Saturday, October 20, 2012

Anaphylactic Reaction to Latex in a Health Care Worker: Case Report.

Anaphylactic Reaction to Latex in a Health Care Worker: Case Report.

Zahariev Vukšinić K, Knežević B, Bogadi-Šare A, Bubaš M, Krišto D, Pejnović N.
Acta Dermatovenerol Croat. 2012 OKTOBER;20(3):207-209.


INTRODUCTION Latex is a stretchy material used in hundreds of items that come in direct contact with the body. Condoms, bras, surgical gloves, toys and radial tire dust particles are some of the most common places where latex is found. Because latex is used in so many products today, there are increasing reports of latex sensitivity (1,2). Allergy to latex comes in two different forms. One form is called "delayed hypersensitivity" (type IV allergic reaction), which is usually seen as a skin rash at the site where the latex product contacts the skin. This rash can be quite severe. A more dangerous form of latex allergy is "immediate reaction" (type I allergic reaction) to latex. It is also related to rhinoconjunctivitis, asthma, angioedema and anaphylaxis. Anaphylaxis can result in a seriously low blood pressure, breathing difficulty, and even death. Continued exposure puts individuals with type IV allergy at a risk of developing the antibodies that trigger type I latex allergy (2). Natural rubber latex allergy affects people who are frequently exposed to products made of natural rubber latex in occupational and everyday settings (3-5). The prevalence of latex sensitization in general population ranges between 5% and 10%. According to Ruëff et al. (6), positive skin tests to latex were noted in 9.5% of 325 adult hospital inpatients waiting for surgical or urological procedures. Ownby et al. (7) found elevated levels of latex specific immunoglobulin E (IgE) antibodies in 6.5% of 1000 volunteer blood donors. Allergy to natural rubber latex is an important cause of occupational allergy in health care workers (8-12). Frequent hand washing and disinfection are inevitable strain on the skin. Since the infections associated with health care represent a major problem worldwide, the World Health Organization (WHO) has issued Guidelines for Hand Hygiene in Health Care Institutions (13). In Croatia, the national guidelines for hand hygiene have been developed on the basis of these WHO guidelines (14). They describe in detail the techniques of hand hygiene. All these guidelines need to be followed, and applying the hand hygiene principles, health care workers damage the protective layer of their skin (15). Powder in gloves is also a potential irritant. Research has shown that the powder in gloves causes irritant dermatitis. Through damaged skin, allergens can enter and cause allergic clinical picture (16-17). This is also the reason why health care workers are at a higher risk to get latex allergy than general population. Many studies demonstrated an increased prevalence of latex sensitization in health care workers, which ranged from 9% to 12% (1,10,18,19). Data from the Register of Occupational Diseases of the Croatian Institute for Health and Safety at Work show that skin diseases accounted for 2.6% to 8% of the total number of recognized occupational diseases in the 2008-2011 period. In this period, only one case of allergic contact dermatitis to latex was recognized. The patient was working as a nurse and she got nearly fatal allergy to latex (20).
CASE REPORT A 51-year-old patient had worked as a nurse for 31 years. At her workplace as obstetrics head nurse, she was in contact with various biological and chemical hazards. Therefore, she mostly used latex gloves. First skin manifestations occurred five years before and were described as possible contact dermatitis. Dermatitis disappeared after local therapy with corticosteroid creams. At that time, allergy tests were not performed. After a short sick leave, she returned to work at the same workplace. In the next four years, she frequently had health problems with skin on both hands but she did not visit a dermatologist. Then she went to the gynecologist for gynecological examination. During the examination by the physician using latex gloves, she suffered anaphylactic reaction to latex. The physician gave her intravenously chloropyramine chloride (Synopen) and soon she felt better. After that incident, she underwent complete diagnostic work-up. Positive patch test reaction to thimerosal after 72 hours and positive prick test reaction to latex were found. Based on the positive workplace exposure and diagnostic tests that showed an allergy to latex, occupational disease was recognized. The patient is now on sick leave and she is waiting for retirement decision.
DISCUSSION A case of a 51-year-old nurse with latex-induced anaphylaxis is presented. She was wearing latex gloves daily at work and washed her hands with disinfectants. She had skin health problems for already five years, but medical examinations that could detect the cause of health problems were not undertaken, so she continued working at the same workplace for years. Because of everyday contact with latex, she finally got an anaphylactic reaction to latex. This case points out several problems. One problem indeed seems to be that health care workers, fearing for the loss of their jobs, tend not to report skin problems associated with wearing latex gloves, and just put up with it. Another problem is insufficient awareness of the risk of latex allergy, which leads them to ignore skin symptoms and avoid seeking medical help. Clearly, this is hazardous in several ways. A failure to recognize the problem may lead to hypersensitivity worsening and failure to prevent life-threatening anaphylaxis. These problems seem to be the main reason why latex allergy in health care workers is unrecognized as occupational disease. The presentation of this case is important to encourage timely diagnosis of occupational skin diseases and to launch further preventive initiatives to avoid serious consequences such as anaphylactic reaction. To prevent latex allergy in health care workers and occupational skin diseases in general, it is necessary to implement preventive measures, including vocational counseling, education and information, and to raise awareness. Vocational counseling is the first column of prevention. Occupational health physician should steer atopic individuals (persons with a tendency to have multiple allergic conditions such as urticaria, asthma, allergic rhinitis) in occupations that would not cause deterioration in their health status. Second column in the prevention is education and information. Health care workers should be educated to protect themselves from latex exposure and allergy at the workplace. They should use non-latex gloves, reduced-powder or powder-free gloves, use appropriate work practices to reduce the chance of contact with and reaction to latex. Limitation of latex use needs to be considered as a long term strategy for solving latex allergies among health care workers since it is known that the first symptoms of latex allergy can occur already after five years of exposure (2,21). Latex allergy awareness can be established through a uniform education program involving information aids such as brochures and videos. A questionnaire that would determine their personal risk of latex allergy could also be useful. After education, they could be able to recognize allergic symptoms. They also should be educated about proper skin care outside the workplace. At the end, health care workers should be encouraged to report every symptom of possible latex allergy (12).
CONCLUSION Education regarding correct glove selection, awareness of latex allergy and available alternatives is essential. All preventive actions should reduce the risk of health care workers developing latex allergy and ensuring safe employment of those who become affected. All this should contribute to preventing or at least reducing the life-threatening anaphylactic reactions to latex among this population of workers.

PMID:  23069310  [PubMed - as supplied by publisher]

Blog Archive