Latex is a natural rubber composed of proteins and added chemicals. Its durable, flexible properties give it a high degree of protection from many micro‐organisms, which makes it an ideal fibre to use for many healthcare products. It currently provides the best protection against infection in the healthcare field. It is found in the following products:

Some of the proteins in the natural rubber latex can cause sensitivity and allergic reactions, and the incidence of latex hypersensitivity seems to be increasing (Wu et al. [236]). Powdered gloves can create the greatest risk as proteins leak into the powder, which can become airborne when gloves are removed, and inhaling the powder may lead to respiratory sensitization. The amount of latex exposure needed to produce sensitization is unknown. Sensitivity can be described as the development of an immunological memory for specific latex proteins, which can be asymptomatic. A substance that causes sensitization is one that is capable of causing an allergic reaction in certain people. Allergy is the visible manifestation of the sensitivity (e.g. hives, rhinitis, conjunctivitis or anaphylaxis), which can be serious and potentially life threatening (Table 16.8) (Hauk [74], HSE [81]).

Once sensitization has taken place, further exposure will cause symptoms to recur, and increasing exposure to latex proteins increases the risk of developing allergic symptoms (HSE [81]). Therefore, sensitivities and allergies should be treated in the same way (Hauk [74]). Routes of exposure include:

Latex allergies are classified as irritant contact dermatitis, type I and type IV reactions (see Table 16.8).

Healthcare providers have an ethical responsibility to prevent latex sensitization; because there is no cure, protection must be paramount. Employers should have a latex allergy policy and procedure, which should provide information and instruction on measures to identify patients at risk, patient education, interventions to reduce undue latex exposure, recognizing symptoms of sensitization and the action to be taken if a sensitization is suspected (HSE [81]).

Assessment and monitoring for symptoms of latex allergy in both conscious and unconscious patients are required at all stages of perioperative care. The assessment should cover the following known risk factors for latex allergy:

If a suspected or confirmed latex sensitivity or allergy is found, this information must be documented in the patient's medical notes and communicated to all members of the healthcare team and departments that the patient may visit, including theatre, recovery, pathology and radiology (Liberatore [102]). Box 16.9 outlines the pre‐operative actions to be taken when a patient has a potential or confirmed latex allergy. The anaesthetist will need to be informed so that decisions can be made regarding potential allergy prophylaxis pre‐operatively. A latex‐safe environment is recommended – one where every reasonable effort has been made to prevent high‐allergen and airborne latex sources from coming into direct contact with affected individuals. Latex‐free alternative items should be collected and stored in a quick‐access location for ease of access and identification. At present, best practice dictates that patients with a suspected or confirmed latex allergy be scheduled first on the morning list because it is assumed that the inactivity in the room during the previous evening hours causes the content of latex‐coated powder in the ambient air to be lowest in the morning (AORN [22], Hauk [74]). Further guidance may be sought online from the Association of periOperative Registered Nurses (www.aorn.org).

There is a voluntary scheme in place for reporting cases of latex sensitization, both of staff and patients, to the Medical Devices Agency, which is an executive agency of the Department of Health (HSE [81]).