See Latex Allergy - the Bare Essentials for a brief account of the principles of management
See the Home Page for a table of contents which will lead you to more detailed information
IgE-mediated anaphylactic reaction in latex-sensitised patients on exposure to the latex antigen.
The patients at risk are those with prolonged or frequent exposure to latex products, especially:
Prevention of reactions by providing a latex-free environment.
Take a careful history in patients at risk, particularly those with co-existing atopy and/or multiple allergies. Ask for a history of balloon or glove intolerance and allergies to medical products used in chronic care e.g. catheters
B. Diagnostic Tests
Routine diagnostic testing in the at-risk population is not recommended at present - only for those with a positive history. Tests available are:
C. Medic-Alert Bracelet.
Patients who are confirmed allergic should have a Medic-Alert bracelet and wear it at all times.
Routine preoperative H1 and H2 blockers and steroids are no longer recommended.
Since latex is an aeroallergen and present in the O.R. air for at least an hour after the use of latex gloves, whenever possible your patient should be scheduled as the first case of the day.
A special Latex Allergy cart is available. It has:
Many surgical items are latex, and substitutes should be available. These include:
A. Check Latex Allergy cart for supplies and "uphill" refrigerator for muscle relaxants.
B. Call Pharmacy and order all drugs you might need, and do not have, dispensed in glass ampules. You will neeed patient's name and clinic number. e.g. Decadron which has to be drawn up into glass syringes by Pharmacy
C. Notify O.R. nurses on service. No latex gloves or latex products should come into contact with the patient Neoprene (non-latex) gloves need to be obtained. O.R. nurses may also provide gloves for anesthesia personnel.
A. Set up a regular circuit on the anesthesia machine and use a neoprene reservoir bag. Use plastic masks (adult or pediatric)
B. Draw up drugs in glass syringes from glass ampules:
In an emergency, the rubber stoppers can be popped and drug drawn up in a glass syringe.
C. IV infusion setup with two three way stopcocks and no injection ports. (Alternatively tape all injection ports over and do not use).
D.Use Webril under the rubber tourniquet for IV placement. Teflon catheters can be used safely (e.g. angiocath). If BP cuff is rubber, use Webril under it.
E.Latex allergy should not alter your choice of anesthetic technique. There are no drugs that are specifically contra-indicated. However, if you are planning a GA, note that:
F. Place the sign, which is supplied, on the O.R. door warning that the patient is allergic to latex.
G. Advise surgeon that if patient needs antibiotics, their service should order them from the pharmacy.
Anaphylaxis has been reported even in patients pre-treated with H1, H2 blockers and steroids and managed in a latex-free environment. Always be prepared to treat. See Diagnosis of Anaphylaxis.
Onset is generally 20 - 60 minutes after exposure to the antigen.
Anaphylaxis presents with the clinical triad of:
NOTE: Hypotension is the commonest sign. A rash is not always seen.
Take blood in an EDTA tube. These tests will help confirm the diagnosis of anaphylaxis, but do not identify latex as the antigen. Results will not be immediately available.
(adapted from: Levy JH. " The Allergic Response" in "Clinical Anesthesia" 2nd ed., Eds Barash PG, Cullen BF, Stoelting RK.)
Treatment of latex anaphylaxis does not differ from the treatment of severe allergy caused by other antigens.
A. Primary Treatment
Epinephrine, in adequate doses, is crucial for the successful treatment of anaphylaxis.
A characteristic of anaphylaxis is the failure to respond to vasopressors other than epinephrine. Start with a dose of 10 ug, or 0.1 ug/kg and escalate rapidly to higher doses depending on the response.
If an IV has not established, epinephrine can be given subcutaneously, in doses larger than would be administered intravenously (300 - 500 ug or more)
NOTE: The dose used initially for hypotension is not the same as in cardiovascular collapse or cardiac arrest. Large doses may ultimately be necessary, but starting with 1 mg epinephrine may cause life-threatening hypertension, myocardial ischemia and stroke.
B. Secondary Treatment may include the following: