About 3% to 6% of the general population is allergic to certain proteins found in latex, which is made from the milk of the rubber tree. Unfortunately, most people don't know whether they are allergic. Patients who've had several previous surgeries and those with food allergies to avocados, bananas and kiwifruit are more likely to be allergic to latex. Healthcare workers are also more likely to be allergic because of their continued exposure to the substance.
Spotting a latex allergy reaction in surgical patients is often difficult. Surgical drapes cover the initial symptoms, including rashes, watery eyes and edema. General anesthesia also masks other early indicators such as itching, sneezing or coughing.
In the early stage, the allergic reaction can be slowed or reversed by stopping the procedure, removing anything containing latex from contact with the patient and, if necessary, irrigating the tissue at the surgical site.
If the symptoms dissipate it's sometimes possible to continue a procedure using latex-free devices and supplies. However, it's important to remember that allergies set off a cascade of events in the immune system that worsen over time.
Serious reaction: anaphylaxis
If untreated, an allergic reaction can evolve into life-threatening anaphylaxis. Anaphylaxis occurs once in every 4,500 to 25,000 surgical patients. One out of 5 cases of anaphylaxis is caused by a latex allergy.
A drop in blood pressure, bronchospasms and hypoxemia are the most common signs of anaphylaxis. A reaction to neuromuscular blocking drugs is the most-common cause of anaphylaxis in the OR. A drug reaction occurs within a few minutes of injection, while a latex allergy reaction usually occurs about 15 minutes after induction. The cascade of anaphylactic events can lead to cardiovascular collapse, brochospasms and loss of the airway due to swelling at the larynx.
Use the emergency checklist on page 63 to be sure your facility is ready to respond to a latex allergy emergency.
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In Case of Latex Allergy Emergency
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What You Need
To prepare for anaphylaxis, you'll need to stock your crash cart with the following drugs:
- Epinephrine for reversing the dilation of the blood vessels and relaxing the airway muscles;
- Diphenhydramine, an H1 antihistamine, for stopping or reversing the effects of histamine release in the allergic reaction;
- Ranitidine, an H2 antihistimine, to help reduce the symptoms;
- Cimetidine, an H2 antihistimine, to help reduce the symptoms;
- Nebulized albuterol to relieve the constriction of continued broncospasms;
- Dopamine to help stimulate constriction of the blood vessels and increase blood pressure;
- Glucagon, a hormone, for increasing blood glucose levels (does the opposite of insulin); and
- Glucocorticosteroids for reversing inflammation.
What You Should Do
- Stop the procedure. Remove all latex items from contact with the patient and discontinue all drugs.
- Follow anaphylaxis protocol. OR team should begin emergency treatment coordinated by the anesthesia provider.
- Maintain the airway. The patient may need to be intubated and repositioned.
- Begin drug therapy. Epinephrine and other drugs may be administered by injection or IV.
- Administer 100% oxygen. The patient may quickly become hypoxic.
- ive blood volume support. Fluid that leaked out of the circulatory system can be replaced with an intravenous line of saline solution or other products for fluid replacement.
- Monitor the patient. Once the team has stabilized the patient, transfer the patient to the hospital. Monitor the patient for 24 hours in the hospital because late-phase reactions can occur.
Prevention
- Identify allergic patients. Knowing that a patient is allergic lets you take the proper precautions before the patient arrives in the OR.
- Latex-free gloves. These can reduce the risk of allergic reactions among your staff as well as patients.
- Latex-free anesthesia cart. Although more expensive, you can stock a cart with latex-free masks, tubing, gloves and other supplies.
- Schedule allergic cases first. Many reactions are a result of latex glove lubricant powder, usually cornstarch, floating in the OR air. There's less in the morning.
- Document allergies and reactions. Make sure that the patient's allergy is part of the medical records that other healthcare providers will see.
- Encourage follow-up. After an allergic reaction, encourage the patient to see an allergist for further testing. Patients often fail to do this, so a follow-up call can help give them a nudge.
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