ROUNDS RESPONSE.
Rounds is your vehicle for sharing your orthopaedic skills and experience. Your response to Rounds will be published in a future issue of Body Cast. We invite you to suggest questions for this column. Please address all submissions to: The Editor, Body Cast, 18 Wynford Drive, Suite 715A, North York, Ontario, M3C 3S2.

This Issue's Rounds Question (responses to be published in next issue)
Why is bone and fracture/wound healing affected by smoking?

In the last issue of Body Cast, Rounds asked: “Are Latex Gloves a danger for allergic patients? Could they potentially cause an anaphylactic reaction?”

The following responses were received:

From Mandy McPolin and Gary James

Mucosal exposures to latex are more probable in causing anaphylaxis. The powdered latex gloves can carry latex protein in the air and produce respiratory symptoms. The latex protein content of the gloves is important if you're going to expose any patient to latex. It may also be helpful to ask them if they have had any reactions to latex before. Allergies to latex include itchy throat after eating banana or kiwi. These fruits contain proteins that cross react with one of the allergenic proteins in latex. Do they have problems blowing up a latex balloon? Patients who have spina bifida (as an example) often require multiple surgeries when young; this often increases the risk of being latex allergic. A common mucosal exposure is at the dentist office. Have they had problems there? Exposure to latex may lead to sensitization, such as with health care workers.

From Brian Lavallee:

Natural rubber latex contains anywhere between one percent and several percent protein. It is the protein that causes the problem in terms of producing the IgE antibody (the antibody associated with allergies) and leading to allergic reactions.

The reaction severity relates to how much allergenic protein the individual is exposed to, how they're exposed and how much allergen gets into either the nose or into circulation. Repeated exposure to an allergenic protein in an individual who is genetically predisposed to allergy disease will, in theory, induce higher levels of IgE antibody and make the allergy worse. It is tough to predict whether an individual will have a reaction or not.

What are the different kind of allergic reactions that people can have? Latex allergy is like most other allergies. It can cause swelling and redness of the skin, a runny nose and watery eyes, and in rare cases, a systemic anaphylactic reaction that can be life-threatening. It is referred to as systemic because it can affect the organs, such as the respiratory tracts and cardiovascular system. An anaphylactic reaction occurs when a sensitized individual is exposed to a substantial amount of allergenic protein either by inhalation or by injection. The allergenic protein gets into the system and can make it difficult to breathe and can lead to shock. The symptoms that one gets are identical to the anaphylactic reaction that occurs in an insect sting allergy or in a peanut-induced allergic reaction.

From Javed Movasseli:

Yes, latex gloves are a danger for allergic patients. Natural latex from the rubber tree Hevea brasiliensis is an allergen in persons with significant cumulative latex exposure, such as those in health care and rubber industries, as well as those undergoing repeated surgeries, especially if they undergo surgeries early in life.

Symptoms of latex allergy may progress rapidly and unpredictably to anaphylaxis. The prevalence of latex allergy has increased as the use of rubber gloves in health care settings has increased. Airborne latex particles that adhere to the cornstarch used to powder gloves are a significant cause of respiratory symptoms and a source of sensitization. Once an individual has become sensitized, he or she may experience allergic symptoms when exposed to any product containing latex. - COPYRIGHT 1998 American Academy of Family Physicians.

From Mary Perkins :

Initial reactions on exposure to latex proteins/allergens may show symptoms which mimic hay fever or asthma. Skin conditions like rashes, hives, itching or dermatitis may also appear. The risk of anaphylaxis is greater in individuals with prior reactions to latex-containing objects. Symptoms of anaphylaxis are usually immediate and progress rapidly to swollen airways, drop in blood pressure, loss of consciousness, respiratory arrest and death. Emergency medical attention should be sought at the first sign of anaphylactic reaction.

From Neuville Yao:

The incidence of serious allergic reactions to latex has increased in recent years. In rare cases, these reactions can be fatal. Health care workers and others who are frequently exposed to products containing latex should be aware of the potential for developing an allergic reaction. Individuals who exhibit symptoms of the allergy should be alerted to the need to limit future exposure to latex products.

The risk of anaphylaxis due to latex appears to be greatest in individuals with prior allergic reactions to latex-containing objects, or prior unexplained reactions or anaphylaxis during a medical or surgical procedure. Health care providers with a history of severe or worsening latex-glove-induced eczema, hives or work-related rhinitis or asthma like symptoms should be especially cautious.

 

Responses were also received from L. Chen, A. Crossman, S. Groulx, J. Humeniuk, C. Longphee, L. MacDonald, G. Marshall, B. Matheson, I. Mills, F. Realubit, C. Rivers, V. Robichaud, B. Sheppard, and S. Woodrow