Latex Allergy: Another Real Y2K Issue
Lisa M. Jennings, RN CRRN
Consider this scenario: You receive a report from another nurse on a patient who is to be admitted to your unit. The patient is a 30-year-old male with a spinal cord injury who is coming in for wound care management. He lives on his own, works part-time, and catheterizes himself every 4 hours. At the end of the conversation, the nurse mentions that this patient has a latex allergy. Immediately, a red flag goes up in your mind, because this is a detail that will change how you will handle this admission. You know enough about latex allergy to appreciate that it is not solely a nursing issue but instead affects all departments. You question whether your facility is prepared to manage this patient safely.
What is latex allergy?
Latex is a processed plant product manufactured primarily from the rubber tree Hevea brasiliensis (Subramaniam, 1995). It contains variable amounts of proteins that the human immune system can recognize as allergens. With recurrent exposure, some people can become sensitized to latex. Exposure to latex occurs through contact with the skin or mucous membranes, inhalation, ingestion, and wound inoculation. The possibility of a reaction and the degree of its severity can vary greatly in each sensitized person. One person can have contact urticaria from being touched with latex gloves or from coming in contact with latex powder residue while on the nursing unit. Another person can suffer an anaphylactic reaction from encountering trace amounts of latex in IV tubing or from eating a banana. “Three components are known to influence the likelihood a sensitized person will react to a latex exposure: the degree of allergic sensitivity in the patient, the amount of latex in the environment, and the route of latex exposure” (Adkinson, 1999, par. 1). Usually, the more highly sensitive an individual is to latex proteins, the smaller the amount of latex needed to elicit a reaction.
What does a banana have to do with it? Many of the proteins that cause latex allergy are also found in fruits—specifically, bananas, kiwis, and avocados—vegetables, nuts (especially chestnuts), and cereals.
Who is affected?
What is the nurse’s role?
The first and most important step in identifying patients with or at risk for latex allergy is to take a thorough history. The history is key because diagnostic tests are limited and cannot be totally relied upon at this time. The patient described at the beginning of this article had already been identified as latex allergic. In many cases, patients may suspect they have an allergy, or you may suspect they have an allergy based on findings during your assessment. Or they may simply be at risk of becoming sensitized and allergic. The risk factors you would want to inquire about include the need for chronic frequent catheterizations, occupational exposure to latex, multiple surgical procedures, dental work, history of atopy, allergy to tropical fruits or nuts, hand dermatitis or eczema, history of anaphylaxis, or other unexplained problems related to surgery, gynecological examinations, condom use, or blowing up balloons.
The next step is to communicate your findings. Your facility should have a policy or procedure on identifying and managing patients who are latex allergic or at risk. If not, you must find a way to alert all departments, including the dietary department (both the nutritionist and the food preparers), the environmental service staff, the laboratory, the pharmacy, therapists, and transporters. This issue involves not only those who come in contact with the patient, but also the behind-the-scenes staff who handle anything that eventually reaches the patient. For example, if your facility allows patients to go to the cafeteria, you must know whether your sandwich makers wear latex gloves.
Next is the issue of creating a minimal latex environment. It is important to limit the patient’s exposure to latex by using latex-free alternatives or creating a barrier between the latex and the patient. Placing a patient in a private room limits exposure to latex products used for roommates. Even when all necessary precautions are in place, you still have to think about what is in the air. It has been determined that 95% of latex allergies in healthcare workers are related to the use of powdered latex gloves. The latex protein binds to the powder granules, and when the gloves are removed, the powder is aerosolized into the environment, eventually landing on surfaces or being inhaled. Even this level of exposure may be enough to trigger an anaphylactic reaction.
Now you are aware of some key interventions to protect your latex-allergic patients. You should also think about prevention—not only preventing anaphylaxis or a reaction in the already allergic patient, but preventing high-risk patients from being exposed and sensitized to latex. Our challenge as healthcare providers is to develop comprehensive latex allergy prevention and exposure control plans.
Back to the original scenario: The unit has put precautions in place, and you feel confident that you and your facility can safely manage this patient and his allergy. Meanwhile, a party is being put together to celebrate one of your facility’s many successes. The celebration planners have decorated the lobby with balloons, distributed balloons to all nursing stations and gyms, and thoughtfully offered balloons for patients to place on their wheelchairs. Fortunately, you recognize that the balloons are latex and do not allow them to be placed on the unit. Although they seemed to be a harmless decoration, these latex balloons actually limited the patient’s ability to have therapy in the gym that day or to travel through the halls.
This scenario demonstrates that latex is everywhere and that awareness and preparedness are necessary to prevent injury to your patients. When dealing with latex allergy, you cannot have too much knowledge. Information on latex allergy can be found in medical and nursing journals and on the Internet. Countless abstracts, position papers, and articles have been written on the subject. Latex allergy has been portrayed on the television programs “ER” and “20/20” and was recently featured on the front page of the New York Times. Not being informed is inexcusable.
Lisa Jennings is the assistant nurse manager of the Drucker Brain Injury Center at MossRehab Hospital in Philadelphia. Address correspondence to Lisa M. Jennings, Drucker Brain Injury Center, MossRehab Hospital, 1200 W. Tabor Road, Philadelphia, PA 19141.
Vol. 24, No. 4 (pp.140,142), Jul/Aug 1999
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