Latex Allergy Info

Tell Your Story or Sign the Petition

Fill out the information below if you are allergic to latex, know someone who is allergic to Latex, or would like to just advocate the regulation of the use of Latex. The goal of this petition or survey is to get statistical data of how many people suffer from this allergy and to get stories from people who suffer from this allergy so that the general public can be educated. Use this form if you would like to give your accounts of dealing with a Latex allergy and would like your story posted to the Latex Stories page.
 

Petition for Change

By submitting your info to the petition below, you agree that Latex products should be regulated and that the following types of regulations should be met:
 
•

recognition under the American with Disabilities Act: Latex allergy sufferers have a disability because their ability to carry on a normal and functional life relative to a healthy individual. Their specific needs should be met under the American with Disabilities Act.
•

The Right to Eat: Latex gloves should be banned from the foodservice industry and the Department of Health of each state should enforce the use of non-Latex gloves while prepping food. Any restaurant or food manufacturing company should be fined if found to be using Latex in their food prepping or production.
•

The Right to Medical Attention: Hospitals and medical care facilities should be completely Latex free so that those suffering from the illness can seek medical care whenever needed.
•

The Right to WORK: Work environments should be Latex free. Any employees showing Latex allergy symptoms should be accommodated and Latex products should be removed from the work atmosphere.
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The Right to BREATH: Those who suffer from the more advanced stages of Latex allergies can get reactions by inhaling Latex particles. That means, if they just smell a product containing latex, they will get a reaction. Manufacturers and public officials should work to remove Latex from every day life so that airborne Latex allergy reactions are not common.
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The Right to A NORMAL LIFE: Public areas and consumer products should not use natural Latex in their products. For example: use of latex in carpeting, automobiles, children's playgrounds, fitness centers, etc.
 

Note: Please submit your information only once so our statistics are accurate.
 
 

The Petition (* denotes required info)
First Name:*  
 
   
Last Name:*  
 
   
Phone Number (Like this 123-456-7890):*  
 
   
Email Address:*  
 
   
City:*  
 
   
State:*  
 
   
Profession:*  
 
   
1. Are you allergic to Latex?*  
Yes   No  
   
2. Do you get any Latex allergy symptoms after eating at restaurants?*  
Yes   No  
   
3. Do you get any shortness of breath or asthma type symptoms when smelling Latex products?*  
Yes   No  
   
4. Select all the symptoms you suffer from below?  
Vomiting  
Diarrhea  
Difficulty Breathing/Asthma  
Sore Joints/Muscles  
Dizziness/Vertigo  
Nausea  
Anaphylaxis  
Sore/Scratchy Throat  
Swelling  
   
5. Enter any comments or your story below. If you want your story added to the Latex Stories page, enter it below and select Yes in the question below? (2000 character max)  
 
   
6. If entered above, would you like your story to be displayed on the Latex Stories page on this web site?*  
Yes   No  
   
7. Would you like your story to be considered for inclusion in a book about Latex allergies:*  
Yes   No  
   
8. If you are allergic, would you like to be considered for inclusion in any lawsuits that fight for the regulation of Latex allergies:*  
Yes   No  
 
9. Check the "I Agree" box below if you have read and agree to the Disclaimer & Privacy Policy for this web site:*  
I Agree  
 
If you see this, leave this field field blank.
 		  
   
Note: Be sure all information above is ready to submit. You will not be able to edit it after click the button below.  
 

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