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NEWS & INFORMATION
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Source To Surgery - January 1993, Vol. 1 Issue
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Management of the Latex Sensitive Patient
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Kevin Kelly, MD, Medical College of Wisconsin, Milwaukee, Wisconsin
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Management of the patient sensitized to latex protein is a challenging
problem. The majority of patients sensitized will have spina bifida,
congenital urinary tract malformations, frequent surgeries, atopy or be
health care workers and workers in latex manufacturing industries.
Identification of patients preoperatively may be done through history
and physical examination. A history of contact urticaria to rubber
products, conjunctivitis, rhinitis or wheezing with contact to rubber
products are sensitive clinical indicators. Because of the high
prevalence of latex allergy in the spina bifida population, latex
avoidance should be carried out from birth. A hospital program to
insure removal of non-essential latex products should be established
within the hospital operating room, inpatient floors, emergency rooms
and clinics. Adequate substitute products should be made available as
replacements. Items purchased by the hospital should be identified as
to their content of natural rubber latex. Patients should be identified by
allergy banding and their rooms should be free of latex products
because of the risk of aerosolization of latex protein in the room where
latex products are stored. The room where the patient is staying should
be marked at the door as requiring latex precautions.
Because medical products are not the only devices that contain natural
rubber used in the hospital, support services need to be aware of this
problem. These products also should be identified (e.g., housekeeping
rubber gloves used for cleaning, baby pacifiers and rubber toys such as
balloons, Koosh balls or rubber balls). If these patients require
operation, selected use of premedication regimens of corticorsteroids,
H1 and H2 antagonists and Ephedrine should be considered in patients
identified at high risk of developing anaphylaxis in the operating
room. Conflicting results have been published on the benefit of this
therapy, but the risk of this therapy preoperatively is minimal. This
decision can be made in consultation with the hospital anesthesiologist
and allergist. Patients sensitized to latex should be counseled in the
use of emergency Epinephrine and latex avoidance in the home
environment. Patients identified with latex allergies should wear a
medical alert device alerting health care professionals to their allergy.
Health care workers manifest latex sensitivity initially as contact
urticaria although rhinitis, sinusitis, asthma and generalized urticaria
may be the only manifestation of their illness. Between 6-10 percent
of health care workers may be sensitized to latex protein at this point
in time. Whether the institution of universal precautions and increasing
use of latex gloves is responsible for this is unclear. Continued
exposure by the sensitized health care workers may cause progression
of symptoms. Individuals may need to alter their work environment in
the hospital, and the employer must accommodate that individual. The
cost of altering this work area is not prohibitive. Occupational health
personnel are important in making a satisfactory work environment for
the latex sensitized health care worker. Health care workers who are
experiencing asthma attacks at work may benefit from the use of peak
flow monitoring at home and at work.
As new research demonstrates improved methods of prevention and
management of latex allergy in the sensitized patient, the AnsellCares
Scientific Advisory Board will be updating you at regular intervals
through this newsletter in order to give you the latest information.
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