School Health Latex Free Information

School Health-Latex-Safe Information

Latex-Safe Information

Disclaimer:
In the medical industry, some products contain Natural Rubber Latex (NRL), which has been associated with sensitization or allergic reactions. The contents of this section are for informational purposes only. It is not to replace medical direction or advise. If you have any questions or medical concerns, please consult an allergist or immunologist.

To the best of School Health Corporation's knowledge, the information provided by manufacturers about Natural Rubber Latex content is considered to be true. See section, Manufacturer's Statement, for further information.

What Does It All Mean?

Frequently Asked Questions

Manufacturer's Information

Resource Links

Latex Safe Products

What Does It All Mean?

	Latex
	Latex Allergy
	Rubber Allergies
	Incidence
	Medical Glove Allergenicity
	Powder-Free
	Hypoallergenic
	School Nurse Responsibilities
	Recommendations for Health Care
	Allergenic Cross-Reactivity of Latex and Foods
	References
	Latex Latex is a milky fluid produced by the rubber tree, Hevea brasiliensis. Natural rubber latex is found in a variety of health care products such as gloves, tubes, syringes, adhesive bandages, etc. Latex Allergy Latex allergy refers to allergy caused by natural rubber latex. Synthetic latex products do not appear to cause the same reactions for those with natural rubber allergy. Rubber Allergies Two types of allergies are associated with rubber:

	1.	Chemical Contact Dermatitis-a delayed cell-mediated Type IV localized allergy that is caused by chemicals used to manufacture rubber products.
	2.	Latex Protein Immediate Hypersensitivity (termed latex-allergy)-Latex Allergy is a Type 1 IgE-mediated hypersensitivity reaction that involves systemic antibody formation to proteins in products made from natural rubber latex. Natural rubber latex is harvested from the rubber tree, Hevea brasiliensis, and used to manufacture rubber products. Natural rubber latex contains up to 240 potentially allergenic protein fragments, and different persons may be sensitized to different combinations of latex allergens. Synthetic latexes are not involved in latex allergy.

Incidence:
Studies have shown the incidence of latex allergy to be as high as 67% in patients with spina bifida, (1) 6.5% in patients who have undergone multiple surgeries, (2) 8% to 17% in health care workers, (3-5) and between 1% and 6% in the general population. (4,6,7) These figures would indicate, based on assumptions, that there are presently more than 5.5 million health care workers in the United States (1) and 272 million Americans in the current US population. An estimated 440,000 to 935,000 health care workers, or 2.7 million to 16 million Americans, may suffer from some type of allergic reaction to latex.

Medical Glove Allergenicity
Latex Medical Gloves are the most prominent source of latex allergen exposure by cutaneous contact, inhalation, wound inoculation and ingestion. (8,9) Allergens levels vary considerably in gloves from different manufacturers, and from lot to lot, with higher levels occurring in powdered gloves and examination gloves than in powder-free gloves and surgical gloves. (8,10) Latex gloves that are inadequately processed during manufacture contain loosely-bound protein that readily rubs off or leaches into sweat, then accumulates on glove wearer's hands and easily transfers by touch to other persons and objects (e.g. medical records, telephones, doorknobs, food, etc.).

Powder-Free
Adverse reactions to natural rubber latex gloves have emerged as an important occupational health concern for workers who are required to wear gloves as a barrier against infectious agents. (11) The most severe reaction associated with latex gloves, Type 1 immediate hypersensitivity, a rare but potentially life threatening allergic reaction to latex proteins, may be elicited not only by dermal contact with gloves but also by exposure to latex proteins contained in airborne glove powder. (11,12) Powder can become airborne during unpackaging, putting on and taking off of gloves. (11) Airborne particles of powder and protein may remain suspended for up to 5 hours, contaminating the air, ventilation system, skin, hair, clothing, wounds and objects which can result in occupational asthma. (14,15)

Cornstarch powder has long been used on latex gloves as a lubricant to facilitate putting the gloves on. Cornstarch or other powder is also used by some (but not all) manufacturers to ease removal of gloves from molds. For powder free gloves, the powder is removed afterwards by washing. The United States Food and Drug Administration (FDA) has recommended that powder free gloves contain no more than 2mg residual powder and powdered gloves no more than 120 mg powder. (13) The FDA guidelines only apply to gloves for medical use.

Hypoallergenic
The "hypoallergenic" label generally means that gloves are low in chemical contact sensitizers, but "hypoallergenic" does not refer to latex allergens. (16)

School Nurse Responsibilities in Creating a Latex Safe Environment

1.	Educate School Personnel: Educate personnel regarding students and other school personnel with latex allergies and the need to minimize the risk of sensitizing children or personnel who are at risk for developing latex allergy. Also, attempt to balance two needs: maximum inclusion of the child in school life and activities with safety from exposure to a potentially life threatening allergy. Identify latex sensitized students and personnel.
	a.	Establish an inventory of non-latex alternatives for latex medical devices
	b.	Educate personnel regarding latex allergy and related issues
	c.	Implement latex allergy guidelines pertaining to students and school personnel
	d.	Provide task appropriate, powder and latex free gloves
2.	Identify Potential Exposure: Access high-risk areas for latex sensitive students
	a.	Classrooms for erasers and rubber bands, art supplies, science and lab equipment
	b.	Cafeteria for food preparation with latex gloves. School personnel should understand the cross contamination between latex and certain foods such as bananas, kiwi and avocado
	c.	Gym and playground for rubber mats and flooring, balls and racquet handles
	d.	Housekeeping supplies, latex gloves for cleaning classrooms, hallways etc. may leave allergic powder on surface or in the air
	e.	Nurse's office deserves a real close look. Even if a child has a separate supply of non-latex gloves and other first aid items, protein-laden powder from latex gloves used with other children can easily contaminate surfaces and remain airborne long enough to trigger a respiratory reaction
3.	Develop Emergency Protocol: Protocols should include specific plans for recognizing and treating a reaction in each child, when to call for help and facilitating ambulance and emergency room preparedness and latex safety. Easily accessible latex free first aid supplies are an important part of any emergency plan.
A few things to keep in mind:
1.	Oil-based solutions (hand moisturizers containing jojoba, aloe vera, palm oil, coconut oil, lanolin, mineral, petrolatum products) break down the molecular structure of latex and some synthetic glove materials within a few minutes.
2.	Soaps, detergents, alcohol and various chemicals also degrade latex.
3.	Water and glycerin-based hand care products are compatible with latex.
Allergenic Cross-Reactivity of Latex and Foods For more information on cross-reactivity between latex and food, click on this link to go to the Tripod.com website to see an article published with permission by Greer Laboratories. Latex Allergic People Cross React to Many Plants "The latex and food allergy connection" by Judy E. Perkin. Journal of the American Dietetic Association. Nov, 2000.
References
1.	Kelly KJ, Krup VP, Reijula KE, Fink JN. "The diagnosis of natural rubber latex allergy." J. Allergy Clinical Immunology 1994;93:813-816
2.	Moneret-Vautrin DA, Beaudouin E, Widmer S, et al. "Prospective study of risk factors in natural latex sensitivity." J. Allergy Clinical Immunology 1993;77:905-908
3.	Watts DN, Jacobs RR, Forrester B, et al. "An evaluation of the prevalence of latex sensitivity among atopic and non-atopic intensive care workers." Am J Ind Med 1998;34:359-363 Medline
4.	Arellano R, Bradley J, Sussman G. "Prevalence of latex sensitization among hospital physicians occupationally exposed to latex gloves." Anesthesiology 1992;77:905-908.
5.	Liss GM, Sussman GL, Deal K, et al "Latex Allergy: epidemiological study of 1351 hospital workers." Occup Environ Med. 1997;54:335-342 Medline
6.	Ownby DR, Ownby HE, McCollough J, et al. "The prevalence of anti-latex lge antibodies in 1000 volunteer blood donors." J. Allergy Clinical Immunology 1996;97:1188-1192 Medline
7.	Sussman GL, Beezhold DH. "Allergy to Latex Rubber" Annals of Internal Medicine 1995;122:43-46 Medline
8.	Yunginger, JW (1995) "Variances in antigenicity of latex products. Immunology and Allergy Clinics of North America", 15 (1), 61-70.
9.	Yunginger, J, Jones, R, Fransway, A et al. (1994) "Extractable latex allergens and proteins in disposable medical gloves and other rubber products. Journal of Allergy and Clinical Immunology", 93:83-42.
10.	Jones, RT, Scheppmann, DL, Heilman, DK and Ynuginger, JW (1994). "Prospective study of extractable latex allergen contents of disposable medical gloves." Annals of Allergy. 73(4), 321-325.
11.	Lynch MC, Neiders ME. "Risks of occupational exposure to latex gloves." NY State Dental Journal 1998; 64:35-9.
12.	Gliniecki CM. "Management of latex reactions in the occupational setting." AM Assoc. Occup. Health Nurses Journal 1998: 46:82-93
13.	Food and Drug Administration. Medical Glove Guidance
14.	Kelly, KJ
15.	American Academy of Allergy, Asthma, and Immunology and American College of Allergy, Asthma and Immunology. "Joint Statement Concerning the Use of Powdered and Non-Powdered Natural Rubber latex-Gloves." Arlington Hts., IL: ACAAI, July 21, 1997.
16.	Truscott, W. (1995). "The industry perspective on latex. Immunology and Allergy Clinics of North America", 15 (1) 89-121.

Frequently Asked Questions

Q:	Who is at risk of developing latex allergy?
A:	1.	Health care workers are at risk because they use latex gloves frequently. Workers with less glove use (such as hairdressers, housekeepers and workers in industries that manufacture latex products) are also at risk.
	2.	Children at risk: Spina Bifida patients Children who have been in intensive care for long periods. Children who have had a lot of surgeries. Children who have had invasive medical procedures with latex items.
	3.	People who have allergies to certain foods; see section on Allergenic Cross-Reactivity of Latex and Foods.
Q:	What are the symptoms of latex allergy?
A:	The symptoms are: skin rash, hives, flushing, itching, nasal, eye or sinus symptoms, asthma and sometimes anaphylactic shock.
Q:	Do I have to worry about other medical products besides gloves?
A:	Latex is found in many items in health care settings and the home. Included could be such items as: elastic and adhesive bandages, rubber bite blocks, BP cuffs, condoms, diaphragms, balloons, cloth adhesive tape, teething rings, pacifiers, manual ventilation bags, tourniquets, medication ports on I.V. lines, ECG electrodes, pencil erasers and rubber bands.
Q:	Will hypoallergenic gloves protect me from latex allergy?
A:	Hypoallergenic gloves are not latex-free, although they contain fewer additives and reduce the risk of allergic contact dermatitis. Wearing a cotton glove liner does not help either; latex can leach from the gloves onto perspiring hands.
Q:	Are your School Health Brand Adhesive bandages latex-safe?
A:	The School Health Adhesive Bandage is latex-free, BUT the adhesive on the bandage package does contain natural rubber latex. A better choice for a 100% latex free bandage and packaging would be the 100% Latex-Free Bandages offered by School Health. Click here for ordering information.

Manufacturer's Information
To the best of School Health Corporation's knowledge, the information provided by manufacturers about Natural Rubber Latex content is considered to be true. School Health Corporation cannot be responsible for products containing NRL that may be still in an inventory or distribution system by a particular manufacturer. We have provided the list of our manufacturer's websites so you may obtain specific information related to a product of interest.

	Becton, Dickinson and Company		BSN-Jobst, Inc.
	Hartmann-Conco Inc.		Kendall
	CROSSTEX International		Laerdal
	DASH Medical Gloves		3M
	Hermitage Hospital Products, Inc.		Welch Allyn, Inc.

Resource Links

General Information
Latex Allergy News: The Information Sharing Vehicle of ELASTIC (Education for Latex Allergy Support Team Information and Coalition)
Telephone: 860.482.6869

Latex Allergy Link - Educational networking site brought to you by the members of the National Latex Allergy Network (ELASTIC, Inc.)

Spina Bifida Association of America
(Can supply updates list of latex products and substitutes)
Telephone: 800.621.3141

American Academy of Allergy, Asthma and Immunology (AAAAI) -The largest professional medical organization of specialists in allergy, asthma and immunology. Go to key word and type in: latex allergy

National Institute for Occupational Safety and Health (NIOSH).- Occupational Latex Allergies

Association Position Statements:
National Association of School Nurses

American Nursing Association

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