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The information below was published in the December 1996 issue of ASBAH's journal, LINK
Sensitivity to latex (natural rubber) can be a problem for people with spina bifida because of the frequency with which they come into contact with it.
Many healthcare products contain latex so people with spina bifida (and medical professionals) are exposed to it on a regular basis - either during surgery (through the use of latex gloves and anaesthetic equipment) or during bladder and bowel management (through the use of latex tubing, gloves and catheters).
Latex allergy occurs when the body's natural defences against an allergen come into force. It involves the production of antibodies when there is contact with a specific antigen (in this case latex). Antibodies are produced by the initial reaction to latex which sensitise the cells in all tissues. The severity of subsequent reactions depends on the means of entry of the antigen.
Exposure to latex occurs when products containing rubber come in contact with a person's skin or mucous membranes such as the mouth, eyes, genitals, bladder or rectum. Serious reactions can also occur when latex enters the bloodstream. In addition, the powder from balloons or gloves can absorb particles and become airborne causing reactions when breathed by a latex sensitive person.
The most potent and life-threatening reaction is entry into the vascular system, which can lead to changes in blood pressure and circulation (anaphylactic shock). Skin contact produces a less severe reaction Рthis is usually raised, pinkish, itchy weals, which develop suddenly and last a few days, but leave no visible trace.
Research has shown in the United States that between 18% and 73% of children and adolescents with spina bifida are sensitive to latex as measured by history or blood test.
Although widely accepted in the United States, latex allergy is still not considered a problem by authorities over here. This is partly due to lack of research into the extent of latex allergy among patients and medical staff, and partly due to a belief that it is impurities in the latex which cause the allergic reaction, not the latex itself.
More is known about latex allergy in hospital staff and dentists than in patients. But things are changing. The Royal College of Nursing's Society of Occupational Health Nursing (SOHN) did a survey of health departments in 1996 to find out the number of staff with a latex allergy in UK hospitals. These figures will be used to lobby the government and to encourage hospitals to introduce allergy screening for new staff and patients, and to work out how to deal with patients and staff who have latex allergy. The Department of Health's Medical Devices Agency has suggested that health professionals ask patients about previous allergic reactions to latex. However, some believe nurses should go further and ask patients about any food allergies as the two are cross-related
The mother of our case study says: ''George seems an isolated case at the moment. We're fighting for his problem to be recognised. People don't believe it. If he ever had to be admitted into hospital as an emergency, I'd have kittens. They would have to suck all the air out of the operating theatre because even latex in the air can affect him.''
ASBAH is conducting its own survey to find out the extent of the problem among service users.
The Spina Bifida Association of America recommends that all individuals with spina bifida should be considered high risk for having an allergic reaction to rubber and should avoid contact with rubber products, particularly during medical or surgical procedures. In addition, it says people who have experienced allergic reactions during surgical or medical procedures should consider wearing a medic-alert bracelet or necklace. The Spina Bifida Association of California issues medical alert cards stating that spina bifida patients often have a severe allergic reaction to latex.
Severe reactions in patients exposed to the latex antigen was first described in 1984. Over the last few years, however, there has been an increasing recognition in the United States of the condition particularly with respect to patients with spina bifida and associated abnormalities. The Food and Drugs Administration (FDA) in the United States has undertaken several studies to examine the incidence of reaction in spina bifida patients to latex either in the form of skin rashes or more serious manifestations of sensitivity. In 1991 this incidence was reported to the FDA to be somewhere between 18-40%. It was noted by the American workers that children appeared to be particularly at risk of hypersensitivity with this allergen.
The Medical Devices Agency in the United Kingdom has been monitoring the subject of latex allergy for several years because of concerns raised by American reports of increased incidents of latex allergy among healthcare workers and certain groups of patients. At the present time there are no authoritative statistics which indicate the extent of the problems in the UK healthcare setting or in the general population. From our own experience in the Royal Liverpool Children's Hospital over the last six months we have documented at least one episode of a major hypersensitivity reaction in a young female patient with spina bifida undergoing corrective spinal surgery. The condition was recognised and she has made a full recovery.
The increased incidence of this sensitivity is thought to be related to the general increase in the use of latex products, particularly gloves, by healthcare workers and also to the incorporation of tube products with a higher latex content. Patients with neural tube defects and congenital urogenital abnormalities seem to be particularly at risk probably because of the increased number of surgical procedures they are exposed to involving equipment containing latex. Latex is present in many different types of material within the operating theatre set-up including surgical gloves, urinary catheters, surgical drains, disposable syringes and IV fluid giving sets.
Latex itself is a cloudy white liquid which comes from a rubber tree, Hevae brasiliensis. Once the liquid has been tapped from the tree, chemicals are added to it which provide the strength, elasticity and dimensional stability characteristic of many rubber products. Natural rubber latex is therefore composed of proteins and added chemicals, some of which would be removed during the later stages of production. The reactions that can occur in an allergic response to latex can range from mild irritation of the skin to more serious general manifestations of anaphylaxis or major shock.
In this country it is clear that more work needs to be done to identify the potential problem so that we can reassure our service users involved in repeated forms of surgery. This also involves increasing awareness among healthcare professionals as well as those service users susceptible to latex hypersensitivity. There are at present tests which are freely available to assess the sensitivity of the individual to latex, the commonest of which, I believe, is the RAST test which is a blood test. It is also possible to perform skin testing to latex allergy.
It is clear that more work needs to be done before we are able, in this country, to give a clearer picture of the true incidence of this apparently relatively rare event in service users undergoing frequent surgical procedures in the UK.
George - A Case StudyOur 15-year-old son George (not his real name) has spina bifida, but no hydrocephalus, and is walking. Over the years he has had problems with his bladder and bowels. So far, he has had five operations. He first had problems, possibly with latex, when he was about six years old. When he came home from school one day, his face started to swell, his nose disappeared and his eyes were like tiny slits. I rushed him to our GP who wanted him to take medication daily (I think some sort of anti histamine). The doctor said it was the worst case he had ever seen. I gave him the medicine but as the weeks went by no other attack followed. As he was already on permanent antibiotics I felt uneasy about so much medication and eventually stopped giving it to him. From then on, about 2-3 times a year he would have swollen watery eyes, feel unwell and sometimes his face would swell, but never as badly as the first time. We started to think of hay fever, but our GP thought it was not worth having him tested. We started to suspect latex when we bought him a latex mask at the seaside. He wore it for a short time before we realised his face was red and swollen. When George was about 14, after a dental examination, he came out in red blotches, swelling and blisters around and in his mouth. The next visit, very soon after, was worse. He then had the same symptoms but also could not breathe properly and had pains in his chest. At this stage I insisted that he was tested. He was diagnosed as latex allergy Type 1 at Hope Hospital, Manchester. The skin prick test also showed a very small reaction to pollen. Since then he has had two reactions, once when he had to leave a hospital where he was visiting a patient because his eyes were very sore and watery, and recently he came home with sore, watery eyes and also breathing problems and chest pains. |
Latex is the sap from the Hevea brasiliensis tree. Common household and hospital products containing latex:
| Household gloves | Hospital gloves |
| Condoms | Condom incontinence aids |
| Wheelchair tyres | Adhesive tapes (sticky plasters) |
| Some urinary catheters | Some enema tubing |
| Protective sheets | Colostomy/urostomy products |
| Balloons and rubber balls | Art supplies |
| Dental dams | Baby bottle nipples and pacifiers |
| Elastic on clothes | Beach toys |
| Chewing gum |
There are alternative, non-latex products for all of these items. Usually, these alternatives are made of plastic, vinyl or silicone.
Research has shown that proteins found in certain foods show similar immune system reactivity to the proteins found in latex. So, if your mouth itches when you eat any of the foods listed below, you could be allergic to latex as well.
Foods which have been identified as having cross reactivity include:
| Bananas | Potatoes |
| Avocados | Tomatoes |
| Kiwi Fruit | Mangoes |
| Chestnuts |
Continence sheath - Clear Advantage from Depuy Healthcare. Freephone 0800-590916.
Disposable gloves - N-dex Nitrile EMS gloves from Sentinel Laboratories Ltd,12-13 Lindfield Enterprise Park, Lewes Rd, Lindfield, West Sussex RH16 2NH. Tel: (01444) 484044. Contact: Brian Smith.
