Do clinicians overreact to latex and penicillin allergies? Cephalexin (Keflex) has a very slight cross-reactivity with penicillin allergy, yet we typically substitute with clindamycin in the operating room. Similarly, do I really need to worry about vials with latex tops or BP cuffs with latex bladders? Can’t rash be treated symptomatically, or is escalation to anaphylaxis a major concern? — Deborah Dulman, CRNA, MSN, Wixom, Mich.

Latex reactions include: (1) a non-allergic irritant contact dermatitis presenting as such skin lesions as dry, flaky skin with papules; fissures; and sores; (2) an immunoglobulin (Ig)E mediated Type I hypersensitivity reaction to latex protein (natural rubber latex), which can present as immediate localized itching, and in rare cases, anaphylactic shock, burning or discomfort, urticaria within five to 60 minutes after contact, rhinitis, and asthma; and (3) a T-cell mediated Type IV hypersensitivity reaction to the chemicals used in latex preparation presenting as dermatitis 48 to 96 hours postexposure (Indian J Dermatol Venereol Leprol. 2008;74:304-310).

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A recent review article discussing medication preparation for the surgical patient at risk for latex allergy commented that “examination of the clinical and basic science literature regarding pharmaceutical vial closures supports limiting the rubber stopper to a single needle puncture as a safer practice, with the caveat that no strategy exists for the complete elimination of risk as long as stoppers made from natural rubber latex are used in pharmaceutical vials intended for human use” (J Clin Anesth. 2010;22:477-483).

An earlier review on latex allergies listed several latex-free alternatives for BP cuffs and tubing: Cleen Cuff (Vital Signs, Inc., Totowa, N.J.), Dinamap (GE Medical Systems, Waukesha, Wisc.), Perfect Balance (Trimline Medical Products Corp., Branchburg, N.J.), and Webril (The Kendall Co., Walpole, Mass.) (J Athl Train. 2003;38:133-140, accessed April 15, 2011). — Philip R. Cohen, MD (151-5)