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Latex is a natural milky fluid found in 10% of all flowering plants.  Not all latex products are made from the natural source of latex.  Some latex is made from man-made synthetic latex and these are unlikely to cause a reaction.

A latex allergy is a reaction to certain proteins found in natural rubber latex.  If you have a latex allergy your body mistakes latex for a harmful substance and it triggers antibodies to fight the latex allergen.  When you are exposed to latex repeatedly, the antibodies signal your immune system over and over to release histamine and other chemicals into the bloodstream, which causes the latex allergy symptoms to occur each time there is latex exposure. If you are allergic to latex you can have symptoms if you are in direct contact with latex, or by inhaling airborne latex particles that can be released into the air. 

Latex allergy reactions can start out mild but can become severe with repeated latex exposure.

Mild Reactions : Mild reactions begin with dermatitis or skin irritations in the areas the allergen is in contact with the skin.  Symptoms include rashes, hives, redness and itching.

Moderate Contact urticarial/systemic reaction: Moderate reactions occur with continued exposure to latex include, sneezing, itchy watery eyes, runny nose, coughing, wheezing, scratchy throat and difficulty breathing. 

S evere/Anaphylactic Shock symptoms: Anaphylactic reactions are the most severe symptoms of latex allergies and are potentially life-threatening conditions.  Symptoms include hives or swelling, wheezing, trouble breathing, nausea or vomiting, drop in blood pressure, dizziness, confusion, and rapid or weak pulse.  Anaphylaxis will eventually lead to death in people who are highly allergic to latex if the exposure to latex continues.

Your doctor will likely want to know the symptoms and reactions you have already experienced when you are in contact with latex.  He or she will likely recommend having two tests done to diagnose a latex allergy. 

Skin Test – a dab of liquid latex proteins is placed on your skin (arm or back) and then is pricked with a small needle to allow the latex to get into the skin surface.  If you are allergic to latex a red, raised bump will occur. 

Blood Test – a sample is taken at a lab and is tested for sensitivity to latex.

There is no cure for a latex allergy.  The only way to avoid latex allergy reactions is to avoid products and foods containing latex.  However, if accidental exposure occurs there are a few treatments that can be used.

Antihistamines can help to control minor allergy irritations such as sneezing, runny nose, and watery eyes.

Corticosteroids creams can help to clear up skin rashes and skin dermatitis. 

Epinephrine or an Epi-pen can be used in severe cases where anaphylactic shock occurs.   It is very important that the latex allergy patient learns how to administer his or her own epinephrine (adrenaline) or Epi-pen. 

*Wearing a Medical Alert Bracelet can help protect you in the event of a medical emergency.  The medical team will then know immediately that you have a latex allergy. 

*Prior to any doctor or dental appointments warn the office of your latex allergy.

  • People working in health care
  • People undergoing many surgeries or medical procedures
  • Rubber industry workers
  • People with a family history of allergies
  • People with Spina bifida
  • Balloons
  • Balls: Koosh balls, tennis balls
  • Art supplies: paints, glue, erasers
  • Hot water bottles
  • Baby bottle nipples
  • Pacifiers
  • Teething rings
  • Some disposable diapers
  • Rubber pants
  • Some toys; old Barbie’s, Stretch Armstrong, etc.
  • Dishwashing gloves
  • Some carpets, carpet backing, rubber gym floors
  • Waistbands on clothing
  • Belts
  • Suspenders
  • Rubber bands
  • Condoms
  • Diaphragms
  • Water toys, swim goggles, bathing caps, scuba equipment
  • Handles on tennis or badminton rackets
  • Handgrips for bicycles or motorcycles
  • Intravenous tubing
  • Oral and nasal airways
  • Catheters
  • Endotracheal tubes
  • Tourniquets
  • Protective goggles
  • Some first aid tape and bandages
  • Electrode pads
  • Respirators
  • Rubber aprons
  • Shoe soles
  • Crutch tips
  • Wheelchair cushions
  • Tires
  • Zippered plastic storage bags
  • Latex gloves
  • Rubber dams
  • Surgical masks
  • Endodontic points
  • Prophy cups
  • Gutta percha,
  • Syringes
  • Blood pressure cuffs
  • Stethoscopes
  • Stoppers at the end of anesthetic vials
  • Dental braces with rubber bands
  • Bite blocks
  • Nose pieces for oxygen/nitrous oxide masks

People who have a latex allergy can be allergic to a number of plant products (usually fruits).  Avocados, banana’s, chestnuts, kiwis, and passion fruits all contain the protein found in latex and can cause latex reactions to occur. Pineapple, mango, fig, strawberry and soy can also cause reactions but do not contain the latex protein.  If you are allergic to latex you will likely be allergic to some of these foods as well. 

*A concern is also foods that are handled with latex gloves .  Latex proteins can be transferred to the foods and cause allergic reactions.

WCB encourages anyone to submit his or her claim to WCB as soon as possible after the allergy occurs or diagnosis has been made.   They stress submit your claim promptly.   Every case is unique and individual and they look at them in a case-by-case basis.   Coverage depends on the severity of your latex allergy.  Retraining is possible but it depends on how severe the allergy.  In some cases, it will be deemed that dental assistants have enough transferable skills to work in other areas of employment where contact with latex is not a problem and retraining will not occur.

Occupational Health and Safety Branch - Ministry of Labour Relations and Workplace Safety Manual States:

Employers have an obligation under the Occupational Health and Safety Regulations, 1996, to replace hazardous or harmful chemical or biological substances with less hazardous ones, where this is reasonably practicable (Regulation 302).  Latex gloves are considered more hazardous than other glove materials because of their ability to cause severe allergic reactions. These reactions can significantly impact the sensitized worker’s ability to continue their current job and requires extensive changes in the workplace to create a latex-safe environment.  Additionally, regulation 308 requires the employer to take steps to minimize a worker’s exposure to chemical or biological substances that may be harmful to a worker that has become sensitized or unusually responsive to the substance. 

In the case of latex allergies, employers must develop a policy for glove use. This policy will prevent new cases of latex allergy and prevent latex exposure to workers whom may have developed latex allergies. This policy must examine procedures used throughout the facility and determine the appropriateness of glove usage.  For each type of procedure, determine whether gloves are needed and what glove material is recommended. Consult with the Occupational Health Committee, occupational health consultants, infection control personnel and staff representatives from all areas and job types. Review and revise the policy on a regular basis to address new procedures or changes to existing procedures.

When dealing with a suspected glove allergy, such as latex, the following steps should be followed:

  1. Encourage the worker to visit their physician for a medical confirmation and evaluation of the nature and extent of their allergy. It is important to determine if they have the potential for severe allergic reactions to latex. Medical specialists can determine whether the person has latex-specific IgE antibodies that are associated with severe reactions. Encourage the worker to provide the employer with any needed medical information on the nature and severity of their latex allergy.
  2. Provide non-latex gloves to workers with latex allergies.
  3. Develop a latex-safe protocol and work area where staff with confirmed severe latex allergies are expected to work. The objective is to ensure, as far as possible, that the allergic workers are not inadvertently exposed to the latex ingredients to which they are sensitized such as airborne powders released from latex gloves. This may involve a thorough preliminary cleaning of a work area to remove latex-containing dusts (e.g., upholstery, carpets, ventilation ducts, plenums and filters, vacuum cleaners and bags).
  4. Require other workers to use non-latex gloves in work areas where a worker has a medically confirmed latex allergy. Any exception (e.g., use of low-protein non-powdered latex) must be based on a careful examination of the reasons. The implications of using powdered latex gloves (e.g., the likelihood that the glove may cause a severe allergic reaction) must be considered.  In most cases it is reasonably practicable for non-latex gloves to be used.
  5. Inform other workers when a co-worker has reported a medically confirmed latex allergy and notify them about required procedural changes.
  6. Encourage workers (especially workers with severe latex allergies) to inform their co-workers.
  7. Identify other known latex products to which the worker is sensitized and may be exposed. Inform sensitized workers of other latex containing products that may trigger an allergic reaction after direct skin or mucous membrane contact. (See the examples in Appendix B). Substitute latex products to prevent putting sensitized workers at risk of severe allergic reactions.
  8. Offer alternative work duties, to the extent that is reasonably possible, to workers who have medically confirmed latex allergies. The regulations require the employer, on the request of the worker, to assign the worker to less hazardous, alternate work, if that work is available.

Latex allergy incidences increased when the adoption of standard infection control precautions took place.  It became mandatory for all medical personnel (dentists, dental assistants, therapists, hygienists, doctors, nurses, etc.) to wear gloves for their own safety and the safety of their patients. 

  1. Refer clients and personnel with a suspected latex allergy for latex allergy testing.
  2. Limit appointment times for people with confirmed latex allergies.  A shorter exposure time allows for a more limited reaction. 
  3. If at all possible remove all latex gloves and other latex materials (including dental dames) from the office and replace them with non-latex alternatives.  Recognizing that no dental office can ever be considered latex-free.  The goal is to limit as much latex as possible and become a latex-safe office. 
  4. At the least, remove all latex gloves and supplies from the operatory the latex patient is being treated in. 
  5. Use Ultracaine local anesthetic if local anesthesia is indicated.
  6. Do not handle products while wearing latex gloves or with unwashed hands after wearing latex gloves.
  7. Do not store non-latex products with natural rubber latex products.
  8. Do not leave dental materials and instruments exposed to airborne allergens and latex glove powder if they are to be used on a latex-allergic patient.

Prior to Confirmed Diagnosis

Refer the latex sensitive employee to their physician

  1. Have testing done to confirm if it is a latex allergy, another allergy or a contact dermatitis.
  2. Investigate alternative causative agents in the work such as soaps, detergents, preservatives, colorants and disinfectants.

Create a latex reduced work environment

  1. Ensure thorough hand rinsing techniques and proper infection control protocol are followed to minimize contact dermatitis.
  2. Lessen reactions by not wearing gloves for longer than needed periods of time.
  3. Ensure good and frequent housekeeping practices exist to remove latex containing dust from the workplace (upholstery, carpets, ventilation ducts and plenums).
  4. Change filters and vacuum bags frequently in latex contaminated areas.
  5. Provide low protein, powder-free gloves to employees.  Be aware that hypoallergenic latex gloves do not reduce the risk of latex allergy but may reduce reactions to chemical additives and powders.  Provide non-latex gloves if possible.  Provide glove liners under the latex gloves, if latex gloves cannot be avoided.          
  6. Inform employees to avoid using oil-based hand creams or lotions (jojoba, some aloe Vera, palm oil, coconut oil, lanolin, petrolatum products, etc.) unless they have been shown to reduce latex related problems and do not degrade the molecular structure of the latex and synthetic glove material.  Glycerin and most water-soluble based hand products are acceptable.

Confirmed Latex Allergy Diagnosis

Office Modifications must be made

  1. Employers now have an obligation to modify the work environment, within reasonable limits, to minimize the employee’s future exposure to the latex allergen.

Modifications to the work environment might include any or all of the following:

  1. Initiating the Latex Sensitive steps already stated above.
  2. Provide non-latex gloves (vinyl or nitrile) and other supplies and remove as many latex-containing supplies as possible.
  3. Develop a latex-safe work area for dental assistants with confirmed latex allergies.  Ensure that the allergic worker is not exposed to the latex airborne protein/powders that they are sensitive to. 
  4. Reassign the employee to areas where no latex gloves are used (if possible).  Offer alternative work duties, such as reception, to dental assistants who have developed extreme sensitivities to latex while working chair side. 
  5. Have injectable epinephrine on hand (Epi-Pen).
  1. Maintain a very thorough medical history
  2. Refer the patient to see their physician for latex sensitivity testing
    1. Have testing done to confirm if it is a latex allergy, another allergy or a contact dermatitis.
    2. Investigate alternative causative agents in the work such as soaps, detergents, preservatives, colorants and disinfectants.
  3. Ensure the patient’s chart indicates latex sensitivity.  If the patient has been diagnosed with a latex allergy, have very visible latex allergy warning stickers on the outer envelope of the chart, within the chart on each page and on the medical history page. 
  4. A medical emergency kit should be easily accessible and must contain non-latex airway bags, masks, bandages and tape.
  5. Place visible signs indicating “latex sensitive” or “latex allergy” in the operatory area or on the day sheet. 
  6. Schedule latex sensitive/allergy patients as the first patient of the day in order to minimize their exposure to airborne latex particles and limit appointment times to minimize reactions. 
  7. Use non-latex supplies (gloves, dams, etc).
  8. As well, remove all latex gloves and supplies from the operatory the latex patient is being treated in. 
  9. Do not use medication vials or syringes that often contain rubber latex plugs.  Ampoules made of all glass are a safer choice.
  10. Be careful when using blood pressure cuffs, stethoscope tubing and dental chair coverings as they often contain natural rubber products.  Simply covering the articles with cloth can minimize latex exposure.
  11. If a reaction does occur, discontinue treatment immediately and observe the patient for at least 20 minutes in a latex safe/free area.  Medical intervention may be needed.
  1. Advise the laboratory of the latex-allergy status of your patient when sending the case out. 
  2. When materials are returned from the lab, do not handle the lab materials with latex gloves or with unwashed hands after wearing latex gloves. 
  3. The materials returned from a dental laboratory may not contain latex but they may have been handled with latex gloves. Ensure all prosthetics and appliances are thoroughly washed with soap and water before insertion into a latex-allergic patients mouth.
  4. Do not store non- latex materials with natural latex rubber products.
  5. Do not leave dental materials or instruments exposed to airborne allergens and latex glove powders if they will be used on a latex allergic patient.

Vinyl is a synthetic product made from polyvinylchloride.  Vinyl does not have the same stretching or strength characteristics as latex. As a result, vinyl does not provide the same fit or infection control barrier as latex.  Vinyl gloves are a popular choice for the food industry and situations where high levels of durability and protection are less of a priority.  Vinyl gloves have a loose fit and are only good for short-term uses.  They are, however, a very economic option for exams or quick appointments where low levels of protection are required. 

Nitrile gloves are made of synthetic rubber and are an ideal alternative to latex gloves if latex allergies are a concern.  They are superior gloves, especially when it comes to being puncture resistant.  Nitrile gloves are referred to as “medical grade”.  They mold well to hands and are usually a great fit.  Nitrile gloves can be worn for an extended amount of time and resist many chemicals.  They also have a long shelf life.  Because of their high cost, they are not usually cost-effective for examination gloves. 

Neoprene gloves are made from synthetic rubbers that are produced by polymerization of chloroprene.  They are very strong and provide a similar protection barrier to latex.  Neoprene elasticity is very close to that of latex and they provide a good, comfortable fit.  They are somewhat puncture resistant, but once punctured tear very easily.  They have a good resistance to most chemicals, oils and fats.  They come in both examination and surgical varieties but are of a much higher cost than latex gloves. 

Polyisoprene gloves are made from synthetic polyisoprene, which provides similar properties to latex and natural rubber.  They are regarded as the “latex” glove without the harmful proteins found in latex, which is responsible for latex allergies. They provide good comfort and fit, and have a fair protection against alcohol and water-based solutions.  They are used primarily as surgical gloves, as they are very expensive but do come in an examination glove as well. 

Syrene-butadiene rubber gloves are relatively new to the surgical glove market.  These gloves are held to a lower standard than latex gloves because of their lower strength and durability.  They are affected by ozone and disintegrate in contact with uncured methylmethacrylate (bone cement).  They are much more slippery than latex gloves and they dissolve in the presence of common alcohols.

http://www.mayoclinic.org/diseases-conditions/latex-allergy/basics/prevention/con-20024233

http://en.wikipedia.org/wiki/Latex

http://en.wikipedia.org/wiki/Latex_allergy

http://www2.worksafebc.com/resources/publications/HStopics/dealing_latex_allergies.pdf

http://latexallergyresources.org/articles/educational-resources

Canadian Latex Allergy Association
96 Cavan St.
Port Hope, ON  L1A 3B7
1-905-885-9708
1-905-885-2839 fax

American Latex Allergy Association
63334 Lohmann LN
Eastman, WI
54626   U.S.A.
Phone: 608-874-4044
Toll Free: 1-888-972-5378
E-mail:  alert@latexallergyresources.org

Carla Sanso
Government of Saskatchewan
Hygiene Research Officer
Occupational Health and Safety Branch
Ministry of Labour Relations and Workplace Safety
6th Floor - 1870 Albert Street
Regina, Canada S4P 4W1
Bus: 306-787-4485
Fax: 306 787 2208
www.saskatchewan.ca

 

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Saskatchewan Dental Assistants’ Association
P.O. Box 294 Kenaston SK S0G 2N0
T 306.252.2769 | F 306.252.2089
E sdaa@sasktel.net