Latex Allergy Alert
By Christine Ozment
Latex is all around us, sometimes in the most unexpected places: toys, carpet backing, the elastic used in clothing, pencil erasers, balloons, pacifiers, adhesive tape, stethoscope tubing, wheelchair cushions and tires. The fact is, as more and more latex enters our world, latex allergies are on the rise. This is especially so in the health care industry, where there has been a steady increase in latex medical-care products, such as blood-pressure monitoring cuffs, surgical and examination gloves and disposable syringes. The response to diseases such as AIDS and hepatitis, has been to cover up health care workers at risk by using products such as surgical and examination gloves. This may also contribute to the following statistics: According to The National Institute for Occupational Safety and Health, at least eight to 12 percent of health care workers regularly exposed to latex become allergic to it, compared with one percent of the general population, although total numbers of exposed workers are not known.
While health care workers are indeed affected, some children with disabilities are also among the particularly susceptible. This includes children with spina bifida, congenital urological abnormalities, cerebral palsy and Dandy-Walker syndrome.
What is a latex allergy?
There are several types of allergic reactions to latex—differentiated by the severity of the response. “Type 4” is limited to the area exposed to the offending agent. Symptoms include a skin rash, redness and irritation, and may occur anywhere from 24 to 48 hours after exposure. Because patient reactions vary, there is no standard time frame for when symptoms start to go away.
“Type 1” hyper-sensitive reactions represent a broad spectrum of symptoms. Very mild symptoms include a runny nose and watery eyes. Very severe cases can include a “systemic anaphylaxis episode,” (a response the body has to a mass allergen exposed). In this case, hives, asthma (wheezing), shortness of breath, nausea and vomiting can occur, and be life threatening. This kind of reaction can be the result of inhaling latex particles that are in the air, or introducing latex through direct contact with rubber products.
What is latex?
Latex is a natural product from the sap of the rubber tree, Hevea brasiliensis. Its popularity as a material is due to its durability, flexibility and low manufacturing costs. Alternatives to latex include silicone, plastic, and vinyl.
Latex can be manufactured in two ways. A product can be made by dipping a ceramic mold in liquid latex, or punching molded rubber products out of solidified rubber. Dipped rubber products, such as toy balloons and rubber gloves typically contain higher levels of latex than those of molded rubber products that include syringes and tires.
How can you find out if you are sensitive? Through research, seven allergenic proteins have been identified, some structurally similar and “cross reactive” with proteins in certain fruits such as avocados, bananas, nuts, kiwis, tomatoes and papayas.
Identifying a sensitivity to latex comes from a review of past medical history, a physical exam and blood tests. Three FDA-approved blood tests for latex-specific IgE antibodies, called IgE immunoassays, are now used: The Pharmacia & Upjohn CAP System, the Diagnostic Products’ Alastat and the Hycor Assay. There is also a recent alternative procedure which involves diagnostic skin testing, and uses the latex reagent. The procedure is currently on the verge of approval by the FDA.
Blood tests can be done at a doctor’s office, clinic or hospital, and then sent to a testing facility for analysis.
Test results define the presence of the sensitization. However, once a sensitivity is present, the IgE antibody cannot be used to predict how severe a reaction from the child’s exposure will be. A latex allergy, like all allergies, occurs with exposure to the allergen. The more latex a person is exposed to, the greater the likelihood that a sensitivity will become more severe. Once sensitivity of any kind has been established, a child should be kept away from latex products at all times.
Tests can be readministered if you wish to find out if sensitivity to latex has decreased.
Caution is critical
According to Dr. Robert Hamilton, Associate Professor at Johns Hopkins School of Medicine, in Baltimore, Maryland, “Avoidance is the primary way of treating a latex allergy.” He suggests that parents be diligent and not let their guard down. “Parents must be adamant and persistent about protection,” he explains. “Expect to meet with skepticism and to be your child’s advocate. Education is the key to preventing tragedy.”
Hamilton also suggested that parents and professionals support the use of alternative products made of silicone, plastic and vinyl as substitutes for those containing latex. Unfortunately, not all products containing latex are now labeled. For more information on latex allergies and latex-free products contact one of the following organizations:
Some health care products containing latex
Some household products containing latex
Christine Ozment has a degree in Allied Health and is a member of the Washington Township, New Jersey, Volunteer Ambulance Corps. Julie Venners Hacker and Jennifer C. Stolting also contributed to this article. Special thanks to Dr. Robert Hamilton, Associate Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
A Latex Awakening
by Joy Bonvino
Our fear of latex began in October of 1994 during back surgery for our son Philip, who is now nine-and-a-half-years old. That is when our desperate research and education began.
Our son has a neuromuscular disease, called nermaline myopathy, which is a rare form of muscular dystrophy. Philip is immobile and cannot speak or swallow. Instead, he uses a button g-tube for feedings and an electronic device to communicate. He is also dependent on a mechanical ventilator 24-hours a day to assist him in breathing. It was during scoliosis surgery with fusion—a grueling 10-hour procedure, that we almost lost him.
The surgery for Philip was risky enough—we never suspected latex to be a danger factor as well. We said good-bye to him as he was wheeled off to the operating room, and felt some ease knowing his home-care nurse of nine years, Karen, was there to accompany him during the operation.
Two hours later, Karen came from the operating room. Gently taking my hand in hers she said, “Philip has turned bright red and is unable to be ventilated.” My heart stopped—so did the surgery.
Philip had reacted to latex. Epinephrine was administered to stop the swelling of his airways, and the operating room was cleared of all material containing latex. The surgeon went on to complete his work without further complications.
Now that we encountered latex intolerance, we found it would be a long-term problem. We knew that we had to try and find new equipment so that Philip could return home to a comfortable environment. Luckily, we found respirator tubings, diapers, suction catheters and feeding tubes. Our next task was his wheelchair, and after calling companies, we found that some were ignorant of the materials and compounds that made up their own products. This made our search more stressful—we wondered if some had told us “no latex”, simply from ignorance!
Living with a child whose prognosis is fatal is difficult enough. The thought of losing Philip to an anaphylactic reaction to latex simply because products are not labeled seems almost negligent. A new addition to our lives is the EpiPen® epinephrine injector. We do not dare leave home without it!
We urge everyone to petition the government to put warning labels on all products and materials that contain latex. There are groups such as ALERT that give lists of alternative products. [See list above for other helpful organizations.]
Joy and her husband, Philip, live in Lindenhurst, New York, with their son, Philip.
A New Way of Life
by Anne Marie Price
Doug and I learned about our baby’s disability during the endless tests routinely given during pregnancy. We never imagined that the alpha-fetal protein test that I took would begin a new way of life and a new way of thinking for us. I had met a few people who had been given some frightening results from tests that later proved to be “false positive.” The results of my blood test were accurate, however; sonograms confirmed our baby had spina bifida.
We learned a great deal about our child’s disability before she was born. For example, we were told she would probably never walk (though I am happy to report that she does). Doctors informed us that she also had severe hydrocephalus (water on the brain) and immediately after delivery would need surgery to place a shunt in her brain to help drain the spinal fluid into her abdominal cavity. We also learned that most people with spina bifida need to be catheterized to urinate. None of these things surprised or even worried us.
One thing did surprise us. We learned that people with spina bifida are often allergic to latex. I remember the moment Doug’s sister gave us the information packet she had received from the Spina Bifida Association of America. We read about latex allergies and felt as if we were facing a brand new diagnosis we needed to prepare for.
As we read the list of common items with latex, we were stunned! Diapers, pacifiers, baby bottles, nipples, balloons and many different types of medical equipment all made the list. Doug and I learned that regular exposure to latex could be the major contributor to latex allergies in people with spina bifida. Now we knew that we had to avoid exposing our child to latex from the very beginning.
From the moment RoseMarie was born, Doug and I were her advocates. Immediately following an emergency C-section, our daughter was admitted to the intensive care nursery (ICN). I had just enough energy to admire her and absorb what all of the doctors were telling me. Meanwhile, Doug was alerting the nurses in ICN about latex precautions.
At first, the doctors seemed to question the reality of latex allergies. We remained firm in our decision to keep her environment latex free and eventually, after presenting literature to the physicians about latex allergies, they began to work with us. Our next step was to have RoseMarie tested for latex allergies because we had seen a rash from the silk tape used in stabilizing her IV ports. The results from a blood test showed that even with minimal exposure, she had a mild, but positive, sensitivity.
RoseMarie was in and out of the hospital for the first three months of her life. She had eight surgeries by the time she was four months old. During a particular surgery, the prevalence of latex and the degree of vigilance needed was brought home to me. She had a broviac line placed in her chest, and I was in charge of flushing the line with Heparin, (a sodium injection) every day. It occurred to one of the nurses that the bottle of Heparin came with a rubber stopper through which I was supposed to push the syringe to draw in the medication. The stopper could have easily included latex materials and an alternative had to be found. Luckily, I was able to find a special device called a “Decapper” (made by Kebby Industries in Rockford, Illinois), which removed the top of each bottle before I used it. I had to become innovative for RoseMarie’s safety!
I wish that I could boast that our home is latex free, but all I can say is that we have been careful, and buy latex-free diapers, pacifiers and teething rings. We have even gone as far as calling the 800 numbers on every package that we buy just to confirm there is no latex in the product. Customer service departments have made checking a lot easier. They call the manufacturer for me! Manufacturers have been responsive, as well. One manufacturer of a non-spill cup contacted the engineer responsible for the cup’s design and asked for a modification for a latex-free alternative.
When RoseMarie was about six months old, she began early intervention. I asked the staff to use latex precautions whenever possible, explaining that even though she had never experienced a serious reaction, the allergy builds with exposure. With continued exposure, she might experience a life-threatening reaction such as anaphylactic shock.
Sometimes I have felt that I am being too “preachy,” but I believe it has paid off. RoseMarie’s therapists have been careful not to expose her to latex in the equipment they use, such as therapy balls and gym mats. They even special ordered a wheelchair with latex-free parts for her.
Our friends and family have also been made aware of the potential risks. They make sure that mylar balloons are available at birthday parties instead of latex ones. It makes us feel great to know that everyone who knows our daughter is watching out for her. We try our best to keep latex far away from her, but we also have to be realistic. Even erasing a pencil mark requires a product with a latex-seal eraser. As “preachy” as it may seem though, I will grab my soapbox and launch into a sermon anytime to keep my daughter safe!
Anne Marie and her husband, Doug, live with their daughter RoseMarie in Old Bridge, New Jersey.
|Reprinted with the expressed consent and approval of Exceptional Parent, a monthly magazine for parents and families of children with disabilities and special health care needs. Subscription cost is $32 per year for 12 issues; call 1-800-562-1973. Offices at 555 Kinderkamack Rd. Oradell, N.J. 07649.