Memorandum by Latex Allergy Support Group
(AL 71)
BACKGROUND
1. The Latex Allergy Support Group is a
national voluntary self-help organisation founded in 1996, with
300+ members. The aims of the Group are to raise awareness of
this allergy, provide support for those affected and promote the
safe and appropriate use of latex products and equipment. An advisory
panel provides advice on medical and technological issues.
2. Allergy to natural rubber latex (NRL)
was first described in 1979 and, as with other allergies related
to an underlying atopic susceptibility, the past 15 years has
seen its recognition as a health issue of increasing importance.
Latex allergy is thought to affect less than 1% of the general
population, but is commoner in certain groups who are regularly
exposed to latex, including healthcare workers from widespread
use of medical gloves, and most notably patients with spina bifida
exposed to gloves/catheters.
3. Latex allergy is generally taken to mean
a reaction to the constituent proteins, of which there are several,
and is an example of an "immediate" Type I IgE-associated
reaction. The clinical effects are similar to those from allergy
to peanuts, in that most will have relatively mild local reactions,
some will have more troublesome local and respiratory problems
and a few will be at risk of potentially fatal anaphylactic reactions.
4. It is not possible at present to predict
which individuals may progress from mild reactions to anaphylaxis,
or when a more severe reaction may occur. The greatest potential
danger to an allergic individual comes from mucosal contact (surgical/medical/dental/obstetric
gloves must be avoided) or from inhalation of latex (carried in
the air by powder from glove or balloon). Patients presenting
with anaphylactic reactions during surgery or with occupational
asthma may be found on subsequent investigation to be latex allergic.
5. A diagnosis of latex allergy may have
profound consequences for the patient from worry about the ubiquitous
nature of NRL in the environment together with its potentially
serious import. In addition, investigation of the allergy is not
without hazard. It is therefore important that patients with suspected
latex allergy be referred to appropriately trained practitioners
to enable accurate diagnosis and sound advice to be given, generally
by an allergist, dermatologist or other clinician with a sub-speciality
interest.
6. Latex is a hazardous substance for the
purposes of the Control of Substances Hazardous to Health Regulations
2002 (COSHH), and healthcare organisations are now expected to
have in place robust policies, both to minimise the development
of latex allergy in the workforce, and also to provide a latex-safe
environment for allergic patients and staff.
7. There is an overlap between NRL (a plant
product) and food (usually fresh fruit) allergy due to common/cross-reacting
antigens. Allergic (including anaphylactic) reactions to, for
example, banana, kiwi or avocado may be the first clinical presentation
of a previously undiagnosed latex allergy.
SPECIALIST SERVICE
8. A recent and as yet unpublished postal
questionnaire survey conducted by a consultant dermatologist and
a consultant allergist of 417 UK specialists shows considerable
variation in latex allergy diagnostic and management practice
both within and between dermatology and allergy departments.
9. Many (75) of those who see patients with
suspected latex allergy do not perform the most reliable diagnostic
investigation of skin prick testing because of its potential for
causing an anaphylactic reaction and/or lack of trained staff/facilities,
and are therefore at risk of under-diagnosing this condition.
10. Provision of basic information to help
allergic patients cope with what can sometimes be a very daunting
prospect is neither standard nor consistent. Advice on the need
or otherwise of self-administered adrenaline is also variable,
reflecting a lack of national guidance on this issue.
11. Over 90% of allergists in this survey
report no reduction in the number of patients they are seeing
with latex allergy. Each region should have allergists in place
to improve the management of latex allergy through educational
and strategic partnership working practices.
LATEX POLICIES
WITHIN HEALTHCARE
12. A recent and as yet unpublished survey
conducted jointly by the National Patient Safety Agency (NPSA),
the Latex Allergy Support Group and the National Association of
Theatre Nurses shows that the policies and practices adopted by
NHS trusts in relation to the potential dangers of natural rubber
latex vary considerably. Some trusts (around 60% overall) have
implemented clear policies and arrangements for managing or minimising
risk. Others have done much less, relying on partial or ad hoc
arrangements, or reacting to events rather than taking proactive
steps. Three broad conclusions emerge from the survey.
13. First, despite national guidance, there
remains a need for trusts to ensure that they have in place a
comprehensive policy supported by efficient management arrangements
for identifying and protecting sensitised staff and patients.
14. Second, trusts will need to be able
easily and with certainty to identify whether or not a product
and/or its packaging contains latex. Appropriate labelling and
catalogue descriptions of products and packaging are therefore
urgently needed.
15. Third, there is an obvious need for
a greater choice of effective, suitable and cost-effective latex-free
products and equipment. This remains a concern for many NHS purchasers
and managers.
SUMMARY
16. Natural rubber latex has many positive
attributes. Comfort, strength, biological protection and low cost
have made latex gloves the standard choice for use within healthcare.
Recognition of the problem with latex allergy has led manufacturers
to reduce the protein content and remove the powder from medical
gloves, although it is not yet possible to completely remove all
NRL allergens.
17. Reduction in NRL allergen content of
medical gloves is likely to reduce the number of healthcare staff
developing latex allergy, but the need remains to provide a safe
environment within healthcare for already allergic individuals,
a few of whom react to even tiny amounts of NRL in the environment.
The recent NPSA survey shows there is still much to do to safeguard
affected individuals.
18. Synthetic glove alternatives are readily
available for use by or for allergic individuals, and advances
in technology are producing improved synthetic gloves as a viable
routine alternative to latex. Where there is no clear need for
latex to be used, items of medical equipment are gradually being
replaced with synthetic substitutes where possible, and this conversion
should be actively encouraged.
19. Investigation and management of patients
with latex allergy can be time-consuming. A lack of trained personnel
and competing demands on time in specialist clinics will inevitably
compromise optimal management for some. There is a need for an
even geographic spread of expertise and support staff along with
consensus national guidance to allow more consistent practice
across the country.
20. There is a dearth of available data,
but anecdotal evidence suggests that latex gloves are widely used
out-with the healthcare setting, for example in garages, restaurants
and hairdressing salons. We do not know how allergenic these gloves
are, but the need to minimise costs is likely to mean that many
are cheap, highly allergenic and powdered. If this is the case,
the gloves will be a risk both for those who wear them (from developing
allergy) and also for their customers (eg from transfer of latex
allergens to car interior or food). It is possible that widespread
use of highly allergenic gloves in such occupations will produce
a similar outbreak of overt allergy that has already been encountered
in healthcare. Further study is needed in this area.
21. The Latex Allergy Support Group sees
the delivery of quality education (including general hand care)
and information (including accurate labelling) for all healthcare
staff, managers, employers and the general public as absolutely
central to addressing this problem. We urge the Government to
recognise latex allergy as an important health issue and provide
the necessary funding to address it properly.
June 2004
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