Latex Allergy and Spina Bifida
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 Ü this 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 latexP L May, MBBS, FRCS, Consultant Paediatric Neurosurgeon and member of ASBAH's Medical Advisory Committee, writes:
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
