Challenge tests with powder-free natural rubber latex (NRL) gloves in health care workers with a history of NRL-induced asthma

Abstract

Rationale NRL-allergic health care workers (HCWs) can reportedly remain on the job if they use NRL-free material (mainly gloves) and their co-workers use, at the minimum, powder-free latex gloves. However, even powder-free latex gloves may release NRL-allergens into the atmosphere and induce symptoms in NRL-allergic HCWs. We conducted this study to determine if powder-free NRL gloves would cause allergic symptoms under controlled exposure conditions. Methods Bronchial provocation challenge tests with methacholine, adsorbable dusting powder (ADP), powder-free and powdered NRL examination gloves were performed in 16 HCWs who were referred to the Osnabrueck clinic with a positive history of work-related NRL-induced asthma and a confirmed NRL-sensitization. The test gloves were analyzed for both powder and allergen levels by in vitro assays. Results The extractable allergen levels from powder-free gloves were 100 to 300 fold lower than those detected from the powdered gloves. Trace quantities of inhalable particles could be detected on the powder-free gloves. No HCW challenged with powder-free NRL gloves exhibited any clinically observable allergic reactions (e.g. rhinitis or conjunctivitis) or bronchial obstruction as assessed by spirometry. In contrast, all 16 subjects developed rhinitis following a challenge with powdered NRL-gloves and 10 of these also experienced a significant drop in FEV1. Conclusions The amount of NRL-allergen produced by handling up to 20 powder-free NRL-gloves was not sufficient to induce any clinically observable allergic reactions in the skin, mucosa or bronchi of latex allergic asthmatics. Powder-free NRL-gloves can be safely used by other personnel without inducing injury in NRL-allergic co-workers.