Latex allergy: care of the child

With the heightened awareness of the need to use personal protective equipment in the healthcare setting, there has been a commensurate increase in the number of staff and patients who appear to have developed a sensitivity, and in some cases a measurable allergy, to a variety of products containing latex.

This guideline outlines the categories of patients that may be at particular risk, as well as general precautions that should be taken in order to avoid developing the condition for staff as well as patients.

It also suggests how the inpatient care environment, as well as the products used in that care, may be adapted to safely manage a child with a noted sensitivity or diagnosed allergy to latex.

Background

An allergy is any immunological reaction to a foreign substance that produces detrimental consequences to the body (Thompson 1994).

There are approximately 40,000 products worldwide that are manufactured from natural rubber latex (NRL), and in excess of 400 are used regularly in the healthcare setting (Johnson 1999, HSE 2008). 

Risk assessment

People at high risk for serious reactions

People at risk for developing latex allergy

• Occupational exposure to latex products, particularly to powdered products such as gloves or to latex aerosols (NPSA 2005) (Rationale 2).

• History of oral allergy syndrome or progressive reactions to foods known to cross-react with NRL, including bananas, kiwi fruits, avocado, stone fruits, raw potato, tomato, papaya, chestnuts or peanuts, or a history of a latex glove-associated contact dermatitis (Rationale 2).

People who should be evaluated for latex allergy

• history of any unexplained anaphylaxis, particularly if occurring in a medical or dental setting

• history of hives or itching after incidental latex exposure, such as occurs during medical or dental examinations, or on contact with balloons or plasters

• history of multiple surgical procedures (Rationale 3)

Routes of exposure

Systemic exposure to latex can occur via several routes:

• cutaneous – through touch on the skin

• mucous membrane – internal examinations, dental treatment, intubation

• inhalation – breathing in microfine airborne particles from glove powder

• intraoperative handling of internal tissue

• intravascular – via injection from products stored or drawn up through rubber bungs on vials

Prevention

There are two goals for prevention:

• to prevent initial sensitisation

• to prevent reactions

Currently, the only effective preventative strategy is latex avoidance.

Since it is virtually impossible to remove all latex from the environment, every reasonable effort should be made to provide a latex-safe area in order to avoid further sensitisation (Kelly et al 1996).

Strategies to prevent an allergic response to latex should include the following:

• When taking a patient history which suggests that a potential sensitivity or allergy to NRL may be present, a blood sample should be taken for RAST testing (Rationale 4).

• A latex-safe box should be available to all clinical areas and its location advertised (See Appendix 1) (Rationale 5).

• Speciality patient care areas, such as operating theatres, should have a list of latex-safe items to meet special care needs (Rationale 6).

• Resuscitation trolleys should contain latex-safe items and manufacturer documentation should be obtained to ensure that the trolley contents are latex-safe (Rationale 7).

• A directory of healthcare products containing latex and latex-free substitutes should be maintained and monitored centrally (Rationale 8).

General care

Patients in high-risk groups, or whose history indicates that they may be at risk of an allergic reaction, need to be identified. Where there are specific issues locally, the area concerned should devise local procedures to meet the needs of affected patients (Rationale 9, Rationale 10).

Staff caring for latex allergic patients should be familiar with at-risk groups and the levels of precaution required (Rationale 11).

They should also be aware of the availability of a latex-safe box and its location (See Appendix 1) and should have received resuscitation training as per Trust policy (Rationale 12, Rationale 13).

Care in ward areas

Latex safe equipment should be used wherever possible (Rationale 14). A latex-safe cubicle may need to be available for known latex allergy patients, with appropriate notification on the cubicle door (Rationale 15).

A risk assessment should be performed with the family on admission in order to identify levels of risk to the child, while preserving the child’s ability to maintain normal social interactions and to receive routine care (Rationale 16).

Staff should be informed prior to admission about the patient’s latex allergic status. Red allergy patient identification bands should be used and the type of allergy should be stated as per Trust ID policy.

Staff should avoid touching latex and then touching the patient and should wash their hands before initiating any patient contact (Rationale 14, Rationale 17).

Staff should ensure they are aware of the location of the patient’s Epipen®Jr/Anapen®Jr throughout their admission (Rationale 18).

Perioperative care

Preoperative preparation

The patient should be first on the operating list. If this is not possible then, in an operating room with standard air changes of at least 25 per hour, there should be an interval of 30 minutes between cases to allow any latex particles to be sufficiently reduced to make the environment safe (Latex Allergy Support Group 2008, Department of Health 2007) (Rationale 19).

Latex-containing products should be either removed or covered. For example, latex tubing on equipment should have latex-safe tape such as Micropore®, wrapped around it in order to cover it completely (Rationale 20).

Trolley with specific latex-safe products should be available (Rationale 21).

A patient transport trolley with a latex containing mattress will need to have it securely covered by:

• waterproof paper sheet or plastic sheeting

• two draw sheets (Rationale 14)

Intraoperative care

All staff should be aware of patient status with reduced numbers of personnel within the theatre (Rationale 22, Rationale 23).

Notices should be posted on the anaesthetic room and theatre doors stating the need to maintain a latex-safe environment (Rationale 24).

Staff should be aware of the ‘Recommended emergency management of acute major anaphylaxis under anaesthesia guideline’  (See Appendix 2) and ‘Treatment of anaphylactic reaction in non-theatre areas’ (See Appendix 3) (Rationale 25).

Postoperative care

Recovery

Patients can be recovered in the main recovery area, provided they can occupy a section that is separate from other patients and that latex-safe equipment and products are available (Rationale 26).

Staff should ensure that appropriate postoperative medications, eg chlorphenamine (Piriton®), hydrocortisone, are prescribed (Rationale 27).

Ward

Postoperative observations should include looking for signs or symptoms of potential allergic reaction: (Rationale 28)

• swelling mucous membranes (eg lips)

• rhinoconjunctivitis

• increasing respiratory effort

• wheezing

• pruritis and/or rash
  

Staff should be aware of the ‘Recommended emergency management of acute major anaphylaxis under anaesthesia guideline’ (See Appendix 2) and ‘Treatment of anaphylactic reaction in non-theatre areas’ guide (See Appendix 3)(Rationale 26).

Appendix

Appendix 1 - Latex safe emergency equipment snatch box contents

Appendix 2 - Recommended emergency management of acute major anaphylaxis under anaesthesia

Appendix 3 - Treatment of anaphylactic reaction in non-theatre areas

Rationale

Rationale 1: Definitive laboratory testing will confirm diagnosis of latex allergy and ensure appropriate care is available for the individual as required.

Rationale 2: Frequent exposure to NRL may increase the risk of developing an allergic response in susceptible individuals.

Rationale 3: To identify individuals who may present with mild through to severe allergic reactions when exposed to NRL-containing environments, or after contact with NRL-containing products, or whose past medical history could indicate the potential development of a latex allergy.

Rationale 4: Definitive laboratory testing will assist in the confirmation of the diagnosis of latex allergy and ensure appropriate care is available for the individual as required.

Rationale 5: To provide known latex safe products in emergency situations or at short notice, eg emergency admission of a latex allergic patient.

Rationale 6: To provide a latex safe environment in areas of potential high exposure.

Rationale 7: To reduce the risk of exacerbating a patient’s condition in the event of an acute reaction and the need for active resuscitation.

Rationale 8: To maintain an up-to-date record of latex safe products that is available to all staff.

Rationale 9: To ensure that special care needs can be met throughout their admission.

Rationale 10: To ensure staff are aware of, and can meet, the special needs of these patients in the ward setting and in special care areas such as operating departments.

Rationale 11: To equip them to cope in the event of an acute reaction.

Rationale 12: To ensure staff have latex-safe equipment available to them in emergency situations.

Rationale 13: To equip them to cope in the event of an acute reaction.

Rationale 14: To prevent any contact between the patient and products containing latex.

Rationale 15: To reduce the potential for accidental exposure to latex-containing products during admission which may induce a reaction.

Rationale 16: To reduce the potential for increased anxiety resulting from higher levels of isolation during admission.

Rationale 17: To reduce the possibility of exposing the patient to accidental contact with latex.

Rationale 18: To initiate first line treatment in instances of allergic reaction, if the patient has not already done so, in an attempt to reduce the severity of the response.

Rationale 19: To reduce potential exposure to aerosolised latex protein build-up.

Rationale 20: To reduce potential exposure of affected patient to latex-containing products.

Rationale 21: To ensure staff have appropriate and documented latex-safe products for use.

Rationale 22: To ensure staff are aware of and can meet the special needs of these patients in the operating theatres.

Rationale 23: To reduce potential for accidental exposure by staff who may have come into contact with latex containing equipment.

Rationale 24: To warn staff of the need to ensure that special precautions are followed when entering the operating theatre.

Rationale 25: To ensure staff are aware of the appropriate actions to take in the event of an anaphylactic reaction occurring.

Rationale 26: To ensure that immediate postoperative care is in a safe environment provided by suitably experienced staff.

Rationale 27: To reduce delay in administration in the event of an allergic reaction in the postoperative period.

Rationale 28: To ensure that staff identify allergic reactions in the early stages in order to inform medical staff and initiate appropriate measures immediately.

References

Reference 1:
Thompson G, Ruane-Morris M, Lawton S (1994) Lines of defence. Nursing Times 90(41): 48-51.

Reference 2:
Johnson G (1999) Avoiding latex allergy. Nursing Standard 13(21): 49-56.

Reference 3:
Health and Safety Executive (HSE) (2008) About latex allergies. www.hse.gov.uk. Viewed on: 07/08/2009

Reference 4:
Hourihane J, Allard JM, Wade AM, McEwan AI, Strobel (2002) Impact of repeated surgical procedures on the incidence and prevalence of latex allergy a prospective study of 1263 children. The Journal of Pediatrics 140(4): 479-482.

Reference 5:
National Patient Safety Agency (2005a) Patient Safety Information Issue 08 Protecting people with allergy associated with latex. www.npsa.nhs.uk. Viewed on: 26/05/2005

Reference 6:
National Patient Safety Agency (2005b) Patient briefing Protecting people with allergy associated with latex. www.npsa.nhs.uk. Viewed on: 26/05/2005

Reference 7:
Kelly KJ, Sussman GL, Fink JN (1996) Stop the sensitization. Journal of Allergy and Clinical Immunology 98(5): 857-858.

Reference 8:
Latex Allergy Support Group (2010) Operating Theatres. www.lasg.org.uk/guidance/operating-theatres. Viewed on: 12/08/2011

Reference 9:
Department of Health (2007) Health Technical Memorandum 03-01: Specialised ventilation for healthcare premises. Part A - Design and installation. London, The Stationery Office

Document control information

Lead author(s)
Teresa Durack, Modern Matron, Corporate Facilities

Additional authors
Liane Pilgrim, Sister, Nephrology
Sheila Simpson, Resuscitation Services Manager, Clinical Unit 10

Document owner
Teresa Durack, Modern Matron, Corporate Facilities

Approved by
Clinical Practice Committee

First introduced: 15 July 2005
Review schedule: Two years
Date approved: 12 August 2011
Next review: 12 August 2013
Document version: 3.1
Replaces version: 3.0