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Every Office Urged to Prevent Latex Allergy

Mucosal exam? Use nonlatex gloves

Nathan D. Childs, OB.GYN News, October 1, 1998

Physicans' offices across the country may need a major overhaul to help curb the rising incidence of natural rubber latex allergy, according to the American Academy of Dermatology.

The academy's position paper on the topic, released in July, strongly suggests that all physicians and dentists establish "latex-safe environments" within offices and hospitals and that all mucosal examinations be performed with nonlatex gloves. (J. Am. Acad. Dermatol. 39[1]:98-106 1998). However, the authors of the paper say that it will be revised.

"In the short amount of time since we wrote the paper and when it was published. 50-60 studies on the subject have been published and the epidemiology is changing," said Dr. David E. Cohen, cochair of the AAD's Committee on Latex Allergy and director of occupational and environmental dermatology at New York University, New York. "But right now we don't feel that we would change any of the current recommendations."

Dr. Cohen believes annual updates of the position paper are necessary, and he plans to maintain the current committee of 13 physicians and 3 technical experts to compose the update that's slated for release next year.

Although most AAD position papers are reviewed every 5 years, the quick revision in this case may reflect growing concerns about latex allergy in medical manufacturing. High-antigen content latex products are quickly being phased out of the marketplace, as their manufacturers face a rising number of lawsuits alleging that they knowingly made dangerous products that could cause physicians and patients to become sensitized to latex.

One of those suits involves 150 claimants, mostly health care workers, and has been filed as a multidistrict suit in Philadelphia Federal District Court. The only such case tried so far resulted in a $1 million verdict for a Milwaukee radiologist who successfully argued that British manufacturer Smith & Nephew AHP negligently made latex gloves with such a high latex protein content that they caused her to become sensitized to latex, which damaged her career.

Given the increasing number of lawsuits in this area, Dr. Cohen decided that the position paper should address primarily the detection and treatment of natural rubber latex allergy and should not be intended to serve as a "legal treatise designed to change the standard of care."

"We want to inform doctors about latex allergy and suggest ways to make adjustments in their practice," he told this newspaper. "It's a strongly worded paper, but we are not laying down the law."

About 2% of the U.S. population is sensitive to natural rubber latex products, specifically, the cytoplasm of lactiferous cells produced by the Hevea brasiliensis tree. However, recent studies have found that up to 69% of health care workers and 65% of spina bifida patients show evidence of sensitivity to the substance.

Many of the changes suggested by the position paper may already be in progress. According to Dr. P. Wendy Huber, a dermatologist at Kaiser Permanente Medical Center in South Sacramento, Calif., and leader of Kaiser’s effort to identify high-quality latex alternatives for all of its facilities. Kaiser Permanente hospitals already have begun using gloves made of synthetic materials for all mucosal examinations.

"A number of manufacturers are changing over their entire product lines to nonlatex materials," Dr. Huber said. "The vendors are ahead of the game. They realize that soon people may not want latex-containing products at all."

Obstacles that formerly prevented physicians from using nonlatex gloves during mucosal examinations are falling by the wayside, Dr. Huber said. Nonlatex gloves block infection and are just as elastic as latex. Nevertheless, they lack the tensile strength of their latex counterparts, which can put physicians at risk particularly during surgical procedures.

In deciding whether to use gloves that don’t contain latex, physicians should consider how particular clinical situation, Dr. Cohen said.

"Obviously, an urban ER requires different decisions as far as risk of infection and allergenicity versus a suburban dermatology practice," he commented. "Doctors need to understand the risks of transmission while weighing the risks of latex allergy in their patient population."


Eight Suggestions to Reduce Latex Allergy
Sidebar excerpted from the J. Amer. Acad. Dermatol. 39(1):98-106, 1998

The American Academy of Dermatology's Committee on Latex Allergy made the following suggestions in its position paper:

Physicians should take careful histories before exposing patients to latex-containing devices. They also should indicate patients' allergy status in their charts and at their bedsides.

Physicians should offer a latex-safe environment, no one should wear powdered latex gloves, only nonlatex gloves should be used to directly examine the patient, and all latex-containing devices they regularly come in contact with should be removed or covered.

All patients who have had type I allergic reaction to latex should be briefed about avoiding latex-containing products and potentially cross-reacting foods, such as avocado or banana. These patients also should carry an Epi-Pen and wear medical alert bracelets indicating their status.

All medical and dental facilities should use only powder-free gloves with low latex-antigen levels.

All emergency medical facilities, including trauma surgery rooms, should be latex safe because proper screening of these patients is not usually feasible.

All medical facilities should use nonlatex gloves for general physical exams, espeiclaly for those in which mucosal tissues such as the mouth, vagina, or rectum are inspected.

All food workers at restaurants, hospitals and food plants should use only nonlatex gloves.

All medical offices should educate employees about latex allergy and have a policy to manage latex-sensitive patients.




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