Strategies for compliance with the internship program among three pediatric interns with latex allergy. / Estrategias para el cumplimiento del programa de formación en tres médicos residentes de Pediatría con alergia al látex.

INTRODUCTION: Latex allergy is common in the hospital setting. OBJETIVE: To describe the clinical situation of three pediatric interns with latex allergy and the prevention strategies implemented during clinical clerkships in pediatric and neonatal intensive care units. PATIENTS, METHODS, AND OUTCOMES: The three interns referred symptom exacerbation during their internship program. Diagnosis was confirmed based on a compatible history and positive specific immunoglobulin E. A semi-structured interview was done to describe perceptions about prevention strategies, the personnel were trained, and nitrile gloves were provided for carrying out procedures. Interns completed their clinical clerkships without having allergic reactions. Positive aspects referred by interns were that they felt cared for and experienced an improved quality of life; negative aspects were a bad predisposition and resistance against change among some other interns. Strategies designed to this end permitted interns to continue their internship program.

INTRODUCCIÓN: La alergia al látex es frecuente en ámbitos hospitalarios. OBJETIVO: Describir la situación clínica de tres residentes de Pediatría con alergia al látex y las estrategias de prevención en las rotaciones de Terapia Intensiva Pediátrica y Neonatal. PACIENTES, MÉTODOS Y RESULTADOS: Las tres profesionales manifestaron exacerbación de síntomas durante la residencia. Se confirmó el diagnóstico con historia compatible e inmunoglobulina E específica positiva. Se realizó una entrevista semiestructurada para describir sus percepciones en relación con las estrategias de prevención, se capacitó al personal y se incorporaron guantes de nitrilo para los procedimientos. Las residentes realizaron las rotaciones sin presentar manifestaciones alérgicas. Refirieron como aspectos positivos sentirse cuidadas y mejor calidad de vida; como aspectos negativos, mala predisposición y resistencia al cambio en algunos compañeros. Las estrategias diseñadas permitieron que las residentes pudieran continuar su programa de formación.

Adaptation and validation of the Spanish version of the Quality Of Life in Latex Allergy questionnaire (QOLLA).

OBJECTIVE: The aim of the present study was to translate into Spanish and transculturally adapt the Quality of Life in Latex Allergy questionnaire (QOLLA) in order to provide a validated instrument for use in research and daily practice. METHODS: Patients diagnosed with latex allergy were invited to participate in an observational prospective multicenter study to validate the Spanish version of the QOLLA following the recommendations of the World Health Organization. The study included 3 phases--feasibility, reliability, and cross-sectional validation-and was approved by the Ethics Committee of Hospital Ramón y Cajal. RESULTS: Mean time to complete the questionnaire was 4.7 minutes. The maximum score was 28 (mean, 7.7; median, 4).The SF-12 score ranged from 25.8 to 51.6 in the physical domain and from 20.8 to 61.5 in the mental domain. Internal consistency was excellent (Cronbach alpha, 0.9348). The kappa index fluctuated between 0.40 and 0.93. A kappa of 0.84 was obtained for the global score in 5 categories. Sixty patients were included to evaluate construct validity. Mean age was 39 years and 49 patients were women (80%). The global score ranged between 0 and 30 (mean, 11.69; median, 11). Spearman correlation coefficients between the QOLLA and a visual analog scale and the SF-12 physical, mental, and severity scales according to the researcher were--0.47, 0.37, 0.29, and 0.54, respectively. CONCLUSION: The QOLLA is a feasible, valid, and reliable instrument for the measurement of disease-specific quality of life in adult patients diagnosed with latex allergy. It could play an important role in determining suitable treatment for latex-allergy.

Quality of life in health care workers with latex allergy.

BACKGROUND: Exposure to latex gloves and glove powder makes health care workers (HCWs) particularly susceptible to developing an allergy to latex. AIMS: To assess the impact on the quality of life (QOL) of HCWs who are allergic to latex products before removal from latex exposure and after removal from exposure. METHODS: We studied 39 latex allergic HCWs from the Health & Safety Executive south area. Twenty-nine attended for an assessment with the occupational physician and were asked to fill out a questionnaire. Spirometry, immunoglobulin E levels and latex radioallergosorbent test levels were measured. RESULTS: In total, 29/39 (74%) of patients responded. All of the participants had a type 1 allergy to latex. All individuals reported a significant improvement of symptoms once latex was removed from their working environment. Of those that reported skin complaints, 83% reported that their skin no longer had an impact on their QOL once latex was removed. Over 90% (n = 26) of all participants stated that their eye/nose symptoms had no longer an impact on their QOL and 86% (n = 25) of all participants stated that their respiratory symptoms had no impact on their QOL following the removal of latex from their working environment. Overall, 45% of the respondents had changed jobs: 61% of this group changed to a completely nonclinical post. CONCLUSIONS: On average, 86% of latex allergic HCWs reported that their QOL had improved significantly since their removal from latex. In employees who are latex allergic/sensitized, taking latex avoidance measures results in cessation or diminution of symptoms.

Emotion with tears decreases allergic responses to latex in atopic eczema patients with latex allergy.

OBJECTIVE: Allergic responses are enhanced by stress, whereas they are reduced by laughter in atopic eczema patients. Emotion with tears decreases plasma IL-6 levels in patients with rheumatoid arthritis. Thus, the effect of emotion with tears on allergic responses in patients with atopic eczema was studied. METHODS: Sixty patients with atopic eczema having latex allergy viewed both the weather information video and the heart-warming movie, Kramer vs. Kramer. Just before and immediately after viewing each video, allergic responses to latex were measured. RESULTS: Viewing the weather information video did not cause emotion with tears in any patients, and it failed to modulate allergic responses. In contrast, viewing Kramer vs. Kramer caused emotion with tears in 44 of 60 patients, and it reduced allergic skin wheal responses to latex and latex-specific IgE production in them. CONCLUSION: Emotion with tears reduced allergic responses, and it may be useful in the treatment of allergic diseases.

The latex allergic psychiatric patient.

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.

Listening to mozart reduces allergic skin wheal responses and in vitro allergen-specific IgE production in atopic dermatitis patients with latex allergy.

In atopic dermatitis patients with latex allergy, listening to Mozart reduced skin wheal responses induced by latex, but not by histamine, whereas listening to Beethoven failed to produce similar results. Listening to Mozart also decreased in vitro total IgE and latex-specific IgE production with concomitant skewing of the cytokine pattern toward the Th1 type, that is, an increase in Th1 cytokine production and decrease in Th2 cytokine production by peripheral blood mononuclear cells, whereas listening to Beethoven failed to do so. These results suggest that therapy using specific types of music may be an effective treatment of allergic diseases.

Disability and medical management of natural latex sensitivity claims.

In 1995 a latex allergy case incurred a cost of $220,000 within the first year of the claim. A number of factors were thought to contribute to the cost of these claims. In 1996 Michigan Health & Hospital Association Service Corporation identified and implemented protocols to intervene early with latex sensitivity claims. The average cost per case has decreased dramatically since the implementation of the protocols. Decreasing the frequency and the average cost of latex sensitivity claims through the identification, treatment, and return to work of legitimate latex sensitivity cases has been the focus. Equally important was to minimize the impact of latex sensitivity on the life of the health care worker. In 1999 and subsequent years, data from glove- or latex-related claims that began from 1996 were analyzed. Latex sensitivity-related claims were sorted as lost-time claims and medical-only claims from the Michigan Health & Hospital Association Service Corporation claims database. The average cost per claim and the frequency of latex-related claims were identified. The average cost of latex-related lost-time claims has decreased significantly; however, the frequency in lost-time claims has been consistent. Health care workers consistently were returned to work successfully. Implementation of latex-sensitivity protocols is effective in the reduction of the average cost of latex-related claims and the impact of those claims on the lives of health care workers. This has been afforded through the confirmation of the diagnosis of latex sensitivity, followed by the implementation of a method to evaluate the physiologic response to the workplace objectively.

Latex sensitivity in Washington State acute care hospitals. A needs assessment and survey of awareness of the issues.

Based on reports from the workers' compensation system and a sentinel health provider network, latex gloves may be one of the most prevalent sources of occupational skin disorders in Washington State's health care industry. To gather information to understand and address this problem, questionnaires were distributed to 105 acute care hospitals in Washington State. Employee health and infection control specialists were queried on their knowledge about latex allergy, the perceived extent of the problem, and the actions taken to address the problem. With 95 of the hospitals returning completed questionnaires (93% response rate), 30% reported having problems with latex allergies among employees in their facility, with most reporting two or fewer cases. Adequate knowledge was found about the causes and effects of latex allergies, but definite knowledge gaps existed. More than 60% of all of the hospitals surveyed had made some type of glove alternatives available to affected employees, 4% had designated latex free zones, 4% had cleaned to remove latex dust, and 7% had done nothing to address the issue.

Living and working with latex allergies: personal perspectives from a nurse.

Living with the limitations of latex sensitivity can be devastating. Even more devastating is when the diagnosis can end a career. For a registered nurse, latex allergy can be a career ender, or it can spur the individual to become increasingly clever in coping with the allergy while maintaining a productive personal and professional life. This article describes the personal struggle an individual registered nurse has overcome to maintain her position in nursing.