- Three types:
- Contact dermatitis:
- Eighty percent of all reactions to wearing latex gloves
- Seen as dry, cracked skin worsened by powder and soap
- Nonimmunological response
- Treat by avoiding irritants and application of topical steroids
- Type IV delayed hypersensitivity:
- Eighty percent of all immunological responses to latex
- T-cell-mediated immunological response to latex allergen, usually chemical additive of latex manufacturing
- Usually presents 6–72 hours after exposure; mild itch to oozing blisters much like poison ivy; may respond to topical steroids
- Type I immediate hypersensitivity:
- IgE-mediated reaction to proteins found in latex
- May be localized with immediate urticaria (hives)
- May be generalized with hives, bronchospasm, airway obstruction, anaphylaxis, cardiovascular collapse
- At-risk groups:
- Health care workers:
- Twenty-four percent of anesthesiologists/nurse anesthetists have contact dermatitis
- Prevalence of latex sensitization in anesthesiologists/nurse anesthetists is up to 15%, and that in general population is up to 6%
- Health care workers who are patients themselves involved in up to 70% of latex-related adverse events
- Rubber industry workers, greenhouse workers, and hair stylists at increased risk
- Patients with multiple surgeries:
- Frequent exposure to latex products experienced by patients with congenital urological anomalies and spina bifida can have incidence as high as 60%
- Food allergies:
- Tropical fruit (avocado, kiwi, banana), chestnuts, stone fruit (peach, nectarine, apricot, almond, plum, cherry). Buckwheat, a grain substitute used in gluten-free diets of patients with celiac disease, is known to have cross-reactivity with latex
- Allergy history:
- Atopic, asthma, rhinitis, hay fever, or eczema
- Identify at-risk patients by history and testing. Well-coordinated perioperative team approach to patient care critical
- Skin prick testing specific and sensitive, but reserved for inconclusive laboratory testing because of potential severe reaction in sensitized patient
- Radioallergosorbent test (RAST), an in vitro test for latex-specific IgE antibodies, recommended, but can have up to 30% false negatives
- Elective cases should be first case of day if possible
- Signs identifying the patient as latex allergic or at risk should be posted throughout the operating and recovery suites
- Pretreatment with antihistamines and/or systemic steroids not shown to prevent anaphylaxis or attenuate severity of Type I response
- Anesthesia (and surgical) equipment latex-free:
- Gloves, nasal/oral airways, endotracheal tubes, blood pressure cuffs, masks, bags, circuits, ventilator bellows, tourniquets, intravenous catheters, Swan–Ganz catheters (balloon: special PACs without a balloon are available), suction catheters, temperature probes
- Rubber stoppers removed from multidose vials; medications stored in syringes should be reconstituted every 6 hours
- Prepare dilute epinephrine (10 μg/mL) immediately available. See chapter 201 for treatment of anaphylaxis
- Cart containing non-latex items and signs identifying patient as latex sensitive should remain with patient throughout hospital course. Medic alert bracelet recommended
- Key is to identify allergic patient by history/testing; if in doubt, treat as such
- Avoid antigen exposure intraoperatively and perioperatively
- Contact dermatitis and Type IV delayed hypersensitivity usually responds to avoiding the offending irritant (powder, soap, glove type, chemical additive) and topical steroids
- Type I immediate hypersensitivity: ...
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