Latex Allergies: How to Best Manage Them
by Dr. Deborah Davis

Addressing the needs of latex-sensitive patients and managing latex sensitivities and skin wellness among staff members are key issues in health care. Because natural rubber latex products are ubiquitous, a “latex-free environment” is impossible to achieve. Only latex-free products, devices and equipment can safely be used with anyone who is sensitive or allergic to natural rubber latex (NRL) protein allergens.

Latex Allergy Guidelines
NRL is made from the sap of rubber trees, and is in many products such as balloons, toys, rubber bands, gloves and condoms. Latex allergies can present a wide range of symptoms from mild to severe itchy, red rashes or bumps, hives, itchy, watery eyes, sneezing, runny nose to wheezing, shortness of breath and chest tightness.

Reactions to NRL products are classified as:
Type I or “immediate hypersensitivity” reactions are IgE mediated and symptoms range from hives at contact sites to systemic allergic reactions (anaphylaxis). These occur in genetically predisposed, sensitized persons who may manifest clinical symptoms on exposure to certain NRL proteins.

Type IV or “delayed hypersensitivity” reactions involve a cell-mediated sensitivity to chemicals used in making latex products. They manifest as a poison-ivy-like rash. Because this reaction is to chemicals and not NRL itself, susceptible individuals may not react to other latex products.

Irritant skin reactions related to latex products (particularly gloves) are not allergic reactions. They may result from compromised skin integrity from retained soaps and moisture. Thorough rinsing and complete hand drying before donning gloves may alleviate this.

Employer Considerations
Healthcare workers with latex allergies may seek workers’ compensation benefits and costs associated with these allergies could be substantial. Turnover is also a major concern, with labor shortages and competitive pressures making employee retention a strategic issue. To minimize the risk of losing employees from latex allergy concerns, some facilities are opting to go latex-free altogether.

An analysis of a 500 bed, non-profit, non-teaching hospital showed it only needed 1.08 workers on disability from latex allergy to financially break-even in converting to synthetic medical gloves. To evaluate the cost of staff loss from latex allergy, consider the cost of replacing an experienced employee, the value of knowledge and experience to the organization and the loss of productivity during a transition. Conservative estimates place turnover costs at 25% of annual salary plus benefits.

Patient Considerations
Some patients don’t know they are latex-allergic and clinicians must determine their status and take measures for appropriate care. Many hospitals have gone latex-free in emergency and trauma areas where patients may be unable to indicate their status. Additionally, infants undergoing surgery should be treated with latex-free products from the very beginning of life.

Prevention Strategies
In its Latex Guideline in the 2007 Edition of Standards, Recommended Practices and Guidelines, the AORN states: “The goals of prevention are twofold: to prevent reactions in individuals who are latex sensitized and to prevent initial sensitization of non-sensitized persons. The only effective strategy at this time is latex avoidance.” There is no clinically acceptable definition of the term ‘latex safe’. The only latex-safe product or device is one that is manufactured without any natural rubber latex. NRL products that have been ‘deproteinized’ or have low-protein levels are not proven to be safe for individuals who are allergic or are sensitized to NRL.

Synthetic gloves and supplies should be used where NRL is not required (e.g., food handling). Synthetic gloves of the past were often stiff, uncomfortable, had lower tactile sensitivity and tear-resistance than NRL. Their barrier effectiveness also raised concerns. Thanks to today’s technology, the properties of synthetic polyisoprene are nearly identical to those of NRL, and as alternatives for NRL, synthetic polymers are often preferred for their greater uniformity and consistency.

Cardinal Health’s Esteem® synthetic surgical gloves are formulated with synthetic polyisoprene using a unique and proprietary formulation and manufacturing technology. These gloves do not elicit Type I reactions and are preferred for individuals with Type I NRL allergies. They have the fit, feel and comfort of NRL and eliminate all concerns of protein allergy.

As a result of potential cost implications and factors such as employee morale, some facilities are opting to go latex-free and avoid the risk altogether. The good news is that options continue to evolve and the types of gloves available today provide better protection and comfort than ever before.

For more information on Cardinal Health’s products and services call 800.964.5227 or visit www.cardinalhealth.com

Deborah Davis, PhD Vice President, Technical and Clinical Marketing Cardinal Health Medical Products and Technologies. Dr. Davis’ primary responsibilities include driving clinical research initiatives, coordinating various aspects of product development among the marketing, regulatory, manufacturing and research and development organizations, and overseeing the publication and presentation of technical information for clinician customers. Dr. Davis received her doctorate in Administrative Leadership from the University of Wisconsin-Milwaukee; her MBA from Loyola University and her MS in Biology from Northeastern Illinois University.

Sosovec, D., Latex Allergy Guidelines: Assessment and management of patients and employees, Cardinal Health, 2003.

Phillips, V.L., et al., 1999. Health Care worker disability due to latex allergy and asthma: A cost analysis. American Journal of Public Health, 89(7), 1024-1028.

Degenhardt, P., Golla, S., Wahn, F. and Niggemann, B., Journal of Pediatric Surgery, Vol 36, No. 10, 2001.

Connor, R., Ed., AORN Latex Guideline, Standards, Recommended Practices and Guidelines, 2007 Edition, Denver, CO.