Latex Allergy

Abstract

We appreciate AORN's attention to the issue of latex allergy but must draw readers' attention to a recent article written by Esah Yip, DSc, of the Malaysian Rubber Export Promotion Council that may be misleading. In general, the article implies that low-protein, low-powder latex gloves are “safe,” but basic scientific facts point to a different conclusion. Yes, latex gloves with fewer allergenic proteins probably will cause fewer reactions, but no one can say how much latex will cause someone to react, anymore than one can say how much penicillin or shellfish will cause an allergic reaction. Common sense tells us that it would be wise to use a glove that not only protects as well as or better than latex, but that also will not create or worsen a latex allergy. Many studies show that there are synthetic, nonlatex gloves, such as nitrile, that actually provide an excellent barrier and, in fact, a stronger barrier against chemotherapeutic agents. The author notes that after polyvinyl chloride and nitrile gloves were punctured, they were found to have high leakage rates, but she fails to note that the puncture resistance of nitrile is dramatically better than latex. Dr Yip says that, “The recommendation to use low-protein, low-allergen powder-free gloves whenever latex gloves are needed is supported by many organizations, such as NIOSH [National Institute for Occupational Safety and Health]…” Recognized groups do not support the implication that latex is the glove material of choice. In fact, NIOSH's 1997 alert was a warning about the potential hazards of latex to workers, not an endorsement. Unfortunately, it has been misinterpreted to imply that the federal agency is recommending latex gloves. They do not. Their 1997 alert says only, “If you choose latex gloves, use powder-free gloves with reduced protein content,”1 Neither NIOSH nor any other federal agency has ever recommended one glove material over another. They simply tell us to have an “intact” barrier. Regarding the author's phrase, “when latex gloves are needed.” We are aware of no circumstances under which gloves made of latex “are needed.” The article seems to stress reactions to latex, but latex gloves can cause allergic sensitization as well, especially when latex is inhaled or touches mucosa. Three allergists recognized internationally for their expertise in latex allergy agree and have made a plea to “Stop the [latex] sensitization.”2 Synthetic, latex-free gloves are important, not only for those who already know that they are allergic to latex but for all OR staff members. It is impossible to tell which staff members have begun their sensitization and who already has the potential for an anaphylactic or asthmatic reaction. In our experience, many OR nurses have only learned of the allergy when, for example, a latex glove or latex catheter is placed against their mucosa during childbirth or surgery. One researcher found that while some hospital staff members progressed from mild to moderate to severe symptoms of latex allergy, others suddenly experienced anaphylaxis without recognizing any symptoms beforehand. We applaud the reduction of protein and powder in latex gloves, but physicians and nurses know that only a few molecules of an allergen can precipitate anaphylaxis. There is no safe level of powder on latex gloves. Just as we would not ask a person with a peanut allergy to eat peanuts with lower protein, we should not ask vulnerable OR staff members or surgical patients to be exposed to latex gloves. When latex gloves are snapped on and off, powder propels latex proteins into the air. Many ORs across the country have lost a perioperative nurse, nurse anesthetist, or technologist who has become progressively sicker with asthma or anaphylaxis. Many anesthesiologists and surgeons also have fallen victim. Sadly, veteran perioperative nurses have been advised to leave the OR, instead of throwing out cheap disposable latex gloves. Just as important is that patients are at risk. Dr Yip's article gives only passing reference to patients with the allergy, but their numbers are growing. At the University of Michigan, one in 14 children on the OR bed were experiencing anaphylaxis until gloves were changed to synthetic, nonlatex gloves.3 Recently, a study of patients at an urban Michigan emergency room revealed that more than 8% had a systemic allergy to latex, leading researchers to conclude that “Latex allergy might be a larger public health problem than we once anticipated…”4 Most agree that latex allergy has become one of the most common causes of anaphylaxis during surgery. Nurses' and physicians' licenses may be on the line, and they may be sued if a patient develops intraoperative latex-induced anaphylaxis. We cannot look at the performance of latex gloves in isolation from all of their effects, including well-documented hazards to the health of patients and staff members.