Monday, August 15, 2011

Management of Latex Allergic Surgical Patient

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

A couple of nice articles recently on latex allergy have crossed my path – one in a journal I subscribe to (Aesthetic Surgery Journal) and the other via twitter and @Allergy  (Ves Dimov, M.D., blogs at Allergy Notes).  I’ve put both full references below.
Latex allergy became widely recognized in the late 1980s and early 1990s.  The increase in latex allergies cases is felt to be associated with the increase use of latex gloves and implementation of universal precautions (now known as standard precautions) in the 1980s.
Management of possible or confirmed latex allergic patients begin with history and suspicion:
All patients who present for surgical procedures or exams which require latex gloves (pelvic exam, dental exams, etc) should be questioned about possible latex allergy.
Patients at highest risk include those who have a history of multiple surgeries (especially for urogenital abnormalities which may require frequent urinary catheterizations), allergic disease, or spina bifida, or who are employed in occupations with inherent latex use (ie, healthcare workers).
If an individual patient notes a history of food allergies (atopy), pay special attention if those foods include banana, kiwi, avocado, or stone fruits like cherries or peaches which are associated with latex allergy.
Regardless of the cause, the presence of hand dermatitis is a risk factor for developing latex allergy among healthcare workers

Confirmation of latex allergy is achieved through laboratory testing.  Dr. Dimov has a nice post which explains this:  Latex Allergy - ACAAI Video
Confirmation should be done if there is time.  If not, then proceed as if the patient is latex allergic.

Here’s my check list:
1.  When I schedule the procedure, I inform the facility so they can prepare using their own check list (ie special cleaning of room and anesthesia equipment, pulling of latex free supplies, labeling room as latex-free, etc).
2.  I schedule latex-sensitive/allergic patients as the first case of the day.  This assumes it is an elective case and not an emergency.
3.  If I need girdles or other postoperative garments, I make sure they are latex-free when I order them.
The second article (the one from Dr. Dimov) takes a look at hospital policies which ban the use of natural rubber latex (NRL) devices and whether they may be an overreaction.
Their conclusions (bold emphasis is mine):
With the reduced incidence of allergic reactions, the availability of specific and sensitive testing for the selection of low-allergen gloves, competitive costs and lower environmental impact, NRL remains an excellent choice of material for medical gloves and should continue to be used.
In recent years, a number of high profile institutions have moved to a totally NRL-free environment, including gloves. However, the evidence within Europe demonstrates that the many benefits of NRL can be retained by purchasing low-allergen, low-protein and powder-free gloves, thereby reducing the risk of type I and type IV sensitization as well as allergic reactions.
NRL gloves are characterized by a high level of barrier performance for staff and patients, good comfort allowing staff to perform safely and efficiently, and competitive pricing in a period of economic difficulty. NRL is an environmentally sustainable material, which is also naturally biodegradable, enabling hospitals to meet their ‘green’ purchasing requirements.
Finally, compared with various synthetic materials, NRL is generally better accepted by the clinicians. There will, of course, be a continuing requirement for synthetic gloves for known latex-allergic patients and staff, and for these purposes several options are currently available. In conclusion, we believe that a sensible balance requires a mix of latex and synthetic gloves.


Recognition and Management of the Latex-Allergic Patient in the Ambulatory Plastic Surgical Suite;  Deborah Accetta and Kevin J. Kelly; Aesthetic Surgery Journal July 2011 31: 560-565, first published on June 1, 2011 doi:10.1177/1090820X11411580
Latex Medical Gloves: Time for a Reappraisal; Palosuo T, Antoniadou I, Gottrup F, Phillips P; Int Arch Allergy Immunol 2011;156:234-246 (DOI: 10.1159/000323892)

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