Early signs of latex allergy often are easy to miss
Early signs of latex allergy often are easy to miss
Skin irritation often precedes other symptoms
Itchy bumps on the hands, a constant runny nose, tightness in the chest. These early signs of latex allergy may often be missed by employee health professionals, according to a survey of hospitals in the state of Washington.
While early signs of latex allergy can be subtle, their detection is a critical part of a latex management program, employee health experts say.
"If we can identify individuals who have the signs early, we can hopefully develop interventions for those individuals or have them get out of the exposure scenarios," says Martin A. Cohen, ScD, CIH, industrial hygiene research manager of the Safety and Health Assessment and Research for Prevention (SHARP) program at the Washington State Department of Labor and Industries in Olympia.
In a survey of employee health nurses and infection control practitioners at 95 Washington hospitals, about 25% of respondents did not associate rhinitis (runny nose), conjunctivitis (red eyes), or asthma with possible reactions to latex exposure.1
"They were reasonably well-educated, but the more subtle issues weren’t as well understood," says Cohen.
Excessive hand washing can spark reactions
In fact, cases of itchy, red, and scaly hands are often due to excessive hand washing, and Type IV allergic contact dermatitis is likely triggered by a reaction to chemicals used in glove processing.2
"When an employee health nurse is looking at these people [with dermatologic symptoms], they need to follow a protocol to determine if they have a latex problem," says Deborah R. Roy, MPH, RN, COHN-S, CET, CSP, president of SafeTech Consultants in South Portland, ME. "The vast majority of dermatitis problems are not latex allergy. They’re just irritant situations. You’ve got to weed out which is which." (See Latex Allergy Protocol for Occupational Health Nurses, inserted in this issue.)
Early detection of latex allergy actually should begin before an employee exhibits any symptoms at all, advises Roy. A simple questionnaire can determine if employees are at high risk for latex allergy.
Risk factors for latex allergy include: multiple surgeries before age 18, frequent bladder catheterization, multiple allergies, asthma or frequent urticaria (hives) or rhinitis, and certain food allergies (including avocado, banana, kiwi, chestnut, and tomato).
"If they are at high risk based on the questionnaire and they’re in a job, as in the OR, where they’ve got daily long-term contact with gloves, they may need to switch to another [non-latex] product," says Roy. "The proactive approach eliminates a lot of problems."
In the most severe cases, Type I latex allergies can trigger anaphylaxis. But Roy notes, "most people are going to have dermatologic symptoms as the early symptoms."
The redness may look similar to irritant dermatitis, which is not caused by allergy. But the allergic reaction involves vesical formation, says Roy. "It’s more than a rash," she says. "It’s raised areas that are broken."
To identify these cases, Roy recommends a protocol that includes frequent re-checking to determine whether symptoms are resolving.
An employee with glove-related symptoms and risk factors for latex allergy should immediately switch to non-latex gloves, advises Roy. Employees without risk factors should use low-protein, powder-free gloves. The corn starch powder can be a nutrient source for bacteria- macerated hands, she says.
Those employees should use nonpetroleum hand cream five to 10 times a day and should consider using cloth glove liners to absorb moisture, Roy says. If employees comply with these recommendations and symptoms still don’t resolve within nine days, they should switch to nonlatex gloves, says Roy.
Ultimately, unresolved cases of skin irritation should be referred to an allergist, she says.
Hospitals responding to latex risk
Meanwhile, hospitals are increasingly taking measures to reduce latex exposure among all patient care employees, Cohen says. When he conducted the survey about latex programs in 1996, most hospitals responded to latex allergy by changing glove type just for affected employees.
But in an update of that survey, which is not yet complete, Cohen says he is finding much more activity and awareness surrounding latex allergy. That includes hospitals that switch to low-protein, powder-free gloves, nonlatex exam gloves, or nonlatex gloves hospitalwide.
"Preventing exposure is the first line of defense," says Cohen. "Regardless of whether people have allergies in the hospitals, they should probably try to reduce exposures so new cases aren’t developed."
References
1. Cohen MA, Kaufman JD. Latex sensitivity in Washington state acute care hospitals: A needs assessment and survey of awareness of the issues. J Am Assoc Occup Health Nurs 2000; 48:297-304.
2. Roy DR. Latex glove allergy — dilemma for health care workers, an overview. J Am Assoc Occup Health Nurs 2000; 48:267-277.
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