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To: tom ablett who wrote (1550)	7/30/1998 10:40:00 PM
From: Jeffrey L. Henken	Respond to of 2887

Latex (rubber) hypersensitivity is a significant medical problem and three groups are at higher risk of reactions: health care workers, children with spina bifida and genitourinary abnormalities, and workers with occupational exposure to latex. ú To identify IgE mediated sensitivity, prick skin tests with latex extracts should be considered for patients who are members of high risk groups or who have a clinical history of possible latex allergy. Although a standardized, commercial skin test reagent for latex is not yet available in the United States, many allergy centers have prepared latex extracts for clinical testing. In vitro assays for IgE to latex may also be useful, although these tests are generally less sensitive than skin tests. ú Patients with spina bifida (regardless of a history of latex allergy) and patients with a positive history of latex allergy ideally should have all medical/surgical/dental procedures performed in a latex-controlled environment. ú A latex-controlled environment is defined as an environment in which no latex gloves are used in the room or surgical suite and no latex accessories (catheters, adhesives, tourniquet, and anesthesia equipment) come into contact with the patient. ú In health care settings, general use of latex gloves having negligible allergen content, powder-free latex gloves, and non-latex gloves and medical articles should be considered in an effort to minimize exposure to latex allergen. Such a combined approach may minimize latex sensitization of health care workers and patients and should reduce the risk of inadvertent reactions to latex in previously sensitized individuals. ú Patients with a history of latex allergy by history or skin testing should wear a medical identification bracelet and/or carry a medical identification card. If patients have a history of anaphylaxis to latex, it may be important for them to carry epinephrine and antihistamines for self-administration. www1.mosby.com