Guidelines for General Practice Management of Latex Allergic Patients
Preamble
These guidelines apply to patients with Type 1 and Type 4 reactions to latex. The need for specific guidelines is because exposure to latex can lead to local and serious systemic reactions, including anaphylaxis. Latex is ubiquitous in health care facilities, and as a result affected patients are presently at considerable risk.
Aim of Guidelines
The most important aim is to attempt to provide a latex safe environment.
A latex free product list must be drawn up and kept readily available within areas of emergency treatment. In practices where powdered latex gloves are used the most difficult part of providing a latex safe environment is ensuring that the patient's air is not contaminated with powder from latex gloves, as this alone can trigger serious reactions in sensitive individuals.
Prophylaxis with steroids and H1 and H2 antagonists has not been found to prevent serious reactions, and should not be relied upon. (Anesth Analg 1993; 76:650-652.)
Where the diagnosis has already been made the aim of management is to reduce contact with latex equipment to a minimum, and so reduce the likelihood of a serious allergic reaction. Even so it is important to be vigilant and prepared to treat severe allergic reactions.
Not all patients will be identifiable, and in view of the increasing incidence of latex allergy if anaphylaxis occurs, especially in patients from high risk groups, latex equipment should be changed to nonlatex alternatives as part of treating the reaction.
The difficulty in preparing guidelines is that the sensitivity to latex varies from patient to patient. Some patients will tolerate latex skin contact, while others may have anaphylaxis to the residual latex powder in a ward. This means that while for some patients these guidelines are excessively cautious, they may not prevent serious reactions in all patients.
Management of known latex allergic patients
Identification of patients.
Enquire about latex allergy, just as a history of drug allergies is routinely sought. Particularly question individuals at risk, eg. patients from high risk occupations, particularly those with atopy, and those with spina bifida. At risk patients should be referred for specialist evaluation.
Patients with undiagnosed episodes of anaphylaxis, and those with severe fruit reactions definitely require further evaluation by a specialist.
Label the patient's notes ideally in a way to differentiate the patient from patients with other allergies.
Preparation of a Latex Safe Environment
What equipment has latex in it
Latex is a component of a large number of medical devices.
At present there is no mandatory labelling and so considerable effort is required to keep an up-to-date record of latex free medical equipment.
Gloves
These are the most likely to cause serious reactions, especially if they contact mucous membranes. (BMJ 1994; 308:246-247.)
All latex gloves need to be removed from the immediate area of the patients.
Synthetic gloves must be used for all procedures. Neoprene gloves are available in sterile gloves and are latex free. Vinyl gloves are the only currently available synthetic examination gloves, but these are not as strong or as impermeable to viral particles as latex.
As a general guide the following need to be checked:
- Surgical drains, urinary catheters, condom drainage, antiembolic stockings, bougie dilators, tourniquets, dental dams, embolectomy catheters.
- Monitoring: BP leads, oximeters, ECG dots, pulmonary artery catheters
- IV lines, and infusion bags
- Latex stoppers in vials
- Plungers in some syringes
- Catheter leg bag straps
- Mattresses
- Dressings, 'Elastic' bandages, Skin adhesives
- Feeding nipples and tubes
Consulting Room preparation
Steps 2, 3 are not necessary if the surgery/consulting rooms do not use any powdered latex gloves.
1. Synthetic gloves must be used.
2. Prepare consulting room, where possible, at least 3 hours before patient admission. Sensitive patients should be seen first patient of the day and the room prepared the night before.
3. All equipment and furniture to be damp dusted to remove late powder.
4. The prepared room must have signs attached at all entrances to ensure a latex safe area.
5. All procedures must be planned
6. Be prepared to treat serious reactions.
Consulting Room procedures
Synthetic gloves must be used.
The following procedures need planning:
1. blood taking: synthetic gloves, tourniquet over clothing
2. suturing/minor surgery: synthetic gloves
3. internal examinations: synthetic gloves
4. giving IV, IM, SC drugs: see below
5. inserting IV: see below
6. bladder catheterisation: synthetic gloves and non latex catheter
Where possible perform procedures within prepared environment.
Monitoring
1. Arm for BP measurement must be covered to protect skin from BP leads.
2. Stethoscopes may contain latex in the tubing, ear pieces and bell.
3. Oximeter probe may contain latex, but can be used over a vinyl glove or a clear dressing.
4. ECG dots may contain latex in the adhesive.
IV lines and Drugs
1. Synthetic gloves must be used.
2. Latex free syringes should be used.
3. No drugs to be drawn up through rubber bungs.
4. No drugs to be given where there is a rubber stopper within the vial. (Anesth Analg 1995; 80:1057-1-58).
5. Use an IV line without latex ports, or if using a line with latex ports they must be removed and replaced with reflux valves, prior to running through IV fluid. There is a case report of anaphylaxis to an IV line where this was not done(J Allergy Clin Immunology 1993; 92:358-359).
6. Infusions to be made up by injecting through giving set port of IV fluid bags rather than through the rubber bung, which is not in contact with the fluid and can be removed.
7. Do not use colloids with latex bungs.
8. Only latex free IV dressings and skin tapes.
Resuscitation Equipment
In general resuscitation equipment purchased should be latex free where this is possible. All resuscitation trolleys should routinely have powderless latex gloves, and nonlatex gloves should only be readily available when a latex allergic patient is in that area. When there is a patient with a latex allergy in an area the following must be available in that area:
Synthetic gloves.
Latex free circuit, masks, catheter mount, oral airways.
Referrals and Investigations
Ensure whenever the patient is referred to other doctors and paramedical professionals, they are informed of the patient's latex allergy and its significance.
If the patient has to go for investigations notify the pathology, or radiology service to ensure they are aware of the patient's condition and its significance and how to safely manage the patient.
Content updated March 2010