Allergy to Latex, Used in Medical and Household Supplies, Can Kill : * Health: The problem does not stop latex condoms from being the ‘barrier of choice’ in the AIDS battle.
Allergies to latex, the versatile rubber product used in everyday items from balloons to rubber bands--and in essential medical supplies--presents a serious concern for health officials.
Although the number of individuals allergic to latex is very small, the reports of incidents have been growing.
Implications of the allergies are worrisome, according to health officials, because rubber is ubiquitous in medical settings. It is used in catheters, IV tubes, surgical gloves, dental dams, intubation tubes, anesthesia masks and many other medical implements.
At least 16 deaths have been reported in recent years in the United States as the result of such allergies, and many people have gone into anaphylactic shock, an allergic condition in which the blood pressure drops and the person collapses.
A year ago, the FDA issued a formal medical alert to warn doctors that patients with histories of sensitivity to latex, even problems when they were blowing up balloons, should be watched carefully during any examinations or surgeries.
It was such concern that helped avert serious trouble for an 11-year-old boy with hay fever who was sent for treatment to Lauren Charouf, chief allergist at Columbia Hospital in Milwaukee. The physician noticed that the child’s chart had recorded that he was allergic to a widely used anesthetic known for its safety.
It struck Charouf as odd, but the child’s mother said the information came from doctors who had told her that the boy went into an allergic shock while having surgery.
Charouf questioned the boy and found that every time he blew up a balloon, his lips swelled.
“What was so important,” Charouf said recently, “was that he was scheduled for another surgery in about two weeks, and nobody had picked up latex as the culprit.”
Latex is the natural rubber made from the milky sap of the tropical rubber tree. The first recorded case of a serious latex allergy was in 1979, when a British housewife’s reaction to her household rubber gloves was described in the British Medical Journal. The woman died.
A few dozen similar cases were recorded in the European journals, said Jay Slater, a pediatric immunologist at Children’s National Medical Center and head of the task force on latex of the American Academy of Allergy and Immunology, but none was reported in North America until 1989.
In the fall of 1989, the FDA began receiving reports of older patients going into anaphylactic shock while undergoing examinations requiring the use of barium enemas. Sixteen patients died from reactions during examinations, and because some of them became ill after the enema was inserted but before the barium was actually introduced, the allergies were traced to a latex inflatable cuff on the enema. In late 1990, the FDA issued a bulletin to health professionals, and those enemas were voluntarily recalled by the manufacturer.
About the same time, investigators at the federal Centers for Disease Control heard about a cluster of 11 cases of anaphylactic shock in a single children’s hospital in Milwaukee. The anaphylaxis occurred before any surgical incision had been made. Ten of the 11 children had spina bifida. One had an abnormality of the genitourinary tract, the bladder and genitals. All of the children were successfully resuscitated in the operating room.
Michele Pearson, a CDC epidemiologist, said an initial investigation showed that the children all had histories suggestive of latex allergy.
She began a nationwide survey of children’s hospitals. In the first 25 hospitals for which CDC had results, there were 75 cases of anaphylaxis among the children with spina bifida or genitourinary problem, an average of three per hospital--so few at each hospital that no trend had been spotted. Further results are not yet available, Pearson said, but the CDC is setting up a reporting system in conjunction with the National Spina Bifida Assn.
Slater said that except for three specific populations, the risk of serious latex allergy is minuscule. The three populations, however, include children with certain birth defects who undergo multiple surgeries, health-care workers and rubber workers.
Slater estimates 10% of his pediatric patients with birth defects have had latex reactions. Up to about 5% of health-care and rubber workers may be allergic, he said.
Allergists, dermatologists and representatives of industry and government say they are not sure why the number of cases is increasing. Orhan H. Sulieman, chief of the Food and Drug Administration’s latex task force, reflects a widespread feeling, however, that response to the AIDs epidemic--and the resulting increased demand for latex products such as gloves and condoms--is in part responsible for the increase.
But virtually everyone agrees on one thing: Condoms, which are manufactured and sterilized more stringently than many other items, “are still the barrier of choice” for protection against the HIV virus” that causes AIDS, Sulieman said. With only 44 reports of minor skin irritations over 3 1/2 years, he said, out of an estimated 2 billion condoms used, “we want to make sure that we don’t contribute to the public hysteria by sending a contrary message about latex.”
“The important thing,” said Slater, “is to recognize that for the vast majority of people, the risk of unprotected sex is far greater than the risk of these kinds of still very rare reactions.”
