Diagnosis: Latex Allergy response
Gail B. Ladwig
NANDA Definition: An allergic response to natural latex rubber products
Type I reactions:
Immediate reactions (<1hour) to latex proteins (can be life threatening); contact urticaria progressing to generalized symptoms; edema of the lips, tongue, uvula, and/or throat; shortness of breath; tightness in chest; wheezing; bronchospasm leading to respiratory arrest; hypotension; syncope; cardiac arrest
May also include:
orofacial characteristics: edema of sclera or eyelids, erythema and/or itching of the eyes, tearing of the eyes, nasal congestion, itching and /or erythema, rhinorrhea, facial erythema, facial twitching; gastrointestinal characteristics: abdominal pain, nausea; generalized characteristics: flushing, general discomfort, generalized edema, increasing complaint of total body warmth, restlessness
Type IV reactions:
delayed onset: eczema; irritation; reaction to additives causes discomfort (e.g., thiram, carbamates); redness; delayed onset (hours)
erythema; chapped or cracked skin; blisters
Related Factors: No immune mechanism response
Related Factors: No immune mechanism response
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
· Immune Hypersensitivity Control
· Symptom Severity
· Tissue Integrity: Skin and Mucous Membranes
· Identifies presence of latex allergy
· Lists history of risk factors
· Identifies type of reaction
· States reasons not to use or to have anyone use latex products
· Experiences a latex-free environment for all health care procedures
· Avoids areas where there is powder from latex gloves
· States the importance of wearing a Medic-Alert bracelet and wears one
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
· Allergy Management
· Latex Precautions
Nursing Interventions and Rationales
· Take a careful history of clients at risk: health care workers, rubber industry workers, clients with neural tube defects, and atopic individuals (hayfever, asthma, atopic eczema). Individuals at highest risk of development of IgE-mediated latex allergy are either atopic, highly exposed to latex, or both (Kelly, Walsh-Kelly, 1998). Early recognition of sensitization to natural latex rubber is crucial to prevent the occurrence of life-threatening reactions in sensitized health care providers and their clients (Tarlo, 1998). Allergic reactions to natural rubber latex have increased during the past 10 years, especially in the many health care workers who have high exposure to latex allergens both by direct skin contact and by inhalation of latex particles from powdered gloves (Nielsen et al, 2000)
· If IgE-mediated latex allergy is suspected, question the client about food allergies to chestnuts, avocados, bananas, kiwis, and other tropical fruits. Clients with IgE-mediated allergy may have cross-reactivity with food allergens such as bananas, kiwis, and other tropical fruits (Kelly, Walsh-Kelly, 1998). Class I chitinases have been identified as the major panallergens in fruits associated with the latex-fruit syndrome, such as avocado, banana, and chestnut (Sanchez-Monge et al, 2000).
· Question the client about associated symptoms of itching, swelling, and redness after contact with rubber products such as rubber gloves, balloons, and barrier contraceptives, or swelling of the tongue and lips after dental examinations. A client's history can suggest the likelihood of his or her developing a reaction to latex; the itching and swelling mentioned are reliable indicators of significant sensitivity to latex (Dakin, Yentis, 1998).
· Materials and items that contain latex must be identified, and latex-free alternatives must be found. A wide variety of products contain latex: medical supplies, personal protective equipment, and numerous household objects (Evangelisto, 1998).
· All latex-sensitive clients (e.g., those who experience reddened, irritated areas under Band-Aid adhesive) are treated as if they have a latex allergy. According to the Centers for Disease Control (CDC) guidelines, all latex-sensitive clients are treated as if they have a latex allergy (Harrau, 1998).
· See Box III-1 for examples of products that may contain latex.
· Five principles for management of latex-allergic clients: (1) recognize the problem, (2) avoid exposure to latex, (3) inform the surgeons and operating room nurses, (4) be prepared to treat anaphylaxis, (5) be vigilant postoperatively and arrange follow-up care. Reactions may be prevented by providing a latex-free environment (Kantor, Smith, Kalhan, 1999). Medical personnel must stay abreast of new data and product information to provide up-to-date care for patients, as well as protection for themselves (Floyd, 2000). Latex aeroallergen is primarily generated by active glove use; carpeting and fabric upholstery can serve as important aeroallergen repositories. Site-wide substitution of nonpowdered latex gloves eliminates detectable latex aeroallergen (Charous, Schuenemann, Swanson, 2000).
· Anaphylaxis from latex allergy is a medical emergency and must be treated differently than anaphylaxis from other causes. Clients with latex induced anaphylaxis must be placed in a latex-safe environment (Kelly, Walsh-Kelly, 1998).
· Do not open or use powdered latex gloves in the client's room. At times it is necessary to convert the whole building to a latex-free environment to prevent inhalation of symptoms of IgE-mediated allergy. Most inhalation allergen exposure derives from protein bound to the cornstarch donning powder on medical gloves. Transfer of this allergen to other products or even the air duct of buildings where gloves are used may result in exposure and clinical symptoms of rhinoconjunctivitis, throat irritation, airway edema, and asthma (Kelly, Walsh-Kelly, 1998). Gloves are the single most important piece of equipment responsible for triggering a reaction to latex. Starch or modified starch gloves are the worst culprits (Dakin, Yentis, 1998).
Home Care Interventions
· Assess the home environment for presence of natural latex products (e.g., balloons, condoms, gloves, and products of related allergies, such as bananas, avocados, and poinsettia plants). Identification and/or removal of allergy stimulants decreases allergic response risk.
· At onset of care, assess client history and current status of latex allergy response. Seek medical care as necessary. Immediate identification of allergic response promotes prompt treatment and decreases risk of severe response.
· Do not use latex products in care giving.
· Assist client in identifying and obtaining alternatives to latex products. Preventing exposure to latex is the key to managing and preventing this allergy. Providing a safe environment for patients with latex allergy is the responsibility of all health care professionals (Baumann, 1999).
· Provide written information about latex allergy and sensitivity. Education of the public is necessary and has been provided by the development of a latex allergy pamphlet, which contains an explanation of symptoms and risk factors for latex allergy (Harrau, 1998).
· Instruct clients to inform health care professionals if they have a latex allergy, particularly if they are scheduled for surgery. To prevent problems associated with exposure to products containing latex, it is essential that clients with latex allergy are identified (Dakin, Yentis, 1998).
· Teach clients what products contain natural rubber latex and to avoid direct contact with all latex products and foods that trigger allergic reactions. Once latex allergy has developed, the client is at risk for anaphylaxis and needs to be informed as to what products contain latex (Tarlo, 1998). This allergy is potentially preventable for both the patient and nurse (Gritter, 1999).
· Teach client to avoid areas where powdered latex gloves are used, as well as where latex balloons are inflated or deflated. Exposure can lead to an anaphylactic reaction (Tarlo, 1998).
· Instruct clients with latex allergy to wear a Medic-Alert bracelet that identifies them as such. Identification of clients with latex allergy is critical for preventing problems and for early intervention with appropriate treatment if an exposure occurs (Kelly, Walsh-Kelly, 1998).
· Instruct client to carry an autoinjectable epinephrine syringe if at risk for anaphylactic episode. An autoinjectable epinephrine syringe should be prescribed to sensitized clientswho are at risk for an anaphylactic episode with accidental latex exposure (Tarlo, 1998).