Latex Allergy Policy
In recent years, an increasing number of people have developed a sensitivity or allergy to latex products. The University of North Carolina School of Dentistry recognizes this major health concern and outlines a policy to identify patients at risk for latex allergy as well as to decrease patients' exposure to latex products.
Latex allergy can result from repeated exposure to proteins in natural rubber latex through skin contact or inhalation. Reactions usually begin within minutes of exposure to latex, but they can occur hours later. Exposure to latex produces a variety of symptoms, including skin rash and inflammation, respiratory irritation, asthma, and in rare cases anaphylactic shock. Types of reactions to latex are classified as follows:
- Irritant Contact Dermatitis - the most common reaction to latex products and is characterized by development of dry, itchy, irritated areas on the skin, usually the hands. This reaction is caused by skin irritations from using gloves, powder in the gloves, and possibly exposure to other workplace products and chemicals. Irritant contact dermatitis is not a true allergy.
- Allergic Contact Dermatitis (delayed hypersensitivity or Type IV hypersensitivity) - results from exposure to chemicals added to latex during harvesting, processing, or manufacturing. These chemicals can cause skin reactions similar to those caused by poison ivy. As with poison ivy, the rash usually begins 24 to 48 hours after contact and may progress to oozing skin blisters.
Latex Allergy (Type I or immediate) - the most serious of the reactions that usually begins within minutes of exposure to latex, but can occur hours later with a variety of symptoms. Mild reactions to latex involve skin redness, hives, or itching. More severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat, and asthma (difficulty breathing, coughing spells, and wheezing). Rarely, anaphylactic shock may occur; but a life-threatening reaction is seldom the first sign of latex allergy.
Incidence of Latex Reaction
Studies indicate that 1-6% of the general population are sensitized to latex. A smaller group of the population has been classified as higher risk for latex sensitization. Those individuals include: 1) persons with multiple allergic conditions, including food allergies, 2) persons with Spina Bifida or other neural tube defects, 3) persons who have undergone multiple surgical procedures, 4) persons requiring multiple bladder catheterizations.
Predicting Severity of Latex Reaction
The type and severity of reaction depend on the level of sensitivity, the amount of allergen, and the site of exposure. A number of exposures may occur before any clinical symptoms appear. In attempting to predict latex reaction, it is important to remember three key factors: 1) the severity of a previous reaction does not reliably predict the severity of a future reaction, (a patient's reaction to latex exposure on the skin may vary greatly from latex exposure through direct contact with mucosal tissues), 2) even casual contact with latex can cause severe reactions in highly sensitive individuals, 3) latex allergy can be mistaken for other allergies.
Procedures for Treating Patients
Identifying patients at risk should be a specific and integral part of the medical history, both initial and update. The following questions can help to determine the likelihood of a patient with a latex allergy:
- Have you ever had or been told you had an allergy to latex (rubber) products?
- When exposed to rubber gloves, glove powder, balloons, Band-Aids, rubber toys (such as a Koosh ball) or other rubber products, have you ever experienced: itching, swelling, sneezing, watery eyes, hives, wheezing, or other breathing difficulties?
- Have you ever experienced itching, swelling of the lips, or other allergic reaction during a dental exam or during the use of a dental rubber dam?
- Have you ever experienced an unexplained allergic reaction during surgery, a urinary catheterization, barium test, or other medical procedure?
- Have you ever experienced itching or swelling of the mouth or other allergic reaction when eating avocados, chestnuts, bananas, kiwi, papaya, or other tropical fruits?
If the patient answers YES to any of these questions, the dental healthcare provider should consult with the patient's allergist before proceeding with any dental care.
Precautions for Patients Identified as Latex Allergic
- Obtain latex-free materials from the Dental Storeroom for each appointment. (See the attached lists of products containing latex and safe alternatives.)
- Prior to any contact with the patient, change cover gown and wash hands to remove all glove powder residue from previous patient.
- Dental procedures should be scheduled first case of the morning. Latex allergen levels in the room should be lower and morning appointments allow time for the latex dust from the previous day to be removed overnight.
- Encourage latex-allergic, latex-sensitive patients to obtain and carry with them at all times some type of allergy identification such as a medical alert bracelet
If a patient demonstrates symptoms of latex allergy, immediately stop procedure and notify the Dental School Emergency Team. Remove all potentially problematic items from contact with the patient.
Exposure Control for All Patients
The amount of exposure necessary to sensitize individuals is not known, but reductions in exposure to latex proteins can result in decreased sensitization and symptoms, according to the National Institute for Occupational Health and Safety (NIOSH). Care must be taken with all patients to reduce their levels of exposure to latex by:
- Wear non-latex gloves when setting up the dental operatory and handling instruments.
- To reduce the possibility of the latex protein becoming airborne, care must be taken by the healthcare worker not to snap gloves on and off.
By touching any latex object and touching the patient, the healthcare worker can transmit the latex allergen to the patient. Caution should be taken to keep glove powder away from the patient since the powder will act as a carrier for the latex protein; hands should be washed after removing gloves.
Latex Allergy Information for the School of Dentistry Employee and/or Healthcare Provider
Since 1988, according to the Food and Drug Administration (FDA), the reported number of allergic reactions to latex-containing medical devices has increased significantly, particularly among healthcare workers. About 1% of the general public and 8-12 % of healthcare workers and others exposed to latex on their jobs have become sensitized to latex. Latex refers to the natural rubber latex manufactured from a milky fluid that is primarily obtained from the rubber tree. Some synthetic materials may be referred to as "latex", but they do not contain the protein that produces latex allergy. The surge of latex allergy among healthcare workers is primarily attributable to greater use of disposable gloves to prevent the spread of AIDS and Hepatitis B. Increased demand and cost pressures for gloves has led some manufacturers to shorten the manufacturing time by reducing the number of washing and purifying steps that reduce the amount of sensitizing protein that the gloves will transmit. In 1996, the FDA published regulations that would require all latex-containing gloves and other devices to be labeled accordingly, including warnings about possible allergic reactions.
Latex is a common component of disposable gloves, stethoscopes, Band-Aids, syringes, rubber dams, prophy cups, suction tips, bite blocks, IV tubing, and other medical and dental supplies. Because of the frequency of use, disposable gloves are the most significant source of latex exposure among healthcare workers. The powder used to line disposable gloves can absorb latex proteins and then become airborne resulting in asthmatic reactions among individuals who did not use gloves but merely inhaled latex-containing dust.
Exposure Control for Employees
Implementing the following recommendations outlined by NIOSH (National Institute for Occupational Safety and Health) can minimize latex exposure in the dental setting:
- Use non-latex gloves for activities that are not likely to involve contact with infectious materials, e.g. routine housekeeping.
- Use powder-free latex gloves for activities that potentially involve contact with infectious materials.
- When wearing latex gloves, do not use oil-based hand creams or lotions unless they have been shown to reduce latex-related problems.
- Wash hands with a mild soap and dry thoroughly after removing gloves.
- Frequently clean work areas that may be contaminated with latex dust.
- If you develop symptoms of latex allergy, avoid direct contact with latex gloves and products until you can see a physician experienced in treating latex allergy.
Attend continuing education programs and review training materials about latex allergy.
- Spina Bifida Association of America. (1997). Latex Information Page, [Online]. Available: http://www.sbaa.org/Latex.htm
- National Institute for Occupational Safety and Health (NIOSH) Publication No. 97-135. (August 1997). Preventing Allergic Reactions to Natural Rubber Latex in the Workplace, [Online]. Available: http://www.cdc.gov/niosh/docs/97-135/
- National Institute for Occupational Safety and Health. (23 June 1997) Alert On Work-Related Latex Allergy Recommends Steps to Reduce Exposures, [Online]. Available: http://www.cdc.gov/niosh/docs/98-113/
- Synder, H.A., Settle, S. (August 1994). Rise in Latex Allergy: Implications for the Dentist. JADA 125:1089-1097.
- Berlow, Bruce. (1997). The Newest Epidemic: Latex Allergies, [Online]. Available: http://www.sansum.com/highlite/1997/2221.htm
- American College of Allergy, Asthma, & Immunology Online. (November 20, 1997). Latex Allergy. [Online]. Available: http://www.acaai.org/allergist/allergies/Types/latex-allergy/Pages/default.aspx
Last Modified: 09/29/2011