Course 170 Hospital Hazards and Solutions: Latex Allergy

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Latex Allergy Prevention

Latex Definition

According to the Webster’s Dictionary, the term "latex" refers to natural rubber latex, the product manufactured from a milky fluid derived from the rubber tree, Hevea brasiliensis. Several types of synthetic rubber are also referred to as “latex,” but these do not release the proteins that cause allergic reactions.

Latex Allergies

Allergic Reactions
Workers who are exposed to latex gloves and other products that contain natural rubber latex may develop allergic reactions.

Workers in the health care industry (physicians, nurses, dentists, technicians, etc.) are at risk for developing a latex allergy because they use latex gloves frequently. Workers with less frequent glove use (hairdressers, housekeepers, food service workers, etc.) and workers in industries that manufacture latex products are also at-risk for having a latex allergy.

Workers who are exposed to latex gloves and other products that contain natural rubber latex may develop some of the following allergic reactions:

  • skin rashes (such as hives)
  • nasal, eye, or sinus symptoms (sneezing, itchy eyes, or wheezing from exposure to airborne latex particles)
  • asthma
  • shock (rarely)

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1. Which of the following is considered an allergic reaction to latex?

a. Coughing
b. Vomiting
c. Skin rashes
d. Fatigue

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Types of Reactions

Allergic Reactions
Use of natural rubber products can cause allergic reactions.

Use of natural rubber products may result in reactions that fall into the following three categories:

  1. irritant contact dermatitis
  2. allergic contact dermatitis (Type IV delayed hypersensitivity)
  3. IgE/histamine-mediated allergy (Type I immediate hypersensitivity)

Irritant Contact Dermatitis

When gloves are associated with skin wounds, the most common reaction is irritant contact dermatitis. Irritant contact dermatitis may be due to direct irritation from gloves or glove powder. It may also be due to other causes, such as the following:

  • soaps and detergents
  • incomplete hand drying
  • other chemicals

Irritant contact dermatitis presents as dried, cracked, split skin. Although irritant contact dermatitis is not an allergic reaction, the breaking of the intact skin barrier due to these lesions may afford a pathway for other natural rubber latex (NRL) proteins to gain access, which can cause a development of sensitivity. Additionally, irritant contact dermatitis lesions disrupt the barrier function that intact skin provides to inhibit passage of various chemicals and pathogens.

2. Irritant contact dermatitis may be due to ______ irritation from gloves or glove powder.

a. direct
b. indirect
c. delayed
d. unnecessary

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Allergic Contact Dermatitis
Allergic contact dermatitis has an appearance similar to the typical poison ivy reaction.
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Allergic Contact Dermatitis

The second type of reaction that may be associated with glove use is allergic contact dermatitis. When glove use has been associated with this reaction, the majority of cases appear to be due to the chemicals used in processing NRL or other glove materials. Allergic contact dermatitis has an appearance similar to the typical poison ivy reaction, with blistering, itching, crusting, oozing lesions.

Also, like poison ivy, this dermatitis appears 24-72 hours after the use of gloves or exposure to other sources of chemical sensitizers.

3. Most cases associated with allergic contact dermatitis is due to _____.

a. sensitivity
b. processing chemicals
c. lack of education regarding allergy
d. lack of training

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IgE/histamine-mediated Allergy

Symptoms
Symptoms from a latex allergy can range from mild to life-threatening.

The third and potentially most serious type of reaction sometimes associated with glove use is a true IgE/histamine-mediated allergy (also called immediate or type I hypersensitivity) to allergenic glove protein. This type of reaction can involve local or systemic symptoms.

Local Symptoms

Localized reactions occur at the site of exposure. For example, hives that appear in the area where contact occurred, is a localized reaction.

Mild localized symptoms including the following:

  • itching
  • skin redness
  • hives or rash

Systemic Symptoms

Systemic (more severe) symptoms that may indicate a serious latex allergy include the following:

  • sneezing
  • runny nose
  • itchy, watery eyes
  • scratchy throat
  • difficulty breathing
  • wheezing
  • coughing

Anaphylaxis Symptoms

The most serious allergic reaction to latex is anaphylaxis. An anaphylaxis reaction develops immediately after latex exposure in highly sensitive people. It rarely happens the first time someone is exposed.

Signs and symptoms of anaphylaxis include:

  • difficulty breathing
  • hives or swelling
  • nausea and vomiting
  • wheezing
  • drop in blood pressure
  • dizziness
  • loss of consciousness
  • confusion
  • rapid or weak pulse

If any of these symptoms develop following an exposure to latex, medical treatment must be initiated immediately.

4. Which of the following is a systematic symptom of IgE/histamine-mediated allergy?

a. Fatigue
b. Confusion
c. Scratchy throat
d. Increased blood pressure

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Diagnosing Latex Allergy

Antibodies
Blood tests approved by the Food and Drug Administration (FDA) are available to detect latex antibodies.
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A latex allergy should be suspected in anyone who develops symptoms after latex exposure. Any exposed worker who experiences the known symptoms should be evaluated by a physician as soon as possible. Further exposure could result in a serious allergic reaction.

Taking a complete medical history is the first step in diagnosing a latex allergy. Blood tests approved by the Food and Drug Administration (FDA) are available to detect latex antibodies.

Testing is also available to diagnose allergic contact dermatitis. In this FDA-approved test, a special patch containing latex additives is applied to the skin and checked over several days. A positive reaction is shown by itching, redness, swelling, or blistering where the patch covered the skin.

In some cases, tests may fail to confirm a worker who has a true allergy to latex. In other instances, tests may suggest latex allergy in a worker with no clinical symptoms. Therefore, test results must be evaluated by a knowledgeable physician.

5. What is listed as the first step in diagnosing a latex allergy?

a. Contacting your employer
b. Reducing the use of latex
c. Tell your family members
d. Take a complete medical history

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Latex Allergy Protection

Non-Latex Gloves
Use non-latex gloves for activities that are not likely to involve contact with infectious materials.
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Workers who have ongoing exposure to latex should take the following steps to protect themselves:

  1. Use non-latex gloves for activities that are not likely to involve contact with infectious materials.
  2. When handling infectious material, such as blood, use powder-free gloves with a reduced protein content.
  3. When wearing latex gloves, do NOT use oil-based hand creams or lotions, as they can cause the glove to deteriorate.
  4. Frequently clean work areas contaminated with latex dust, such as carpets and ventilation ducts.
  5. Learn to recognize the symptoms of a latex allergy.
  6. Take advantage of all latex allergy education and training provided by your employer.

6. Workers who have ongoing exposure to latex should _________.

a. use oil-based creams or lotions
b. frequently clean work areas contaminated with latex dusts
c. quit their current jobs
d. keep wearing latex

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Developing Symptoms

Medical Alert Bracelet
If you have a latex allergy, wear a medical alert bracelet.
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If you develop symptoms of a latex allergy, avoid direct contact with latex gloves and other latex-containing products until you can see a physician experienced in treating latex allergies.

If you have a latex allergy, consult your physician regarding the following precautions:

  • Avoid contact with latex gloves and products.
  • Avoid areas where you might inhale the powder from latex gloves worn by other workers.
  • Tell your employer and health care providers (physicians, nurses, dentists, etc.) that you have a latex allergy.
  • Wear a medical alert bracelet.

Case Reports

The following case reports briefly describe the experiences of three workers who developed a latex allergy after occupational exposures. These cases are not representative of all reactions to latex but are examples of the most serious types of reactions. They illustrate the experience in some individuals.

  1. A 33-year-old woman sought medical treatment for occupational asthma after 6 months of periodic cough, shortness of breath, chest tightness, and occasional wheezing. She had worked for 7 years as an inspector at a medical supply company, where her job included inflating latex gloves coated with cornstarch. Her symptoms began within 10 minutes of starting work and worsened later in the day continuing 90 minutes after leaving work. Symptoms disappeared completely while she was on a 12-day vacation, but they returned on her first day back at work.
  2. A midwife initially suffered hives, nasal congestion, and conjunctivitis. Within a year, she developed asthma, and 2 years later she went into shock after a routine gynecological examination during which latex gloves were used. The midwife also suffered respiratory distress in latex-containing environments when she had no direct contact with latex products. She was unable to continue working.
  3. An intensive care nurse with a history of runny nose, itchy eyes, asthma, eczema, and contact dermatitis experienced four severe allergic reactions to latex. The first reaction began with asthma severe enough to require treatment in an emergency room. The second and third reactions were similar to the first. The fourth and most severe reaction occurred when she put on latex gloves at work. She went into severe shock and was successfully treated in an emergency room.

Source: National Institute for Occupational Safety and Health

Latex allergy in the workplace can result in potentially serious health problems for workers, who are often unaware of the risk of latex exposure.

7. Which of the following items should you consult your physician on when dealing with a latex allergy?

a. Stay quiet at work
b. Wear a medical alert bracelet
c. Keep wearing latex gloves and products
d. How to talk to your employer

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Barrier Protection

Worker with PPE
Barrier protection must be used when hands would otherwise contact infectious materials, such as blood.
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It is extremely important that barrier protection be used when hands would otherwise contact infectious materials or hazardous chemicals, such as latex.

OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) requires that gloves be worn when it is reasonably anticipated that hand contact may occur with blood, other potentially infectious materials, mucous membranes, non-intact skin, or contaminated items or surfaces, as well as when performing vascular access procedures [except as specified in paragraph (d)(3)(ix)(D)].

When gloves are being worn to protect against bloodborne pathogens, the standard requires that employers provide readily accessible alternatives, such as glove liners, for employees who are allergic to the gloves normally provided.

8. According to OSHA's Bloodborne Pathogens Standard, employers are required to provide _____ for employees who are allergic to latex gloves.

a. accessible alternatives
b. nothing
c. training
d. education

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No Latex Sign
Reducing exposure has been the primary prevention method to protect workers with latex allergies.

Reducing Exposure

NRL is a glove material that has been used in the health care environment for barrier protection for several years. In response to reported NRL allergy in some patients and health care employees, measures have been recommended to reduce the risk of reactions to allergenic NRL proteins in employees. Reducing exposure has been the primary prevention method to protect workers with latex allergies. Gloves made of NRL as well as alternative materials have been cleared by the FDA for marketing as medical gloves. They can be used effectively for barrier protection against bloodborne pathogens.

9. _____ has been the primary prevention method to protect workers with latex allergies.

a. Education
b. Training
c. Reducing exposure
d. Control methods

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Hierarchy of Controls

Hierarchy of Controls
Employers should follow the hierarchy of controls to help prevent latex allergies.

Employers should follow the hierarchy of controls to help prevent latex allergies in the healthcare setting.

Elimination & Substitution: Eliminating exposure to latex is the most effective method of control. Unnecessary latex-containing materials should be eliminated. When materials, such as gloves and bandages, are required, a non-latex version should be substituted to replace the latex-containing version.

Administrative controls: Healthcare facilities should implement administrative controls, which include policies and procedures, to reduce the risk of allergic NRL reactions. For example, creating so-called "safe zones" to protect those employees who are already sensitized to NRL allergenic proteins might be necessary. "Safe zones" are areas where non-NRL products are used and NRL allergenic proteins have been removed from the environment.

Risk Reduction

A prudent risk reduction strategy involves an initial survey and assessment, with a coordinated effort to identify and catalogue all NRL products used in the workplace. An ongoing program involves close coordination between both resources and management staff. This will help monitor NRL content of incoming products so management can be prepared to choose appropriate alternatives to protect at-risk employees.

10. _____ is the most effective method of control when it comes to reducing latex exposure.

a. Ignoring
b. Training
c. Administrative controls
d. Elimination

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Employer Responsibility

Employee Training
Provide workers with education programs and training materials about latex allergy.
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Latex allergy can be prevented only if employers adopt policies to protect workers from undue latex exposures. NIOSH recommends employers take the following steps to protect workers from latex exposure and allergy in the workplace:

  1. Provide workers with non-latex gloves to use when there is little potential for contact with infectious materials (for example, in the food service industry).
  2. Appropriate barrier protection is necessary when handling infectious materials. If latex gloves are chosen, provide reduced protein, powder-free gloves to protect workers from infectious materials.
  3. Ensure workers use good housekeeping practices to remove latex-containing dust from the workplace:
    • Identify areas contaminated with latex dust for frequent cleaning (upholstery, carpets, and ventilation ducts).
    • Make sure that workers change ventilation filters and vacuum bags frequently in latex-contaminated areas.
  1. Provide workers with education programs and training materials about latex allergy.
  2. Periodically screen high-risk workers for latex allergy symptoms. Detecting symptoms early and removing symptomatic workers from latex exposure are essential for preventing long-term health effects.
  3. Evaluate current prevention strategies whenever a worker is diagnosed with latex allergy.

11. How often should you change the workplace ventilation filters and vacuum bags?

a. Once a month
b. Every hour
c. Frequently
d. Yearly

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Worker Responsibility

Wash Hands
After removing latex gloves, wash hands with a mild soap and dry thoroughly.
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Workers should take the following steps to protect themselves from latex exposure and allergy in the workplace:

  1. Use non-latex gloves for activities that are not likely to involve contact with infectious materials (food preparation, routine housekeeping, maintenance, etc.).
  2. Appropriate barrier protection is necessary when handling infectious materials. If you choose latex gloves, use powder-free gloves with reduced protein content:
    • Such gloves reduce exposures to latex protein and thus reduce the risk of latex allergy (though symptoms may still occur in some workers).
    • So-called hypoallergenic latex gloves do not reduce the risk of latex allergy. However, they may reduce reactions to chemical additives in the latex (allergic contact dermatitis).
  1. Use appropriate work practices to reduce the chance of reactions to latex:
    • When wearing latex gloves, do not use oil-based hand creams or lotions (which can cause glove deterioration) unless they have been shown to reduce latex related problems and maintain glove barrier protection.
    • After removing latex gloves, wash hands with a mild soap and dry thoroughly.
    • Use good housekeeping practices to remove latex-containing dust from the workplace. Frequently clean areas contaminated with latex dust (upholstery, carpets, and ventilation ducts).

12. When workers remove latex gloves, what should happen immediately?

a. Wash hands with mild soap and dry thoroughly
b. Throw them away immediately
c. Save them for the next day
d. Tell employer

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