The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [603]
Type I reaction: immediate hypersensitivity, sometimes called immunoglobulin E response. Caused by exposure to proteins in latex on glove surface and/or bound to powder and it can also be caused by proteins in food such as peanuts, watermelons, bananas, avocados, potatoes, tomatoes and some seafood. Symptoms include wheal and flare response, irritant and allergic contact dermatitis, facial swelling, rhinitis, urticaria, respiratory distress and asthma and on rare occasions anaphylactic shock. It occurs within minutes and can fade rapidly after removal of the latex (AORN 2004, Rose 2005).
Once sensitization has taken place, further exposure will cause symptoms to recur and increasing exposure to latex proteins increases the risk of developing allergic symptoms (HSE 2004).
Powdered gloves can create the greatest risk as proteins leak into the powder which can become airborne when gloves are removed and inhaling the powder may lead to respiratory sensitization (AORN 2004, HSE 2004).
Healthcare providers have an ethical responsibility to prevent latex sensitization and because there is no cure, protection must be paramount (AORN 2004).
Employers should have a policy on glove use which will give you information and instruction on risk of latex, safe working methods, recognizing symptoms of sensitization and the action to be taken if a sensitization is suspected (HSE 2004). There is also a voluntary scheme in place for reporting cases of latex sensitization, both of staff and patients, to the Medical Devices Agency (MDA), which is an executive agency of the Department of Health (HSE 2004).
Assessment and monitoring for symptoms of latex allergy in both the conscious and unconscious patient are required at all stages of perioperative care. The assessment should cover the following known risk factors for latex allergy (Box 14.4) (AORN 2004).
Box 14.4 Risk factors for latex allergy
History of multiple surgeries beginning at an early age (e.g. spina bifida, urinary malformation).
Known food allergies (avocado, chestnut or banana).
History of an allergic reaction to latex.
History of an allergic reaction during an operation.
Past experience of itchy skin, skin rash or redness when in contact with rubber products.
Past skin irritation from an examination by a doctor or dentist wearing rubber gloves.
Past sneezing, wheezing or chest tightness when exposed to rubber.
If a suspected or confirmed latex sensitivity or allergy is found, this information must be communicated to all members of the healthcare team and departments that the patient may visit, including theatre, recovery, pathology and radiology (AORN 2004, Rose 2005). The anaesthetist will need to be informed so that decisions can be made regarding potential allergy prophylaxis preoperatively (Rose 2005). The patient is normally first on the theatre list or in a theatre that has been allowed to stand clean and empty for at least 2 hours to ensure the removal of any latex dust and products (Rose 2005). They will need to be cared for in a latex-free environment with no latex or latex products used for the patient or in the immediate care environment (AORN 2004). Box 14.5 lists preoperative actions in the event of a latex allergy.
Box 14.5 Preoperative actions in the event of a latex allergy
Notify operating theatre of potential or confirmed latex allergy 24–48 hours (or as soon as possible) before scheduled procedure.
Identify the patient’s risk factors for latex allergy and communicate them to the healthcare team.
Schedule the procedure as the first case of the day if the facility is not latex safe.
Plan for a latex-safe environment of care.
The theatre must be cleaned with latex-free gloves and equipment.
All latex products must be removed or covered with plastics so that the rubber elements are not exposed.
All healthcare staff in direct contact with the patient must wear vinyl gloves during procedures and in the vicinity of the patient.
Secure latex-free products for all latex-containing items used by surgeons