Latex Allergy: ANAPHYLAXIS Fact Sheet

 HOW TO RECOGNIZE ANAPHYLAXIS DUE TO NATURAL RUBBER LATEX:

1)                   Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death.

2)                   Anaphylaxis to latex can occur in community settings (for example, after exposure to latex in sports equipment, balloons, or condoms), as well as in healthcare settings.

3)                   Anaphylaxis symptoms can occur within minutes after exposure to latex.

4)                   Anaphylaxis symptoms usually involve more than one body area at the same time. There may be only a few symptoms, or there may be many symptoms. Watch for:

• Skin symptoms: itching, hives, redness, swelling
• Mouth symptoms: itching, swelling of lips and/or tongue
• Throat symptoms: itching, tightness/closure, hoarse voice, difficulty breathing Lung symptoms: cough, wheeze, difficulty breathing
• Gut symptoms: vomiting, diarrhea, cramps
• Heart symptoms: weak pulse, dizziness, passing out

 HOW TO PREVENT ANAPHYLAXIS FROM NATURAL RUBBER LATEX:

 1)                   Be able to identify the sources of latex in the community such as sports equipment, balloons, or condoms.

 2)                   Be able to identify the foods that cross-react with latex; for example, bananas, kiwi, papaya, avocado, potato, tomato.

 3)                   Strictly avoid exposure to latex and the foods that cross-react with it.

HOW TO TREAT ANAPHYLAXIS FROM NATURAL RUBBER LATEX:

1)                   Carry an epinephrine auto-injector such as an EpiPen or Twinject with you at all times, and know how to use it. Inject epinephrine promptly in the middle, outer side of the thigh. Epinephrine is the life-saving drug in anaphylaxis.

 2)                   Call for help promptly (911, EMS, rescue squad).

 3)                   Antihistamines such as Benadryl (diphenhydramine) and bronchodilators such as Ventolin (albuterol) cannot be substituted for epinephrine in the treatment of anaphylaxis because they do not prevent or relieve respiratory failure or shock.

 4)                  Have a personalized anaphylaxis emergency action plan (download from www.aaaai.org) and wear medical identification.

 Latex Allergy: Latex Cross-reactive foods Fact Sheet

 Latex allergens

Allergic reactions to products containing natural rubber latex often result from exposure of sensitized individuals to one or more proteins that occur naturally in raw latex preparations. At least 13 distinct proteins have been identified and associated with latex sensitivities in health care workers, spina bifida patients, and children or adults within the general population, with most allergic patients reacting to multiple latex proteins that vary somewhat between these groups.

 Structure-function-activity relationships

The biological functions or enzymatic activities associated with most latex allergens have been determined. Several of these proteins are active enzymes involved in defending the latex plant from microbial attacks, particularly colonization and growth of numerous fungi. In general, proteins that serve similar functions in different plants (whether genetically related or not) usually contain highly conserved sequences and three-dimensional structures, so it is not surprising to find plant defense or pathogenesis-related proteins with activities comparable to those found in latex in a wide variety of plants that include many common foods.

 Cross-reactivity with foods

These relationships are relevant to latex allergy because a number of these common plant defense proteins are potent allergens. The tendency of latex-sensitive individuals to express allergic reactions after ingestion of certain foods has been recognized for many years, and subsequent clinical and laboratory studies have confirmed both the sources of the offending allergens and their relevance to the allergic condition. Our immune systems recognize particular antigen structures as foreign without regard to the origin of these molecules. Close structural similarities between any two allergens from divergent sources can produce similar allergic reactions in sensitive patients, and is termed cross-­reactivity or cross-sensitization.  Due to the presence of these common or cross-reactive protein allergens, ingestion of some foods produce allergic symptoms in patients sensitive to latex inhalation or contact.

 This association between latex sensitivity and food allergy is often referred to as the latex-fruit syndrome, although many vegetable foods have also been identified as possessing clinical and/or immunologic cross-reactivities with latex proteins. The foods shown below have been linked allergenically to latex in published reports and are grouped based on high, moderate or low/undetermined degrees of association to latex or prevalence of allergic reactions. It is likely that other foods not yet identified also possess some allergenic similarities to latex.

• High (4)                         Avocado, Banana, Chestnut, Kiwi
• Moderate (7)              Apple, Carrot, Melons, Papaya, Potato, Tomato, Celery            
• Low/undetermined (33)        Apricot, Cherry, Citrus fruits, Fig, Grape, Lychee, Mango, Nectarine, Passion fruit, Peach, Pear, Persimmon, Pineapple, Strawberry, Buckwheat, Rye, Wheat, Coconut, Hazelnut, Walnut, Castor bean, Chick pea, Peanut, Soybean, Dill, Oregano, Sage, Peppers (Cayenne, Sweet/bell pepper), Shellfish, Sunflower seed

 It is important to note that some of the foods on listed above may not produce clinically important reactions in latex-sensitive individuals, for numerous reasons. However, recognition of the foods that are known to share some major or minor allergens with latex can help patients and their families minimize exposures to possible sources of provocative allergens and understand the risks associated with inclusion of these foods in their diets.

LATEX ALLERGY 101 FACT SHEET/CROSS-REACTIVE FOODS/GRIER/ ALAA/8-09

Consult a board certified allergist.  Together, you can develop a treatment plan to help you

live well, despite your allergies!

• Have frequent sinus infections, nasal congestion or itchy, puffy eyes
• Find that exposure to certain substances causes unpleasant reactions, such as sneezing, coughing, or watery eyes
• Experience hay fever or other allergy symptoms several months out of the year
• Find that over the counter medications do not control allergy symptoms or have unpleasant side effects
• Feel allergies are affecting the quality of your life
• Get tired of taking multiple medications to control the symptoms of allergies
• Have trouble catching your breath during exercise or strenuous activity
• Wheeze or cough, especially at night or after exercise
• Sometimes feel shortness of breath or tightness in your chest
• Find your asthma symptoms are not under control, even though you are being treated for the disease
• Have reactions to foods, medications or stinging insects
• Have eczema or other unexplained rash
• Need help identifying strategies for preventing allergic reactions

                                                                                …… An Allergist Can Help

Molds readily grow in the soil of potted houseplants. They are frequently found in other household areas such as around window basins, damp basements and cellars, and bathrooms. Outside mold is frequently found in decaying piles of leaves and cut grass.

Precautions

•  Use air conditioning and try to keep the relative humidity in the house below 50%.
•  Use fungicide cleaners or Clorox bleach and water around window basins, bath tubs, or any other areas that mold is noted. 
•  Decrease the amount of live potted plants in the house.
•  Frequently clean vaporizers and air conditioning and inspect for presence of molds.

Normal reactions to insect stings or bites include pain, local redness and swelling and local itching. This reaction may last several days and may respond to topical steroid creams (such as Cortaid), ice application, and oral antihistamines (such as Benadryl).

 Allergic reactions typically occur within seconds to minutes of a sting and are characterized by hives, generalized itching, throat closure, wheezing, dizziness, nausea, vomiting, and stomach cramping. If any of these symptoms occur, you should seek emergency medical assistance immediately and be evaluated by an allergist to identify possible insect allergy.

 Insect avoidance 

• Do not walk outside barefooted; wear socks with covered shoes (no sandals or Tevas).
• Avoid wearing brightly colored clothes or clothes with floral patterns, as these may attract flying stinging insects.
• Do not swat at stinging insects.
• Survey and exterminate yards for fire ant mounds and stinging insect mounds.
• Do not wear perfume or cologne.
• If you have been identified as having an insect allergy, wear a Medic Alert bracelet and carry a self injectable epinephrine at all times.

• Elevate head of crib to an angle of 30 ° (about 6 inches) by placing bricks under head of bed.
• Reduce the quantity at feedings (volumes), but increase the frequency feedings.
• Thicken formula with rice cereal.

Adults

• Elevate head of bed to 30° by placing bricks under the head of the bed.
• Eat dinner early in the evening and avoid eating 2-3 hours before sleep time.
• Avoid spicy foods, alcohol, and fatty foods.
• Avoid beverages and foods containing caffeine.
• Eat smaller amounts of food at each meal. Eat several small meals rather than a few large ones.

• If you have been given a prescription for a self injectable adrenaline device (Epi pen), you should carry it with you at all times.
•  Self injectable epinephrine kits are to be used for life threatening problems, such as throat swelling, tongue swelling, or difficulty breathing.
•  You should inject your Epi pen into the upper, outer portion of the thigh. If necessary, it can be given through clothing.
•  After injection, you may experience trembling, or a sensation that your heart is racing. These effects are expected and may last 30 minutes to one hour.
•  After administration, you should call 911 or proceed to the nearest emergency center even if you are beginning to feel better.
•  Notify your physician after you have received emergency medical assistance.
•  Epi pens should be stored in the storage case provided to you, as epinephrine is light sensitive.
•  Check expiration dates and replace before expiration date.

•  Get rid of clutter that may be collecting dust
•  Clean windows, book shelves and air conditioning vents thoroughly as they may have collected dust and mold throughout the winter
• Put mattresses, box springs, and pillows in allergy-proof or “non-allergenic” cases
• Vacuum carpeting, or replace it with washable throw rugs
•  Wash blankets, sheets, and pillowcases in 130-degree water and dry in a hot dryer
• Fix leaks – they leave surfaces wet and allow mold to grow
•  Clean moldy surfaces, such as the corners of showers or under sinks.
•  Clean under stoves, refrigerators, or toasters where loose crumbs can accumulate and attract cockroaches
• Block cellar doors, outside drains, and wall, window or floor cracks where cockroaches could enter your home.

 Symptoms of Indoor Allergies

If you see an increase in sneezing, coughing, red eyes or other allergy symptoms, it is important to take steps to reduce allergens in your home.  Indoor allergy symptoms can occur quickly, or they may build and become most severe eight to twelve hours after contact with an allergen.

Causes of Indoor Allergies

• Dust Mites thrive in house dust, which is composed of plant and animal material. Their droppings are the most common trigger of perennial allergy and asthma symptoms.
•  Molds are microscopic fungi. Their spores float in the air like pollen, and are present throughout the year in many states. Molds can be found indoors in attics, basements, bathrooms, refrigerators and other food storage areas, garbage containers, carpets and upholstery.
•  People are not allergic to their pets’ hair, but to a protein found in the saliva, dander (dead skin flakes) or urine of an animal with fur. These proteins are carried in the air on small, invisible particles and can trigger allergy symptoms.
•  Cockroaches live in warm, tropical climates, but various species dwell in the offices and homes of humans living in various climates. A protein found in their droppings can trigger allergy and asthma symptoms.

 Please contact Coastal Allergy & Asthma, PC for information on treatment options and tips on reducing allergen exposure. It is important to learn what causes your indoor allergies so that you can take steps to make them easier to live with. An allergist/immunologist is the best qualified medical professional to manage the prevention, diagnosis and treatment of allergies and asthma.

Information from www.aaaai.org

Symptoms of eczema 

Sufferers of eczema generally have dry skin. Because dry skin itches, patients often scratch. Scratching, however, can cause the skin to crack and become infected. When patients with eczema have “flare-ups”, the skin may appear irritated and red.

On infants and young children, patches of eczema may ooze and appear red. The predominant sites of affected skin include the face, body and the outside of arms and legs. 

In older children the skin may appear thick and scaly (lichenified). The skin areas predominantly affected include skin folds – such as the neck, under the arms and the arm folds, and behind the knees. In adults, the appearance is similar to that of an older child but predominantly involves the hands and sometimes the feet.

Eczema and allergies 

Children with eczema frequently have allergies and/or asthma. Some children with eczema may have food allergies. Both respiratory allergens and food allergens may cause eczema flare-ups. Identification of these allergens may therefore be helpful in controlling flare ups. Not all patients have an identifiable allergy trigger, however. 

Managing eczema 

The most important management issue is providing adequate moisture to the patient’s skin. Remember, dry skin is itchy skin, so moisturizers must be used daily, 6 to 8 times per day.

Skin care routine

Bathing is ok, but should be limited to durations of less than 10 minutes.

• Do not use very hot water; hot water decreases natural skin oils and moisturizers. Run baths at a lukewarm temperature.
• Use as little soap as possible. Use mild soaps. Soaps may also remove the skin’s natural oils.
• Add mineral oil. 1 to 2 tablespoons added to bath water will act as an added moisturizer.
• BE CAREFUL – THE BATH TUB WILL BE SLIPPERY.
• Pat your child dry after a bath. Rubbing irritates the skin and removes moisture.
• Apply moisturizer immediately to the entire body, not just to the affected skin area.
• Apply moisturizer a minimum of 3 additional times during the day; more if the patient’s skin appears dry, scaly, or flaky. Also, apply moisturizer any time the patient is itching.
• Reserve the use of topical steroid creams only for acute eczema flare-ups (i.e. red, irritated skin).
• Apply the steroid cream only to the red area and apply 2 to 3 times a day for only 3 to 5 days at a time unless directed by a physician.
• Do not apply any steroid cream stronger than hydro-cortisone 1% to the patient’s face, groin or armpits.

Choosing a soap 

Recommended soaps that can be found at grocery/drug stores include:

• Dove (unscented)
• Purpose
• Basis 

Avoid Ivory soap and anti-bacterial soaps Acceptable soap substitutes include: 

• Cetaphi1
• Aquanil
• Moisturel Cleanser

Choosing a moisturizer

Moisturizers come in lotions, creams, or ointments. Ointments generally work the best because they stay on the skin longer. However, they tend to be thick and greasy. Ointments may be reserved for bedtime, with creams and lotions preferred for the daytime. Recommended moisturizers found in pharmacies and some grocery stores include: 

• Eucerin (cream or lotion)
• Cetaphil (cream or lotion)
• NutraDerm (lotion)
• Cure (lotion)
• Moisture] (cream or lotion)
• Dermovan (cream)
• Vanicream (cream or lotion)
• Aquaphor (ointment)
• Vaseline petroleum jelly (ointment)

These moisturizers have no perfumes or fragrances and are less likely to irritate a child’s skin.

Itching 

The daily skin care regimen described above may control all of the patient’s itching; however, frequently, the use of oral antihistamines is additionally required to control pruritis. Some antihistamines will cause sedation, which can be a benefit at bedtime to control itching and scratching. Avoid the use of synthetic clothes fibers (polyester) and wool, and opt for loose fitting cotton clothing. 

Flare-ups

These are the times when the patient’s eczema worsens. Flare-ups may be characterized by:

• skin becoming red or irritated
• skin looks weepy or oozes
• skin appears thick and scaly
• increase in itching

Flare ups can happen at any time, and may occur for no reason at all. Some triggers may include:

• weather changes
• contact with or ingestion of an allergen

When flare-ups occur, use the topical steroid creams. Remember though: apply them sparingly and only to the red flared areas, and only continue using for 3 to 5 days.

Infections

• Children with eczema are more likely to get skin infections. These can be caused by bacteria, virus or fungi. Signs of infection may include: fever, redness, swelling, draining skin, or blisters. Call your physician if these symptoms develop.