• Medical Alert tag
• Warning sign posted on chart
• Warning sign posted on bed
(Modified with permission from the publisher and author. From Hoízman RS. Clinical management of latex-allergic children. Anesth Analg. 1997; 85:529-533.)
4. A latex-free cart containing items likely to be used should accompany the patient throughout his/her hospital stay (Appendix A). Additionally a list of the available non-latex product alternatives should be prominently displayed in patient care locations and readily available through the purchasing and central supply areas of the facility.
5. The patient should be instructed to obtain a medical alert bracelet or necklace.
6. Pharmacological prophylaxis. The use of allergy-attenuating premedication is controversial. Recommendations by Sockin and Young in 1991 included preoperative prophylaxis with diphenhydramine, cimetidine and methylprednisolone.63 Others have argued that pretreatment might serve only to attenuate the early immune responses, leaving anaphylaxis as the first evidence of an allergic reaction.64 More recently, Setlock et al. have demonstrated that premedication is not universally successful in preventing latex anaphylaxis. Current opinion as expressed by Holzman has moved away from administering allergy-attenuating premedication.66
With the ubiquitous presence of latex, it is extremely difficult to make an operating room and perioperative care area completely latex free. Furthermore, the degree of latex avoidance measures necessary to avert allergic reactions is not known. For example, systemic allergic reactions were reported as a result of administration of medication whose only exposure to latex was contact with the rubber stopper in the medication vial. Others have been skeptical that the contact between medication and the latex plungers of disposable syringes, ports of intravenous tubing or stoppers of medication vials provides sufficient exposure to produce a reaction among latex allergic patients.68 Consistent with this opinion is a report by Yunginger et al. in which the investigators were unable to detect latex-allergenic proteins in a multidose vial until there had been 40 punctures.69 However, more recent data documents the transfer of latex proteins from medication stoppers in sufficient quantities to elicit a dermal reaction in latex allergic subjects.
Contact dermatitis and Type IV latex reactions can usually be successfully treated with interventions such as the avoidance of irritating skin cleansers and treatment with topical corticosteroids.
The treatment of a systemic reaction to latex generally follows the sequence outlined for other systemic allergic reactions (Table 5). The offending agent should be identified and removed to limit patient exposure. This can be a difficult process when the reaction is occurring in the operating room and the source of latex exposure is unclear.
Type 1 latex reactions may present with a spectrum of symptoms and signs. These are generally systemic histamine-like reactions. The treatment depends upon the severity of the symptoms.
1. Mild reactions frequently resemble an attack of hay fever and respond to anti-histamines. Topical nasal steroids may be used when rhinitis is a prominent symptom.
Table 5: Treatment of Latex-Induced Hypersensitivity Reactions
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