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Guidelines for Preventing Sensitivity and Allergic Reactions to Natural Rubber Latex in
the Workplace

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Acknowledgements

Copyright © 2014
Society of Gastroenterology Nurses and Associates, Inc. (SGNA).
First published 1998; revised in 2004, 2007, 2010 & 2014.

This document was prepared and written by the SGNA Practice Committee and adopted by the SGNA Board of Directors. It is published as a service to SGNA members.

 

Contributors

SGNA Practice Committee 2014-2015
Michelle R. Juan, MSN RN CGRN — Chair
Ann Herrin, BSN RN CGRN — Co-chair
Catherine Bauer , MBA BSN RN CGRN
Susan Bocian, MSN BSN RN
Midolie Loyola, MSN RN CGRN
Beja Mlinarich, BSN RN CAPA
Marilee Schmelzer, PhD RN
Stephanie White, MSN/Ed RN CGRN HCI
Sharon Yorde, BSN RN CGRN
Cynthia M. Friis, MEd BSN RN-BC

 

Disclaimer

The Society of Gastroenterology Nurses and Associates, Inc. presents this guideline for use in developing institutional policies, procedures, and/or protocols. Information contained in this guideline is based on published data and current practice.

The Society of Gastroenterology Nurses and Associates, Inc. assumes no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and practices of any practice setting. Nurses and associates function within the limits of state licensure, state nurse practice act, and/or institutional policy.

 

Preface

In 1987, when the Center for Disease Control (CDC) issued recommendations for universal precautions, the demand for gloves as one component of personal protective equipment (PPE) escalated dramatically. This increased demand may have temporarily changed manufacturing procedures, resulting in a poor-quality, highly allergic product (Gawchik, 2011). This may have resulted in the development of sensitization in health care workers and patients as a result of exposure and the inhalation of aerosolized latex (Kelly, 2011). In 2008, the FDA released a proposed guidance document entitled “Medical Glove Guidance Manual”, which recommended protein and glove powder limits. With the reduction of latex proteins in gloves and the use of powder-free gloves, the allergen levels in health care workers has declined (Kelly et al., 2011; Power, 2009; Rolland & O’Hehir, 2008). Although latex sensitization has decreased, latex allergy can be a serious problem.

The purpose of this document is to maintain an awareness of the potential dangers of latex to both patients and healthcare workers (HCW).

 

Definition of Terms

For the purpose of this document, SGNA has adopted the following definitions:

Allergy refers to a state of hypersensitivity induced by exposure to a particular antigen (allergen) resulting in harmful immunologic reactions on subsequent exposures.

Anaphylaxsis refers to an acute, potentially life-threatening hypersensitivity reaction, involving the release of mediators from mast cells, basophils and recruited inflammatory cells. It is the most severe acute reaction characterized by a combination of respiratory, cardiovascular, and cutaneous signs and symptoms (Huber, 2006).

Latex refers to natural rubber latex (NRL) and includes products made from dry natural rubber (Occupational Safety and Health Administration [OSHA], 2008).

Sensitization is the process of developing an immunologic reaction to an antigen (OSHA, 2008).

Sensitivity refers to a state of altered reactivity that develops after sensitization.

 

General Principles

A. Routes of Exposure
Healthcare workers and patients are at risk of developing latex sensitivity. Major risk factors include length and frequency of exposure and exposure at an early age (Niggermann, 2010; Pfenninger & Fowler, 2011; Pollart, 2009). The routes of exposure are (Al-Shaikh, 2013; Association of periOperative Registered Nurses [AORN], 2012; Gawchik 2011):
a. direct contact (e.g. gloves, face masks, blood pressure cuffs),
b. airborne sources that affect mucous membranes of the eyes, nose, trachea, bronchi and oral cavity,
c. particles swallowed after entering the nose or mouth,
d. direct contact between HCWs’ NRL gloves and patients’ internal tissues during surgical procedures,
Latex Sensitivity and Allergy
e. direct contact between NRL devices and patients’ internal tissues (e.g. wound drains, catheters).

B. Types of Reactions to Latex
Three types of reactions can occur in persons using latex products: Irritant Contact Dermatitis, Allergic Contact Dermatitis, and Latex Allergy.
1. Irritant Contact Dermatitis (Contact dermatitis)
The most common reaction to latex products is irritant contact dermatitis. This is exhibited by the development of dry, itchy, irritated areas on the skin, usually the hands, and is not a true allergy (Grota et al., 2014, National Institute for Occupational Safety and Health [NIOSH], 2012; OSHA, 2008). It may occur on the first exposure and is not life threatening (Gawchick, 2011).

2. Allergic Contact Dermatitis (Delayed Hypersensitivity or Type IV)
Allergic Contact Dermatitis or delayed hypersensitivity (Type IV) results from
exposure to chemicals added during manufacturing. Erythema, pruritus and blisters
usually occur 24 to 96 hours after contact (Al- Shaikh, 2013; Gawchik, 2011; OSHA,
2008; NIOSH, 2012).

3. Latex Allergy (Immediate Hypersensitivity or Type I)
True latex allergy (Type I) is more serious than either of the two preceding conditions and should be further evaluated as it could lead to anaphylactic reactions. It is unknown how much exposure to the proteins in latex is needed to cause sensitization or progression of symptoms. Reactions usually begin within minutes of exposure to latex, but they can occur hours later. Mild reactions involve skin redness, hives or itching. Serious symptoms include runny nose, sneezing, itchy eyes, scratchy throat, wheezing, coughing or difficulty breathing (Al-Shaikh, 2013; Kumar, 2012; NIOSH, 2012; OSHA, 2008) Progression to anaphylactic shock is rare and life threatening but is seldom the first sign of sensitivity (NIOSH, 2012).

D. High Risk Individuals (Al-Shaikh, 2013; Kumar, 2012; Gawchik, 2011; Niggerman, 2010). Individuals who are at a higher risk of developing a latex allergy include those with:
1. prolonged or ongoing exposure to latex,
2. genetic predisposition to hypersensitivity or allergic reaction (atopy),
3. allergies to certain foods especially avocado, chestnuts, kiwi fruit, and bananas,
4. spina bifida,
5. a history of multiple surgical procedures.


E. Assessment and documentation
There is no standardized testing protocol for diagnosing latex allergy (Huber, 2006; Pollart, 2009). Medical diagnosis is based the correlation of symptoms with latex exposure (Gawchik, 2011; Pfenninger & Fowler, 2011). Therefore, it is essential to take a thorough history to be aware of potential or actual latex allergy. A history should include evidence of seasonal allergic rhinitis, asthma, eczema and food allergy, occupation, and surgeries, and hidden reactions such as swelling of lip or tongue after blowing up a balloon (Gawchik, 2011; Pfenninger & Fowler, 2011).

 

Recomendations

The following recommendations for preventing latex allergy in the workplace are based on current knowledge and a common-sense approach to minimizing latex-related health problems (Kumar, 2012; OSHA, 2008; NIOSH, 2012).

  1. Assess patients for possible latex sensitivity allergy.
  2. Reduce latex exposure by using latex-free products, when available.
  3. Provide a latex free environment for individuals with known latex allergy.
  4. Be aware of products that contain latex and whether latex free alternatives are available (e.g. EUS balloons, extraction balloons for biliary stones, and variceal bands).
  5. Educate staff about latex sensitivity including incidence, risk factors, and identification.
  6. Refer to institutional policies and procedures for specific information on the care of patients with latex sensitivities.

Summary

Latex avoidance measures have a positive impact on preventing latex sensitization (Pfenninger & Fowler, 2011). HCWs are responsible for providing a safe environment by utilizing latex free products whenever available and being cognizant of the latex contents in patient care products and PPE.

References

Al-Shaikh, B. & Stacey, S. (2013). Essentials of Anaesthetic Equipment, 4th edition. Appendix E, 269-270.
London, England: Elsevier Ltd.

Association of periOperative Nurses [AORN] (2013). Recommended Practices for a Safe Environment of Care. Recommendation VIII. Pg 15-17. Retrieved from www.aornstandards.org

Gawchik, S. (2011). Latex Allergy. Mount Sinai Journal of Medicine. 78: 759-772. Retrieved from Wiley
Online Library at www.wileyonlinelibrary.com.

Grota, P. et al. (2014). APIC Text of Infection Control and Epidemiology, online, 4th Edition, Dickey, Linda; Chapter 115, Water Systems Issues and Prevention of Waterborne Infectious Diseases in Healthcare Facilities. Washington, DC: Author.

Huber, M.A. & Terezhalmy, G. T. (2006). Adverse reactions to latex products: preventive and
therapeutic strategies. The Journal of Contemporary Dental Practice, 7(1), 1-15.

Kelly, K.J., Wang,M.L., Klancnik, M., & Petsonk, E.L. (2011). Prevention of IgE Sensitzation to Latex in Health Care Workers After Reduction of Antigen Exposures. Journal of Occupational and Environmental Medicine. 53(8). 934-40. doi: 10.1097/JOM.0b013e31822589dc.

Kumar, P.R. (2012). Latex Allergy in Clinical Practice. Indian Journal of Dermatology. 57(1), 66-70.

Niggermann, B. (2010). IgE-mediated latex allergy-An exciting and instructive piece of allergy history. Pediatric Allergy and Immunology. 21, 997-1001.

National Institute for Occupational Safety and Health [NIOSH]. (2012). How to Prevent Latex Allergies. Publication No. 2012-119. Retrieved from http://www.cdc.gov/niosh/docs/2012-119/pdfs/2012-119.pdf

Pfenninger, J. L. and Fowler, G. C. (2011). Pfenninger and Fowler’s Procedures for Primary Care, 3rd Edition. Philadelphia, PA.: Mosby.

Pollart, S.M, Warniment, C., & Mori, T. (2009). American Family Physician. 80(12), 1413-1418.

Power, S., Gallagher, J. & Meaney, S. (2010). Quality of life in health care workers with latex allergy. Occupational Medicine. 60, 62-65.

Rolland, J., & O’Hehir, R. (2008). Latex allergy: a model for therapy. Clinical and Experimental Allergy, 38, 898-912.

United States Department of Labor Occupational Safety and Health Administration [OSHA]. (2008). Potential for sensitization and possible allergic reaction to natural rubber latex and other natural rubber products. Retrieved from http://osha.gov/dts/shib/shib012808.html

Recommended Reading

American Latex Allergy Association (ALAA) Allergy to Latex Education and Resource. [Resource organization]. Retrieved from http://www.latexallergyresources.org/

Amaresekera, M. , Rathnamalala, N., Samaraweera, S. & Jinadasa M. (2010). Prevalence of Latex Allergy Among Healthcare Workers. International Journal of Occupational Medicine and Environmental Health, 23(4), 391-396.

Amado, A & Taylor, J. (2006). Women’s Occupational Dermatologic Issues. Dermatologic Clinics, 24, 259-269.

Bousquet, J., Flahault, A., Vandenplas, O., Ameille, J., Duron, J., & Pecquet, C. et al. (2006). Natural rubber latex allery among healht care workers: A systematic review of the evidence. American Academy of Allergy, Asthma and Immunology, 118(2), 447-454.

Hamilton, R.G. (2013). Latex Allergy: Epidemiology, Clinical Manifestations, and Diagnosis. 2013 UpToDate. Retrieved from www.uptodate.com/contents/latex-allergy-epidemiologyclinical-manifestations

Mota, A. & Turrini, R. (2012). Perioperative latex hypersensitivity reactions: an integrative literature review. Latin American Journal of Nursing, 20(2), 411-420.

Risenga, S. M., Shivambu, G. P., Ntuli, S., Maligavhada, N.J., Green, R. J. (2013). Latex allergy and its clinical features among healthcare workers at Mankweng Hospital, Limpop Province, South Africa. South African Medical Journal, 103(6), 390.

Shah, D., & Chowdhury, M. (2011). Rubber Allergy. Clinics in Dermatology. 29, 278-286.

Slade, S. (2012). Latex Allergy in Health Care Workers. Joanna Briggs Institute. Retrieved from http://connect.jbiconnectplus.org/

United States Food and Drug Administration (2008). Medical glove guidance manual. Retrieved from http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocument s/ucm150053.htm

 
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