WARNING! "Latex Allergy"
Reprinted from The Medicaid Bulletin, Volume 111, Issue 11, Summer 1998
Researchers have discovered that some people have allergic reactions to
latex.
Latex, the sap of the Hevea brasiliensis and other rubber trees, is used
in the manufacture of many of today's medical and consumer products
including: balloons, erasers, swimming goggles, diaphragms, baby bottle
nipples, Band-Aids, stethoscopes, tourniquets, catheters, disposable
syringes and surgical gloves, just to name a few.
The term "latex allergy" is commonly used as a shorthand reference for
"natural rubber latex allergy." After extensive research and testing, the
Food and Drug Administration (FDA) created a rule in Chapter 21, Code of
Federal Regulations, Part 801, "User Labeling of Natural Rubber-Containing
Medical Devices Requiring Warning Labels On All Medical Devices and
Medical Device Packaging Containing Natural Rubber That May Contact
Humans." This rule becomes effective September 30, 1 99X. The rule calls
for warning labels on all medical products containing natural latex
rubber, including the powder inside latex surgical gloves.
How concerned should medical practitioners be about latex allergy?
Warning labels follow almost a decade of increasing research and concern
by the FDA. From 1989 through 1990, patients began dying from anaphylactic
shock related to the use of barium enema kits with latex cuffs. As the
number of deaths increased during that period, the manufacturer
voluntarily recalled the devices and started using silicone cuffs. In 1990
through 1991, anaphylactic reactions to latex anesthesia equipment were
reported among children. The Center for Disease Control discovered that
all of the children who had reactions had spine bifida or other conditions
involving the genitourinary tract. Between 19XS and 1992, more than 1000
systemic allergic reactions to natural rubber, including 15 deaths,
Establishing procedures for latex allergic and high-risk patients will
provide a formal mechanism to minimize allergic reactions. Procedures
should include:
*    using items such as latex alert stickers on medical charts to identify
at-risk patients;
*    posting written step-by-step guides telling staff how to prepare a
latex-free exam room; and
*    establishing clinical protocols for examinations and treatments
requiring the use of non-latex medical devices.
In addition to using non-latex medical devices when examining or treating
high-risk or latex-allergic patients, consider the surrounding
environment. The following good housekeeping practices should also be
considered:
*    identify and frequently clean areas exposed to latex - containing dust;

*    change ventilation and vacuum filter bags frequently; and
*    require all personnel to wash their hands immediately following the use
of latex equipment, especially powdered latex gloves, to minimize the
transportation of latex particles.
(Airborne latex particles can also be reduced by converting to
non-powdered latex gloves.)
Surgical preparations are more complex and many hospitals have assembled
non-latex surgical carts and protocols that include a full array of
substitute items, such as neoprene anesthesia bags, oxygen masks and vent
circuits; non-latex catheters, dressings, endotracheal tubes and airways,
IV ports; OR masks, hats, shoe covers, drapes and packs, suction tubing,
syringes, tourniquets, etc.
If you will be performing surgery or an invasive examination on a
high-risk or latex allergic patient, or are referring a patient for
possible surgery or an invasive examination, make sure that everyone
involved in the care of the patient throughout the hospitalization is
aware of the need for non- latex medical devices and a latex-free
environment.
For details on medical supplies currently available through Medicaid,
refer to Appendices B and C (DME fee schedules) of the Florida Medicaid
DME/Medical Supply Services Coverage and Limitations Handbook. DME fee
schedules list reimbursable procedure codes and identify some
characteristics of items in the corresponding descriptors ( e.g. silicone
or coated latex with Teflon).