Physical reactions to latex gloves or particulates from other dental equipment are no longer easily ignored. Combat allergies among staff members and patients by minimizing exposure.
Cynthia M. Stewart, RDH
To an allergy sufferer, latex seems to be everywhere you turn. At least it seems that way. Many items today contain latex. Bandages, balloons, carpet backing, erasers, blood pressure cuffs, dental dams, prophy cups, and latex gloves are just several of more than 40,000 products known to contain latex rubber.
Although most latex allergy sufferers are bothered by direct contact with latex, some individuals are troubled by inhalation of airborne latex particles. A person does not necessarily have to touch latex to experience an allergic reaction. The handling of latex products can cause latex particles to be dispersed into the air.
Protein allergens can often be carried through the air by means of the powder found in medical gloves. Allergens can also be strewn into the air from rubber tire particulates. When a susceptible person inhales these particles, an allergic reaction may occur.
This response, which usually occurs within several minutes of exposure, is termed an immediate allergic reaction. Hives, wheezing, coughing, shortness of breath, or symptoms resembling hay fever - such as sneezing, nasal congestion, runny nose, conjunctivitis, and nasal, palatal, or ocular itching - are all indicative of immediate reactions.
Hives may be seen on any part of the body. However, that body part may or may not have been in direct contact with the latex rubber. An individual may exhibit hives on his whole body during a dental visit when the examiner wears latex gloves and comes into contact with the oral mucous membranes - or an individual may exhibit a more localized urticaria.
This immediate reaction to latex allergens could develop into a life-threatening response when blood pressure drops, airways become blocked, and the throat closes. The patient could go into anaphylactic shock. Asthma, hay fever, and hives are all believed to be characteristic of anaphylaxis because they are all caused by the irritation of an allergen to which a person has been sensitized.
More often, though, latex allergy responses occur 10 to 30 hours after latex has come into direct contact with skin. This more familiar response is identified as a delayed allergic reaction. Usually, an erythematous, edematous, itchy rash becomes visible where the latex contacted skin. Sometimes vesicles develop. Sometimes the skin cracks and peels.
Because the reaction is deferred, determining the cause of the allergy often requires much detective work.
Manifestation of a contact dermatitis rash on your hands, which appears after wearing latex gloves, is of particular concern. This is highly significant of latex rubber sensitivity. If this irritation ensues and steps are taken to reduce exposure to latex items, a latex allergy may be avoided. The best way to deter any allergy, remember, is by avoiding the material causing the sensitivity.
A broader reach for sufferers
Latex allergies have been dismissed by some medical professionals for years. It has been previously believed that latex rubber sensitivities did not exist. Allergic to rubber? How could that be possible? Since latex derives from a living plant - the Brazilian rubber tree - it is comprised of natural proteins that can stimulate allergic reactions in sensitive individuals - just as any other allergen does. Any foreign matter that is capable of soliciting an inappropriate immune response can be considered a potential allergen. The chemical additives used in producing rubber products have also been implicated as a cause of allergic reaction.
Because of latex rubber`s durability, elasticity, versatility, and excellent barrier protection, latex usage has escalated during the past 10 years. This increase may account for the 5 to 10 percent rise of today`s health care professionals who may have latex allergies.
In 1991, the U.S. Food and Drug Administration published a medical alert concerning allergic responses to medical devices containing latex. Reports of 1,118 cases of latex-induced conditions involving both patients and allied health workers were received by the FDA within a four-year time span.
Most latex-sensitive individuals fall into at least one of three categories:
- Those with occupational exposure to latex.
- Those with other types of allergies.
- Those with a history of multiple surgeries.
Occupational exposure to latex is most prevalent in the health care professions. Many medical supplies and devices contain latex rubber. Exposure is extensive, and 10 to 17 percent of health care workers have a tendency to acquire an allergy to latex.
Common patterns among sufferers
Of course, occupational exposure can also be found in the rubber manufacturing industries. A 1991 research study of rubber factory personnel documented that skin irritations were present in 11 percent of the surveyed workers. Occupationally induced asthma was evident in 6 percent of the surveyed workers.
Latex allergy sufferers usually have other allergies. Certain food allergies may be indicative of latex allergy. If a person allergic to avocados, bananas, carrots, celery, cherries, figs, hazelnuts, kiwis, papayas, passion fruit, raw potatoes, tomatoes, or water chestnuts, this could be a warning sign that he may also be allergic to latex. These fruits and vegetables are comprised of proteins resembling those of latex.
The human body generalizes allergic responses between analogous proteins through a process called cross-reactivity. In view of this, reactions to those aforementioned foods may be a premonition of susceptibility to latex allergy.
People who have undergone multiple surgeries are also considered a high-risk group for developing latex allergy. This is especially true for children who have endured several surgeries since birth. Almost 50 percent of children with spina bifida develop latex allergy.
When sustaining surgery, a patient is routinely exposed to many articles containing latex rubber. The more frequently a person is exposed to an allergen, the greater the possibility of developing an allergy. Direct contact between latex and mucous membranes has been determined to result in the most severe reactions. That`s why it`s so important to avoid direct contact of latex to mucomembranous tissue.
To alleviate potential emergencies in the dental office and increase awareness of latex allergies, include questions in the patient`s medical history that address possible latex sensitivity. Patients in high-risk groups can be alerted to their increased susceptibility.
The dental office`s inquiry about reactions to rubber dishwashing gloves, condoms, undergarment elastic, rubber grips or handles (found on sports equipment, automobile steering wheels, and gear shift knobs), toy balloons, adhesive strips, and other rubber household items could be advantageous.
If a latex allergy is suspected, it would be wise to refer the patient to an allergist to verify the diagnosis with immunological evaluations. After procuring an extensive medical history, an allergist may order a skin test or a radioallergosorbent (RAST) test. During the skin test, a small amount of the allergen is placed under the skin and the patient`s response is closely observed. The RAST is a blood test that measures antibody levels to latex.
Alternative nonlatex products can be substituted for latex products when dealing with potentially susceptible or identified allergic individuals. Dental professionals who are allergic to latex must limit their exposure. This can be achieved by wearing vinyl gloves or gloves made from synthetic polymers. Wearing a surgical mask when handling any latex items and requesting that co-workers wear nonpowdered latex gloves can also reduce exposure to airborne allergens.
Reactions to latex can range from contact dermatitis to anaphylactic shock. Some symptoms exhibited are urticaria, coughing, wheezing, dyspnea, and hay fever-like conditions.
There is no medication available to prevent latex allergic reactions. The best treatment is avoidance of the allergen. Medications provide palliative treatments only. Symptoms can be relieved with antihistamines, decongestants, corticosteroid creams, nasal sprays, anti-inflammatories, and bronchodilators.
The problem with using these medications arises when a latex allergy sufferer feels a false sense of security. Since his symptoms have subsided, he feels he can continue to be exposed to latex. But the more frequently an allergic individual is subjected to latex allergens, the greater his chances of having a life-threatening anaphylactic response.
Immunotherapy has been contraindicated for this type of allergy because even tiny amounts of the latex allergen can sometimes cause extremely severe reactions.
Again, it is important to remember that the more frequently a latex allergic individual is exposed to latex allergens, the more sensitive that individual may become. Medications will only mask symptoms - they won`t eliminate them. Please be on the look out for the latex allergic individual.
Cynthia M. Stewart, RDH, is a contributing writer in Nazareth, Pa.
Creating the no-latex environment
Following are several precautionary measures that could be recommended to the latex sensitive person:
- Alert all health care professionals of your latex allergy. If you come into contact with a nonbelieving professional, ask your allergist to write a note stating the diagnosis of your latex allergy.
- Permit the use of nonlatex items only. Often, alternative products can be substituted for those containing latex. (Hypoallergenic latex gloves are still rubber - don`t allow usage of these).
- Do not hesitate to ask if an article may contain latex rubber. If a health care professional is unsure of the composition, the manufacturer can be contacted.
- Request to be the first patient of the day when visiting your doctors` offices or when scheduling surgeries. There are less latex particles in the air earlier in the day compared to later in the day.
- Wear a medical alert chain indicating your latex allergy and any other allergies.
- Carry a self-injectable dose of epinephrine with you at all times. Understand the directions and routinely check the expiration date.
- Inform your co-workers, family, and friends of the necessity to use your epinephrine if a life-threatening reaction occurs. Stress the importance of getting to the closest hospital emergency center immediately after administration of the epinephrine.
- Contact your hospital emergency and ambulance departments, (before you need their services), to check about their procedures for maintaining a latex-free environment.