Learning Objectives
By the end of this section, you will be able to:
- Discuss the pathophysiology, risk factors, and clinical manifestations for latex allergy
- Describe the diagnostics and laboratory values for patients with a latex allergy
- Apply nursing concepts and plan associated nursing care for patients with a latex allergy
- Evaluate the efficacy of nursing care for patients with a latex allergy
- Describe the medical therapies that apply to the care of patients with a latex allergy
The natural protein derived from the sap of the rubber tree, Hevea brasiliensis, is used to create latex. Latex allergies can cause allergic reactions including conjunctivitis, rhinitis, urticaria, asthma, contact dermatitis, and anaphylaxis. Since the introduction of latex-free and non-powdered latex gloves, the incidence of latex allergies has gradually decreased.
Latex gloves are made by converting liquid rubber into a stretchable solid form; the process uses more than 200 chemicals. The source of allergic reactions is thought to be from either the rubber proteins or the numerous chemicals used. Not all latex products have the capability to cause allergic reactions; it depends on the manufacturing method used to produce the products. Table 24.3 lists latex-free alternatives to the wide variety of home and hospital items that traditionally contain latex (Spina Bifida Association, 2009).
| Category | Latex-Containing Items | Alternatives or Latex-Free Brands |
|---|---|---|
| Home Items | Balloons | Mylar balloons |
| Condoms, diaphragms | Durex Avanti and Reality products, polyurethane products | |
| Diapers, incontinence pads | Always, Huggies | |
| Feminine hygiene products (pads, tampons) | Kimberly-Clark | |
| Wheelchair cushions | Sof Care or ROHO cushions | |
| Hospital Items | Ace brown bandage | Ace white, cotton bandage |
| Adhesive bandages, Telfa, Band-Aids | Cotton pads with plastic or silk tape, DuoDERM, 3M Active Strips | |
| Anesthesia equipment | Neoprene anesthesia equipment | |
| Blood pressure tubing, cuff, bladder | Single-use nylon or vinyl cuffs, Clean Cuff, or use stockinette between equipment and patient clothing | |
| Catheters and catheter leg straps | Vinyl or all silicone IV catheters, Velcro straps for leg straps | |
| Crutch axillary pads, hand grips, tips | Cover silicone with tape or cloth | |
| EKG pads | Red Dot 3M EKG pads, Baxter | |
| Elastic compression stockings | Kendall SCD stockings (with stockinette) | |
| Enema kits that are prepackaged | Fleet Ready-to-Use, Therevac | |
| Gloves | Vinyl, neoprene, polymer, or Derma Prene gloves | |
| IV catheters | Deseret or Jelco IV catheters | |
| IV rubber injection ports | Cover Y-sites and ports and be careful not to puncture. Use 3 way stopcocks on plastic tubing. | |
| Levin tube | Salem sump tube | |
| Medication vials | Remove the rubber stopper | |
| Penrose drains | Zimmer Hemovac or Jackson-Pratt drains | |
| Pulse oximeters | Nonin oximeters | |
| Resuscitation bags | Puritan Bennett, Laerdal, and some Ambu | |
| Stethoscope tubing | Cover with latex-free stockinette; PVC tubing | |
| Suction tubing | Davol or Laerdal (PVC) | |
| Syringes | Abbott PCA Abboject or Terumo syringes | |
| Tapes | Micropore, Dermicel | |
| Theraband | Plastic tubing, new Theraband Exercisers | |
| Thermometer probes | Daitek covers | |
| Tourniquets | Avcor (X-Tourn) straps |
Pathophysiology and Risk Factors
Latex allergy is a type I IgE-mediated immediate hypersensitivity due to the natural rubber proteins or other chemicals used in manufacturing. After sensitization, IgE antibodies stimulate mast cells and basophils to release histamine, prostaglandins, leukotrienes, and kinins that result in an immune response. Individuals at risk for latex allergies include patients with atopic allergies, patients with multiple surgeries, latex manufacturer workers, some health care workers, spina bifida patients, food handlers, automobile mechanics, hairdressers, and any individual in a profession that wears latex gloves. Those with latex allergies are at risk for developing an anaphylactic reaction. There have also been cross-reactions reported: some individuals with latex allergies are also allergic to bananas, avocados, kiwis, pineapples, mangoes, passionfruit, and chestnuts.
Latex exposure routes can be aerosol, parenteral, mucosal, percutaneous, or cutaneous, but allergic reactions are more likely to occur with parenteral or mucosal exposure. The most common reaction is from cutaneous contact by wearing latex gloves. The powder used in the latex gloves can also be a carrier of the rubber proteins; if the powder becomes airborne, it can lead to inhalation or settle on skin, clothing, or mucous membranes. Examples of mucosal exposure include catheters, airways, latex condoms, and nipples. Examples of parenteral exposure include hemodialysis equipment or intravenous lines.
Clinical Manifestations
There are various types of reactions to latex, including irritant contact dermatitis, allergic contact dermatitis, and latex allergy. Irritant contact dermatitis is not an allergic reaction. It is caused by skin damage due to irritation and the eventual loss of epidermoid skin. Causes include repetitive handwashing, extreme use of soaps, mechanical irritation like sweating or rubbing inside gloves, insufficient hand drying, exposure to chemicals used in the manufacturing process, and the alkaline pH of powdered gloves. Clinical manifestations may be acute (erythema, edema, burning, pruritus, or discomfort) or chronic (dry, thickened, and cracked skin).
Allergic contact dermatitis is usually the result of the chemicals used in the manufacturing process. The reaction is not life-threatening; it generally has a slow onset and occurs 18–24 hours after exposure and resolves within 3–4 days. Severe reactions may happen with re-exposure. Clinical manifestations include edema, erythema, pruritus, crusty thickened skin, blisters, and skin lesions.
Latex allergy can be due to inhalation or contact with the skin, mucosa, or internal tissues. Severe reactions are common with parenteral or mucosal exposure types. However, any individual with this type I hypersensitivity is at risk for anaphylaxis. Clinical manifestations can occur within minutes after exposure and may include localized edema, erythema, edema, pruritus, and systemic reactions such as anaphylaxis. Other clinical manifestations may include urticaria, rhinitis, flushing, laryngeal edema, bronchospasm, conjunctivitis, asthma, angioedema, extreme vasodilation, anaphylaxis, cardiovascular collapse, and even death.
Assessment and Diagnostics
Latex allergies are diagnosed by history and diagnostic test results. Laboratory tests may include serum-specific IgE, ELISA, EIA, or the level of Hevea latex–specific IgE antibodies. The preferred method for individuals with contact allergies is skin patch testing, which can detect sensitization to chemicals used in the manufacturing process. Only clinicians with expert experience with T.R.U.E. or other skin tests should perform this type of testing in the event of systemic or local allergic reactions.
Nursing Care of Patients with a Latex Allergy
Nurses play an important role in managing care for those with latex allergies. Nursing care includes completing a nursing assessment to recognize and analyze cues, prioritizing hypotheses, generating solutions, taking action, and evaluating care and outcomes. If any outcomes have been deemed nonsatisfactory, then the nurse must reassess using the Clinical Judgment Measurement Model and start over with recognizing and analyzing cues and then following subsequent steps until a satisfactory outcome is reached.
Recognizing and Analyzing Cues
As part of recognizing and analyzing cues, the nurse should conduct a physical examination and obtain the patient’s personal and family history of allergies. Physical examination findings may reveal any of the clinical manifestations previously. An assessment should include the patient’s onset of symptoms after exposure to the suspected or known allergen. The nurse may use a latex allergy screening form with any new patient who may be exposed to latex.
Link to Learning
This link from Martin One Source provides a general assessment form that may be used to screen for a latex allergy.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
After documenting findings from the physical examination and patient history, the nurse should verify orders received from the provider. Interventions may be aimed at finding alternative, latex-free products for those with known or suspected latex allergies, as well as improving symptoms with reactions and educating patients about avoidance therapy and emergency measures.
Nurses working in surgery settings, emergency departments, or intensive care units should pay special attention to the possibility of patients with latex allergies. Review (Table 24.3) for alternatives to latex-containing items found within the hospital setting. Patients who have a reaction require interventions to improve symptoms, which vary depending on the reaction type. Any new latex reactions should be documented as a new allergy. Medications may include epinephrine in extreme cases or when patients have difficulty breathing. Antihistamines or corticosteroids may also be prescribed. Since anaphylaxis is a risk with any allergic reaction, the nurse must assess and be ready to intervene in the event of this type of emergency.
The nurse should educate the patient on signs and symptoms that warrant a medical emergency, instructions for using an EpiPen, and the need to report this allergy to other health care providers. The nurse should also advise the patient to be careful around foods that have been reported to be cross-linked with latex allergies, such as bananas, avocados, pineapples, and chestnuts. The nurse should identify items in the patient’s home that may include latex and help identify alternatives.
Evaluation of Nursing Care for Patients with a Latex Allergy
Evaluation is an essential part of the nursing process. The nurse should compare observed outcomes against expected outcomes. This allows the nurse to evaluate for signs of improvement, decline, or if unchanged. The nurse would then use their judgment to assess whether the interventions were effective or if other interventions are needed.
Evaluating Outcomes
The nurse will want to evaluate expected outcomes for patients with latex allergies. The nurse can determine if symptoms have improved based on clinical examination as well as patient verbalization. The nurse can determine comprehension by having the patient verbalize or reiterate the teachings regarding diagnosis, symptoms, medications, and allergen avoidance measures. The patient should also be able to demonstrate how to properly administer their medications and be able to describe signs and symptoms to report like those of anaphylaxis, difficulty swallowing, wheezing, difficulty breathing, peripheral tingling, and urticaria.
Medical Therapies and Related Care
The primary management for latex allergies includes eliminating exposure. Patients with latex allergies should have a kit containing an EpiPen and antihistamines, and they should wear a medical alert bracelet. The patient should report this allergy to any health care facility where they are receiving care, local paramedic and ambulance companies, and their employer in the event of a job duty that may require exposure to latex. The patient can also get labels for their vehicle to alert paramedics or police about their allergy in the event of an emergency. The patient should also be encouraged to carry latex-free gloves with them. Those with type I latex hypersensitivity may not be able to continue their occupation if avoidance is not an option. Patients may also need to be referred to local support groups due to the significant changes that may take place with avoidance therapy or loss of occupation.