1. ROLE OF LATEX ALLERGIES IN VACCINATION
PRESENTATION BY: MEGAN HANDLEY, PHARMD CANDIDATE
 Allergicreactionstolatex andrubberproductshave become increasinglycommonsince the institution
of universal precautionsforexposure tobodilyfluids. The AmericanLatex AllergyAssociationreports
lessthan1% of the general populationinthe UnitedStateshasa sensitivitytonatural rubberlatex
(about3 millionpeople);additionally,8-17% of healthcare workershave thissensitivity.
 Latex glovesare utilizedlessfrequentlyinhealthcare settingsdue toincreasingprevalence of latex
allergiesinpatientsandhealthcare professionals;however,glovesare notthe onlyconcernwhenit
comesto vaccinatinglatex-allergicpatients.Latex derivativesare oftenusedtomake productssuchas
medicationvial stoppersandsyringe plungersof vaccinations.
BACKGROUND: LATEX ALLERGIES
 Latex is the milkyfluidobtainedfromtappingthe rubbertree, Hevea brasiliensis.Itcontainsa varietyof
naturallyoccurringsubstances,includingcis-1,4-polyisopreneinacolloidal suspensionandplant
proteins,whichare believedtobe the primaryallergen.
 The term “natural rubber”includesnatural rubberlatex,drynatural rubber,andsyntheticlatexor
syntheticrubberthatcontainsnatural rubberinitsformulation.
 Productsthat containnatural rubberare made usingtwocommonlyemployedmanufacturing
processes,the natural rubberlatex (NRL) process,andthe drynatural rubber(DNR) process. Examples
of productsthat may containnatural rubberlatex include:medical gloves,catheters,tracheostomy
tubes,andcondoms.Examplesof productsthatmay containdrynatural rubberinclude syringe
plungers,vial stoppers,andinjectionportsonintravasculartubing.
 The clinical manifestationsof IgE-mediatedreactionstolatex caninvolve afull spectrumof symptoms
associatedwithmastcell degranulation.Localizedpruritusandurticariaoccur aftercutaneouscontact;
conjunctivitisandrhinitiscan resultfromaerosol exposure orfacial contact.Systemicreactions,
(bronchospasm,laryngospasm, hypotension) mayoccurwithmore substantial exposure orinextremely
sensitiveindividuals.Vascularcollapse andshockleadingtofatal cardiovasculareventsmayoccur.
 Avoidance remains the cornerstone of treatmentforlatex allergy.Preventionandsupportive therapy
are the mostcommon methodsformanagingthisproblem. Latex-allergicpatientsandtheircaregivers
mustbe continuouslyvigilantforhiddensourcesof exposure.
PREVENTING ALLERGIC REACTIONS TO VACCINATIONS THAT CONTAIN LATEX
 The most commonlatex allergiespresentasa contact-type allergy(hives,rash,itching,etc.);however,
severe,rare,anaphylacticallergiesmayoccur. Those witha history ofan anaphylacticreaction to latex
shouldnot be givenvaccinationsthathave been in contact with natural rubber or latex.
 All patientsbeingadministeredvaccinationsshouldbe askedif theyhave anallergytolatex. If a latex
allergyisreported,the nature of the allergy shouldbe documented.
 The package insertforthe vaccine shouldbe retrievedandexaminedtodetermine if latexinanyof its
formswas utilizedinaportionof the vaccine. If the vaccinationinquestioncontainslatex,itshouldbe
avoidedinlatex-allergicpatients,especiallythosewithahistoryof a systemicallergicreaction. Examples
of a systemicallergicreactioninclude:difficultybreathing/swallowing,chestdiscomfortortightness,
swellingof the face,eyes,ortongue,nausea,vomiting,diarrhea,dizzinessorlightheadedness,
hypotension, palpitations,cough,orflushing.
 The CDC also publishesalistof vaccinationsthatare suppliedinvialsorsyringesthatcontainnatural
rubber. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/latex-table.pdf
 Duringadministrationof anyvaccination,providersshouldbe preparedto recognizeand treatan
allergicreaction. Anaphylaxisishighlylikelywhenapatientpresentswithanyof the following:
respiratorycompromise,reducedbloodpressure,generalized hives,flushing,angioedema,and/or
persistentgastrointestinalsignsandsymptoms.Skinsignsandsymptomsare presentinupto90% of
allergicreactionsandrespiratorysignsandsymptomsoccurinupto 70% of episodes.

2.  Promptlyandsimultaneously:
o Give epinephrine0.3-0.5mg intramuscularlyinthe mid-outerthighandrepeatevery5to 15
minutesasneeded,nottoexceed3doses.Epinephrine isthe firstandmostimportant
treatmentinanaphylaxis.
o If tolerated,place patientinthe recumbentpositionand elevatelowerextremities.
o Give oxygen8-10 liters/minuteviafacemask,orupto 100% oxygenasneeded.
o Rapidlyinfuse normal saline 1-2litersIV.Repeatasneeded.
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References:
 Russell M, Pool V, Kelso JM, et al. Vaccination of persons allergic to latex: a review of safety data in the Vaccine Adverse Event Reporting System (VAERS).
Vaccine. 2004;23:664-7.
 2014-15 Flu Vaccine Information. American Latex Allergy Association. September 2014. <http://latexallergyresources.org/news/2014 -15-flu-vaccine-
information> Accessed April 18, 2015.
 Latex in vaccine packaging. Center for Disease Control and Prevention. July 2014.
<http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B /latex-table.pdf> Accessed April 18, 2015.
 Institute for Vaccine Safety: Allergens. 2014. <http://www.vaccinesafety.edu/components-A llergens.htm> Accessed April 18, 2015.
 Ask the experts: Precautions and contraindications. Immunization Action Coalition. 2015. <http://www.immunize.org/askexperts/precautions-
contraindications.asp> Accessed April 18, 2015.
 Kelso JM, Greenhawt MJ, Li JT. Adverse reactions to vaccines practice parameter 2012 update. J. Allergy Clin Immunol. 2012;130:25-42.
 Fluvirin 2014-2015 formula [package insert]. Novartis Vaccines and Diagnostics Limited. Speke, Liverpool, UK. Novartis Vaccines and Diagnos tics, Inc.
Cambridge, MA. 2014.
 Boostrix (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed) [package insert]. GlaxoSmithKline Biologicals. Rixensart,
Belgium. Novartis Vaccines and Diagnostics GmbH. Marburg, Germany.
 Covar RA, Fleischer DM, Cho C, et al. Allergic Disorders. Current Diagnosis and Treatment: Pediatrics. McGraw-Hill Education; 2014:Chapter 38.