Overview
Definition:
Latex allergy is an adverse immune reaction to proteins found in natural rubber latex, ranging from mild skin irritation to severe, life-threatening anaphylaxis
In surgical settings, exposure can occur via gloves, catheters, and other medical devices
It is a critical consideration for patient and staff safety.
Epidemiology:
The prevalence of latex allergy in the general population is estimated to be 1-6%, but it is significantly higher in healthcare workers (up to 17%) and individuals with frequent exposure to latex products or underlying conditions like spina bifida or multiple surgeries
Risk in surgical patients varies.
Clinical Significance:
Latex allergy poses a serious risk during surgical procedures, potentially leading to intraoperative anaphylaxis, delayed wound healing, and requiring significant protocol modifications
Prompt recognition and management are vital for preventing morbidity and mortality.
Clinical Presentation
Symptoms:
Contact dermatitis: localized redness, itching, dryness
Urticarial reaction: hives, localized swelling
Respiratory symptoms: rhinitis, conjunctivitis, cough, wheezing, dyspnea
Systemic anaphylaxis: hypotension, tachycardia, bronchospasm, angioedema, cardiovascular collapse.
Signs:
Erythema and edema at contact sites
Urticarial wheals
Mucosal swelling
Wheezing on auscultation
Tachycardia
Hypotension
Signs of shock
Decreased oxygen saturation.
Diagnostic Criteria:
Diagnosis is based on clinical history of exposure and symptoms, confirmed by specific IgE testing (skin prick tests or in vitro tests)
However, in surgical emergencies, immediate management is prioritized over definitive testing.
Diagnostic Approach
History Taking:
Inquire about previous reactions to latex products (gloves, balloons, condoms)
Document known allergies to foods like bananas, avocados, kiwi, and chestnuts, which can cross-react with latex
Ask about occupational exposure in healthcare settings or frequent use of latex-containing items
Assess for underlying conditions like spina bifida or atopy.
Physical Examination:
Thorough skin examination for dermatitis or urticaria
Assess respiratory status for wheezing or stridor
Monitor vital signs closely for any signs of cardiovascular compromise: heart rate, blood pressure, oxygen saturation.
Investigations:
Specific IgE testing (RAST or ImmunoCAP) for latex allergens is the gold standard for diagnosis when not in an acute setting
Skin prick testing can also be performed by an allergist
In an emergency, diagnosis is clinical, and treatment is initiated empirically.
Differential Diagnosis:
Other causes of intraoperative hypotension (vasovagal, drug reactions, hypovolemia, sepsis)
Other causes of rash or urticaria (drug eruptions, other contactants)
Bronchospasm from other etiologies (e.g., asthma exacerbation)
Other forms of anaphylaxis not related to latex.
Management
Initial Management:
Immediate discontinuation of latex-containing products and substitution with non-latex alternatives
If symptoms of anaphylaxis are present, initiate emergency treatment: administer oxygen, establish intravenous access, and prepare for adrenaline administration
Alert the anesthesia and surgical teams.
Medical Management:
For mild reactions (dermatitis): topical corticosteroids and antihistamines
For moderate reactions (urticaria, rhinitis): oral antihistamines, possibly systemic corticosteroids
For anaphylaxis: Intramuscular adrenaline (epinephrine) 0.5 mg (1:1000 solution), repeated every 5-10 minutes as needed
Intravenous fluids for hypotension
Nebulized bronchodilators for bronchospasm
IV antihistamines and corticosteroids
Consider glucagon for refractory hypotension.
Surgical Management:
If the reaction occurs during surgery, the surgical procedure may need to be altered or postponed based on the severity and stability of the patient
Ensure all instruments, drapes, and medical devices used are latex-free
Surgical teams must be aware and use appropriate personal protective equipment
Meticulous attention to airway management is crucial if bronchospasm is present.
Supportive Care:
Continuous monitoring of vital signs, oxygen saturation, and cardiac rhythm
Maintain airway and adequate ventilation
Strict adherence to latex-free environment
Post-reaction observation in a monitored setting until fully recovered
Patient education on avoiding latex in the future.
Complications
Early Complications:
Anaphylactic shock leading to hypoperfusion and organ damage
Severe bronchospasm and respiratory failure
Post-anaphylactic pulmonary edema
Recurrent anaphylaxis
Prolonged hypotension.
Late Complications:
Skin sensitization with chronic dermatitis
Psychological impact and anxiety related to future medical procedures
Potential for delayed wound healing if severe inflammation occurs.
Prevention Strategies:
Strict implementation of latex-free protocols in operating rooms and healthcare facilities
Comprehensive staff training on latex allergy recognition and management
Use of latex-free personal protective equipment (gloves, masks, gowns)
Clear labeling of latex-containing products
Preoperative screening for latex allergy in high-risk individuals
Maintaining a latex-safe environment throughout the hospital.
Prognosis
Factors Affecting Prognosis:
Severity of the allergic reaction
Speed of diagnosis and treatment
Patient comorbidities
Promptness of switching to latex-free alternatives
Effectiveness of airway management.
Outcomes:
With prompt and appropriate management, most patients recover fully from latex-induced anaphylaxis
However, severe cases can lead to significant morbidity or mortality
Recurrent exposure can lead to sensitization and more severe reactions.
Follow Up:
Patients with confirmed latex allergy require lifelong avoidance of latex products
Regular follow-up with an allergist for ongoing management and education is recommended
Patients should carry an allergy identification card
For surgical patients, clear documentation in their medical records is essential for all future care.
Key Points
Exam Focus:
Intraoperative anaphylaxis differential diagnosis
Management of anaphylaxis (adrenaline dosage and routes)
Importance of latex-free environments
Cross-reactivity with foods
High-risk patient groups.
Clinical Pearls:
Always have a latex-free kit readily available in OR
Consider latex allergy in any unexpected hypotension or bronchospasm during surgery
Educate patients and staff proactively
Cross-reactivity with certain fruits (banana, avocado, kiwi) is a key historical clue.
Common Mistakes:
Delaying adrenaline administration in suspected anaphylaxis
Failing to identify latex as the trigger in intraoperative emergencies
Inadequate sterilization of equipment after suspected latex contamination
Not thoroughly documenting latex allergy for future reference.