When 400 plus scientists, manufacturers, nurses, clinicians, regulators, and other allied
health personnel entered the ballroom of the
Hyatt Regency Baltimore in early November,
there was more than a reasonable doubt in
many minds about the reality of the newly
reported medical condition called latex allergy.
Two and one-half days and 60 scientific
presentations later, there remained little doubt
that the condition of latex allergy was very real
and the increase in reported incidence was
growing rapidly.
Billed as the "International Latex Conference:
Sensitivity to Latex in Medical Devices" and
sponsored by the Food and Drug Administration,
Center for Disease Control, and National
Institute of Allergy and Infectious Diseases,
speakers and interested viewers from around
the world converged to learn the current state-
of-the-art knowledge or lack of knowledge
regarding this allergy.
Latex hypersensitivity has been reported to
cause anaphylactic reactions, asthma, eczema,
urticaria and death. Anaphylaxis and deaths in
the radiological suite have been attributed to
improperly manufactured barium enema
balloon catheters. Anaphylaxis in the operating
rooms was first reported in a spina bifida patient
series and is now being documented in the
general population as well. Its cause is unknown.
Possibly the most disturbing reports came from
Finland, Central Europe and the U.S. that the
greatest at-risk population for latex allergy are
health care workers. Continual exposure to
latex in exam gloves and surgical gloves
(estimates now range from 5.5 to 6 million
health care workers must glove daily due to
now enforced OSHA-Universal Precautions
regulations) may be a part of the cause.
However, recent reports released by hospitals
inquiring of manufacturers about latex, reveal
hundreds of medical devices, especially
operating room products, contain natural
rubber latex.
Switching to vinyl gloves from latex does not
appear to be a viable alternative as recent
studies indicate that latex affords nine times the
barrier protection of vinyl and for most health
care workers in this HIV, HBV age, that's not
good enough. There are emerging alternatives
for health care workers as newer synthetic
materials begin to appear on the market. The
bad news is they are expensive - very
expensive - which will do little for health care
cost containment. While synthetics will isolate
the hypersensitive from direct hand contact with
latex, they afford no protection from other latex
bearing products whose route of sensitization
may be through inhalation of latex particles.
Only a few glove manufacturers have been
successful in lowering protein allergen levels
to negligible amounts by extensive leaching
and washing of the latex during the
manufacturing process. Numerous hot water
leaching baths and post-process washings are
required to reduce or remove the water soluble
proteins from gloves.
What to do next? As an FDA publication reports, there's the rub. Until
reliable tests for the allergy are developed, the best protection for
patients and health care workers is a careful history and avoidance
should the history indicate past problems. FDA may soon require all
device manufacturers to label all products which contain natural rubber
latex. Latex precaution protocols are being developed at many hospitals
and alternative product lists are being developed to those products
known to contain latex.
When scientists and clinicians were questioned by the conference
participants as to whether or not this latex allergy was the "tip of an
occupational health iceberg," the answer seemed to be a universal "yes."
