exposure to yourself and others.
• Remove latex-containing dust from the workplace.
• Enroll in latex allergy training and education classes.

The following actions should be taken if you should develop a latex allergy on the job:

• Inform your employer of the NRL exposure.
• Contact your organization’s occupational health and safety department or medical personnel, who may prescribe a self-administering epinephrine device and antihistamine for emergency use.
• Eliminate products that contain NRL, or find acceptable substitutes for them.
• Check state workers’ compensation laws to determine eligibility to receive occupational medical benefits.
• Wear a Medic-Alert bracelet that identifies the NRL allergy.
• Avoid beta-blockers that can trigger allergic reactions (check with you physician).
• Arrange for latex-safe medical and dental care.
• Avoid foods that cross-react with NRL (listed above).
• Develop a therapeutic plan to treat related symptoms that develop.

Keep in mind also that some of the patients you are called to administer to may have latex allergies. This information should be prominently noted on their chart and in medical records. Be aware that if you touch a latex object, you can transmit the allergen to the patient. Also, many items used in patient treatment contain latex; these items include intravenous (IV) tubing ports, rubber injection ports on IV bags, syringes, catheters, tourniquets, and tubing. To view the AANA “Latex Allergy Protocol,” go to www.aana.com/crna/prof/latex.asp.

For additional information, contact the AANA at (847) 692-7050 (phone); (847) 692-6968 (fax).
Source: American Association of Nurse Anesthetists; Web site: www.aana.com.