Management of natural rubber latex allergy

Issues of impairment, compensation, and disability are appropriately directed at health care workers with latex allergy and occupational asthma or anaphylaxis who may not be able to re-enter a work environment with ambient exposure to latex proteins. The following stepwise approach for managing a high-risk health care worker with natural rubber latex (NRL) allergy is recommended: (1) confirm the diagnosis of NRL allergy by using rational, validated methods; (2) justify cessation of further NRL exposure in the workplace; (3) determine whether there is impairment and disability resulting from NRL allergy; (4) advise employer and risk managers regarding the diagnosis and their responsibility to institute effective environmental interventions; (5) if accommodation efforts are unsuccessful, advise the worker to seek workers' compensation benefits and rehabilitation. Objective evidence of residual impairment caused by NRL-induced anaphylaxis or occupational asthma is often absent. Therefore, the physician must determine disability based on how work restrictions resulting from NRL allergy affect the worker's ability to perform current required tasks and duties. According to the Americans with Disabilities Act, the employer must make reasonable accommodations for an impaired employee. Therefore, an employee with NRL allergy and no objective evidence of impairment would not be considered to be disabled after successful interventions, which totally eliminate continued NRL protein exposure and the risks of work-related asthma and anaphylaxis.