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 allergy is reported to be an international public health issue—possibly the biggest public health problem since the outbreak of AIDS. Latex allergy is a serious medical problem for a growing number of people, and it is a disabling disease, especially among healthcare workers. Reactions to latex range from mild skin irritations to asthma to anaphylaxis. Latex allergy can result in chronic illness, career loss, disability, and sometimes death.

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?

Approximately 3 million people in the United States are affected by latex allergy. The two populations most widely affected are children with spina bifida (among whom 67% are latex-allergic) and healthcare workers (3%–17%). Children with spina bifida are thought to be sensitized early on because of their need for so many surgical procedures. The greatest incidence among healthcare workers is in those who wear latex gloves and change them frequently throughout the day (e.g., operating room, emergency room, dental personnel). Other groups that have been affected are latex industry workers, people with a history of atopy (a predisposition to being allergic), people who have had multiple surgical or other medical procedures, day care workers, emergency medical technicians, police officers, and hairdressers.

What is the nurse’s role?

The 1999 CARF standards mandate that all programs that seek accreditation as comprehensive integrated inpatient rehabilitation programs or spinal cord rehabilitation systems of care and that serve any children or adolescents must provide information about allergies and precautions. CARF specifically cites latex allergy as an example. As a rehabilitation nurse, your responsibility to protect your patients involves addressing this issue via a thorough patient assessment, communication with all relevant departments, creating and maintaining a minimal latex environment, treating anaphylaxis if it occurs, and educating patients and all hospital staff.

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.

Adkinson, N.F., Jr. (1999). Ask the doc. InteliHealth [On-line]. Available:
Subramaniam, A. (1995). The chemistry of natural latex. In J. Fink (Ed.), Immunology and allergy clinics of North America: Vol. 15. Latex Allergy (p. 1). Philadelphia: W.B. Saunders Company.

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.

Rehabilitation Nursing
Vol. 24, No. 4 (pp.140,142), Jul/Aug 1999
© The Association of Rehabilitation Nurses (ARN)
Do not reproduce this article in any form without permission.
Reprint or reproduction permission must be obtained from ARN.

Table of Contents

Latex Allergy Links — Main Menu

Latex Allergy Links Message Board

Toys & Baby Products — Manufacturers’ Phone Numbers

Latex Gloves in Food Operations PDF
Wisconsin Department of Health and Family Services Sep 07 2001

Ever more complex;
Lawsuits and increasing regulation mount as argument over NR latex policies rages

Miles Moore Rubber & Plastics News Jul 30 2001

Living With Latex: Where to be alert for latex
Medical University of South Carolina Children’s Hospital

Handle with care
Ben Van Houten Restaurant Business Aug 01 2000

Allergenic Cross-Reactivity of Latex and Foods
Greer Labs Technical Bulletin #10 Jan 05 2000

Latex Allergy: Another Real Y2K Issue
Lisa M. Jennings, RN CRRN Rehabilitation Nursing Jul/Aug 1999

Potential for Allergy to Natural Rubber Latex Gloves and other Natural Rubber Products
OSHA Technical Information Bulletin Apr 12 1999

Looking Out for Latex
Sandra A. Holmes Science and Children Feb 1999

The Vow of Silence
Marianne McAndrew Journal of Nursing Administration Feb 1999

The legal implications of latex allergy
Peter Kohn RN Jan 1999

Latex Allergy: Everyone’s Concern
Lawrence D. Duffield, DDS Journal of the Michigan Dental Association Jun 1998

Allergen Content of Latex Gloves.
A Market Surveillance Study of Medical Gloves Used in Finland in 1997

Palosuo, Turjanmaa, & Reinikka-Railo

User Facility Reporting Bulletin
selected articles FDA Fall 1997

Latex Allergy Alert
Christine Ozment Exceptional Parent Oct 1997

Latex gloves hand health workers a growing worry
Margaret Veach American Medical News Oct 13 1997

Living with Latex
Lisa Legge Nursing Minnesota Aug 1997

Research Review:
Association between latex sensitization and repeated latex exposure in children

Victoria M. Steelman RN, PhD(c), CNOR AORN Journal Jul 1997

Latex allergy: How safe are your gloves?
Kenneth K. Meyer, MD, FACS and Donald H. Beezhold, PhD
American College of Surgeons Bulletin Jul 1997

User Facility Reporting Bulletin
FDA Spring 1997

Latex allergy among staff poses major headache for hospitals
Meredith Goad Press Herald Portland, ME May 06 1997

Oregon picks up latex glove controversy
Patrick O’Neill The Oregonian Portland, OR Apr 21 1997

Facilities react to growing number of allergies to latex
Linda L. Mullen South Bend Tribune South Bend, IN Apr 13 1997

Growing number of HCW’s developing dangerous reactions to latex
Liz Kowalczyk The Patriot Ledger Quincy, MA Apr 01 1997

Shriners Hospital Stops Using Latex
Pat Cahill Springfield Union Springfield, MA Mar 07 1997

Latex Allergy and Contraception
The Contraception Report Patient Update Mar 1997

Is Latex Paint Hazardous To Latex Allergy Sufferers?
Don Groce Latex Allergy News Oct 1996

Cotton, Nylon, Lycra Spandex and Allergies
Don Groce Latex Allergy News Sep 1996

Paving, Asphalt, Tires & Latex Allergies
Don Groce Latex Allergy News Aug 1996

Special Bulletin: Latex Allergy
American College of Allergy, Asthma & Immunology

Q & A: Latex Allergies
American College of Allergy, Asthma & Immunology

Preguntas y Respuestas: Alergias al Látex
Asociación Americana de Alergia, Asma e Inmunología

Latex Allergy Survival Kit
Nancy Mitchell 1996

Downloadable/Printable Latex Allergy Signs
For personal, non-commercial use only

Pre-1996 FDA documents
Miscellaneous legislative and other documents
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