Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Three types: Contact dermatitis: Eighty percent of all reactions to wearing latex glovesSeen as dry, cracked skin worsened by powder and soapNonimmunological responseTreat by avoiding irritants and application of topical steroidsType IV delayed hypersensitivity: Eighty percent of all immunological responses to latexT-cell-mediated immunological response to latex allergen, usually chemical additive of latex manufacturingUsually presents 6–72 hours after exposure; mild itch to oozing blisters much like poison ivy; may respond to topical steroidsType I immediate hypersensitivity: IgE-mediated reaction to proteins found in latexMay be localized with immediate urticaria (hives)May be generalized with hives, bronchospasm, airway obstruction, anaphylaxis, cardiovascular collapseAt-risk groups: Health care workers: Twenty-four percent of anesthesiologists/nurse anesthetists have contact dermatitisPrevalence 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 eventsRubber industry workers, greenhouse workers, and hair stylists at increased riskPatients 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 latexAllergy history: Atopic, asthma, rhinitis, hay fever, or eczema ++ Identify at-risk patients by history and testing. Well-coordinated perioperative team approach to patient care criticalSkin prick testing specific and sensitive, but reserved for inconclusive laboratory testing because of potential severe reaction in sensitized patientRadioallergosorbent test (RAST), an in vitro test for latex-specific IgE antibodies, recommended, but can have up to 30% false negativesElective cases should be first case of day if possibleSigns identifying the patient as latex allergic or at risk should be posted throughout the operating and recovery suitesPretreatment 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 probesRubber stoppers removed from multidose vials; medications stored in syringes should be reconstituted every 6 hoursPrepare 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 suchAvoid antigen exposure intraoperatively and perioperativelyContact dermatitis and Type IV delayed hypersensitivity usually responds to avoiding the offending irritant (powder, soap, glove type, chemical additive) and topical steroidsType I immediate hypersensitivity: ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.