Natural Rubber Latex Gloves Research Articles

The immuno cross-reactivity of gutta percha points

Objective The purpose of this study is to test the postulated immuno cross-reactivity between proteins derived from raw gutta percha (RGP), gutta percha point (GPP) and natural rubber latex (NRL). Methods Antigenicity and cross-reactivity of proteins were determined by the FITkit (FITBiotech, Finland) and ELISA inhibition assays. Results Antigenicity of proteins derived from RGP or GPP was not demonstrated. Except for NRL glove extracts, neither extracts from RGP or GPP were reactive in ELISA inhibition assay. Significance There is no immunologic cross-reactivity in vitro between proteins derived from RGP or GPP, and from NRL gloves. Thus, therapeutic use of GPP is unlikely to initiate adverse immuno-reactivity in individuals previously sensitized to NRL proteins.

Primary prevention of latex related sensitisation and occupational asthma: a systematic review

Methods: Eight primary prevention intervention studies on natural rubber latex (NRL) published since 1990 were identified and reviewed. This is the largest evidence base of primary prevention studies for any...

Strict Avoidance of Exposure to Natural Rubber Latex (NRL) Glove Products is Associated with Longitudinal Reduction in Percutaneous Reactivity to NAL and Hev B Proteins

RATIONALE: Longitudinal effects of avoidance of powdered NRL glove exposure on puncture skin test (PST) reactivity to non-ammoniated latex (NAL) and purified native allergens (Hev b) have not been assessed.

Safer Surgical Gloves: Evaluation and Implementation

In 2003 the Scottish Health Service Central Legal Office was consulted on the requirement to supply an alternative to natural rubber latex gloves for healthcare professionals within NHS Lothian University Hospitals Trust. Counsel stated that as latex is now accepted as being hazardous to health, employers must prove the statutory defence in Regulation 7(1) of the Control ofSubstances Hazardous to Health Regulations (HSE 2002). Counsel also stated that, as there are now adequate alternatives to latex gloves, NHS employers would have an indefensible position if no attempt was made to supply alternatives.

Self‐reported allergy to latex gloves among health care workers in Jordan

The objective of this study is to determine the prevalence of natural rubber latex allergy and its associated factors among health care workers in Jordan based on a self-administered questionnaire. In this cross-sectional study, the data were obtained through a self-reported hand-delivered questionnaire that was distributed to 500 health care workers who use natural rubber latex gloves. A total of 420 (84%) health care workers responded by filling the questionnaire. Of the total number of 420 health care workers who filled the questionnaire, 57 (13.6%) reported allergy to latex gloves. The prevalence of allergy to latex gloves was significantly higher for those who had allergy to some foodstuffs (especially avocado, kiwifruits and chestnuts) or with history of eczema and hay fever. However, allergy to latex gloves was independent of gender, age, job, family history, type of gloves, hours of use/day and number of years of use. It is concluded that a high rate of allergy to latex gloves was reported among health care workers in Jordan.

Sensibilisation aux gants en latex poudrés: Une prévalence élevée chez le personnel hospitalier

The prevalence of latex allergies in industrial countries has skyrocketed since the 1980s. Between 2.6 and 22% of hospital workers are diagnosed with latex allergy, which has been recognized as an occupational hazard in France since 1997.To assess the prevalence of latex allergy among Montpellier University Hospital Center staff.From 1999 to 2002, we interviewed and conducted skin-prick tests on 537 hospital staff members from different departments and with different degrees of exposure to airborne latex allergens.Symptoms while using natural-rubber latex gloves (most often contact dermatitis) were reported by 88 (16.4%) staff members. Overall work-related allergic symptoms included rhinitis, reported by 65 (12.1%), contact urticaria by 28 (5.2%), and bronchial symptoms by 16 (1.1%). In all, sensitization to latex was identified in 7.1% of our staff, and this percentage was higher (11.3%) in units where latex gloves were used more often. Sensitization was associated with high latex exposure and atopy.This high rate of latex sensitization and the risk factors are similar to those already published. Based on this study, we have eliminated powdered latex gloves, as have many other hospitals.

Conversion to Low-Protein, Powder-Free Surgical Gloves: Is it Worth the Cost?

This study was conducted to determine changes in overall costs associated with conversion to powder-free gloves including cost of workers' compensation cases for natural rubber latex (NRL)-related symptoms and health care workers' glove satisfaction. The study, a 2-year, longitudinal design with retrospective and prospective aspects, was developed to determine health care worker use of powder-free, low-protein NRL gloves, sensitization, cost, and glove satisfaction. Informed consent was obtained from 103 health care workers. Prior to glove conversion, nearly one-half (44%, 36 of 82) of the operating room staff reported symptoms related to NRL exposure. At the end of the 14-month data collection period, only 27% (22 of 82, McNemar test = .007) reported symptoms related to NRL exposure. Additionally, a cost savings of 10,000 dollars per year for gloves was evident with reports of increased user satisfaction. This study demonstrated that conversion to the use of powder-free, low-protein NRL gloves not only reduces health care worker NRL symptoms, but also positively affects the costs of glove purchases and workers' compensation.

Prevalencia de sensibilización a látex en personal de pabellones quirúrgicos del Hospital Clínico de la Universidad de Chile

Health care workers (HCW) are a high risk group for developing natural rubber latex (NRL) hypersensitivity and allergy. Some studies showed a correlation between time and frequency of exposure to NRL gloves and hypersensitivity, but a recent meta-analysis showed no clear evidences for such assumption. To determine the prevalence of NRL hypersensitivity and allergy in a group of HCW at the University of Chile Clinical Hospital. Ninety five HCW (aged 37+/-10 years, 59 females) were interviewed about time of exposure, atopic diseases and latex-related allergy symptoms. Different NRL extracts and seven NRL gloves brands were tested by the prick test method. Twenty four workers (25%, 95% CI = 16.9%-35.2%) were sensitized. No gender differences were found. No symptomatic cases were found in the sensitized group. In the workplace, six and two non sensitized subjects had respiratory symptoms or contact urticaria, respectively. Sensitivity to bananas, avocadoes, kiwi and chestnut was not significantly more common among latex sensitive individuals. No differences between sensitized and non sensitized subjects were observed for the presence of atopic diseases or the mean number of years at the workplace. The sensitization rate to NRL increased along with years of work, from 18.6% in patients working less than 10 years, to 28.1% in the group between 10 and 20 years and to 35% in those working more than 21 years (p=0.693). Sensitization was also related to the weekly hours of exposure: 1-10 hours, 17%; 11-20 hours, 23.5%; 21-30 hours, 50% and 31-40 hours, 28.5% (p=0.036). Sensitization increased proportionally to the years and weekly hours wearing NLR gloves. We did not find symptomatic patients in the sensitized group.

Allergen Profiles of Natural Rubber Latex (NRL) Proteins on Gloves and Glove Powders

The contributing role of glove powder in sensitization to natural rubber latex (NRL) proteins has been well documented in laboratory studies and through clinical evaluations. However, the quantitative relationship of the respiratory and topical exposures in the sensitization process remains unknown because the relative levels of protein on the glove powders in relation to the total levels of protein on NRL gloves have not been determined. In NRL allergens--Hev b 1, Hev b 3, Hev b 5, and Hev b 6.02--on randomly selected surgical and examination NRL gloves. We also examined the binding pattern of the four allergens to several glove powders that showed a different affinity to NRL proteins. The level of powder-bound protein was determined by the ELISA Inhibition Assay (ASTM D6499 standard method). Two cross-linked corn starch powders, one sample of cooking corn starch and one oat starch sample, were exposed to ammoniated (AL) or nonammoniated (NAL) raw NRL protein extracts. The levels of individual allergens were determined using the NRL allergen kit. In the NRL glove extracts we observed a wide range in the total allergen levels and a great diversity in the proportion of the four allergens. On the other hand, the evaluated starches had similar ratios of four individual allergens, regardless of the differences in their total allergen levels. The exposure of starches to NRL proteins with different allergen profiles did not affect the allergen ratio. All samples demonstrated a selective affinity for binding Hev b 1 and Hev b 5 allergens and a lesser affinity for the Hev b 6.02 allergen. Allergen Hev b 6.02 made up about 60% of the total allergen in the NAL extract, but only 12-30% of Hev b 6.02 was bound to starches. In contrast, there was only 3-7% of Hev b 1 allergen in the NAL extract, but powders had 35-45% of Hev b 1. These findings indicate that allergenic properties of NRL gloves and respective glove powders may be different.

Safe dental care for latex-allergic patients

Background The number of people with allergy to natural rubber latex (NRL) has increased significantly in recent years. Aim To assess the experiences of latex-allergic patients in accessing appropriate dental care, and also the willingness and ability of general dental practitioners to provide care for these patients. Method Two self completing postal questionnaires, one to patients and one to general dental practitioners. Results The majority of latex-allergic patients are able to obtain dental treatment. Some do experience adverse reactions, which may be severe, in spite of precautions being taken. Although many general dental practitioners are willing to accept such patients for treatment, few appear to be fully aware of all the necessary precautions required. Most do not have policies for the management of sensitised patients and staff, and a number are still using powdered natural rubber latex gloves in spite of the risk to patients and staff. Conclusion Latex-allergic patients can usually obtain safe treatment in general dental practice, but more education of dentists about the risks associated with natural rubber latex is required. Information about the latex content of equipment would be advantageous.

The provision of dental care for patients with natural rubber latex allergy: are patients able to obtain safe care?

The number of people with allergy to natural rubber latex (NRL) has increased significantly in recent years. To assess the experiences of latex-allergic patients in accessing appropriate dental care, and also the willingness and ability of general dental practitioners to provide care for these patients. Two self completing postal questionnaires, one to patients and one to general dental practitioners. The majority of latex-allergic patients are able to obtain dental treatment. Some do experience adverse reactions, which may be severe, in spite of precautions being taken. Although many general dental practitioners are willing to accept such patients for treatment, few appear to be fully aware of all the necessary precautions required. Most do not have policies for the management of sensitised patients and staff, and a number are still using powdered natural rubber latex gloves in spite of the risk to patients and staff. Latex-allergic patients can usually obtain safe treatment in general dental practice, but more education of dentists about the risks associated with natural rubber latex is required. Information about the latex content of equipment would be advantageous.

Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers

Background The development of allergy to natural rubber latex (NRL) is a risk for health care workers. A regulation banning powdered NRL gloves was implemented in Germany in 1998. Objective This study assesses the effects of this regulation on the development of occupational skin disease caused by NRL in health care personnel working in facilities insured by the German statutory accident insurance company, covering some 1.8 million insured health care workers. Methods We reviewed the annual numbers of reported suspected cases of NRL-induced occupational allergies (mainly contact urticaria) from 1996 through 2002, as well as the number and type of gloves purchased in acute-care hospitals from 1986 through 2002. Results The number of purchased nonsterile examination gloves increased by 1387% between 1986 and 2002. The purchase of powder-free NRL examination gloves exceeded that of powdered gloves in 1998. The incidence of suspected cases increased until 1998 and has since decreased by 79.9%. Most suspected cases (67.9%) were identified as occupationally caused. Conclusions Reducing the purchase of powdered NRL gloves is associated with a decrease in suspected and proved cases of occupational contact urticaria caused by NRL. Development of occupationally caused contact urticaria by NRL can be reduced by banning the use of powdered NRL gloves.

Longitudinal study of sensitization to natural rubber latex among dental school students using powder-free gloves.

A high rate of sensitization and clinical allergy to latex proteins has been reported in health care personnel. This is thought to be due to increased occupational exposure especially to natural rubber latex (NRL) gloves with an estimated prevalence varying widely (2.8-18%). This was a longitudinal study to monitor a cohort of first-year dental students throughout 4 study years during exposure to powder-free gloves. Their atopic status was determined by skin prick testing using a panel of common allergens, and any sensitivity to latex proteins and the cross-reacting food allergens assessed. Skin prick testing was carried out on the volunteers using latex, avocado, kiwi, banana, grass pollens, tree pollen, house dust mite and cat dander. Each volunteer completed a questionnaire detailing allergic history and any previous latex exposure. Skin prick testing showed a 65% incidence of atopy in the longitudinal study group. Initial latex skin testing was positive in 3 of the 63 students followed throughout their period of study. Subsequent testing gave a negative result in one student and one declined retesting. The third continued to give a positive response on each testing; she wore only nitrile gloves and remained free of clinical NRL allergy symptoms. No student developed latex sensitivity during the 5 yr of this study. Exposure to powder-free latex gloves was not associated with subsequent sensitization over 5 yr in a population with a high atopic incidence.

Immunomodulatory effect of endotoxin on the development of latex allergy

Background Although numerous studies have been conducted delineating the clinical manifestations of latex allergy and characterizing the protein allergens, little is known regarding the natural history of the disease. Objective These studies were undertaken to investigate the immunomodulatory role of inhaled endotoxin on the development of latex-specific IgE-mediated responses to natural rubber latex (NRL) proteins by using a mouse model. Methods Female BALB/c mice were exposed to 25 μg of NRL proteins with or without increasing concentrations of endotoxin (50-25,000 EU) through the respiratory tract. Serum antibody levels were evaluated biweekly during the study. After sensitization, mice were challenged with methacholine or NRL proteins, and airway hyperreactivity (AHR) was evaluated with whole-body plethysmography. After NRL challenge, lungs were excised for histopathology, and lung-associated lymph nodes were removed for cytokine mRNA evaluation. Results When compared with mice exposed to latex alone, mice exposed to latex and endotoxin demonstrated up to 50% lower levels of latex-specific IgE and decreased latex-specific AHR and mucin production. Conversely, these same animals demonstrated increased levels of latex-specific serum IgG2a and IgA antibodies and an increase in IFN-γ and IL-12 mRNA levels in the draining lymph node cells. Concurrent exposure to LPS with nonammoniated latex resulted in increased alveolitis and nonspecific AHR on respiratory challenge with methacholine. Conclusion Coexposure with LPS and allergen decreased latex-specific IgE but augmented nonspecific AHR. These studies demonstrate that endotoxin associated with NRL gloves can modulate the development of allergic responses to NRL proteins.

Effect of reduced exposure on natural rubber latex sensitization in health care workers

Knowledge about the long-term course of allergy or sensitization to natural rubber latex (NRL) is insufficient. To investigate the long-term effect of preventive measures on sensitization variables in health care workers who had been diagnosed as having NRL allergy (NRLA) or NRL sensitization (NRLS) without clinical symptoms. Repeated follow-up investigations, skin prick tests, and NRL specific IgE serum antibodies were performed in 88 health care workers-33 with NRLA and 55 with NRLS. All workers had been instructed to avoid NRL exposure. At the workplace, powder-free NRL gloves for all other employees were gradually introduced. Re-evaluations were done at 14 +/- 3.7 (N = 86) and 38 +/- 4.0 (N = 78) months after the first examination. At the last follow-up, a loss of skin prick test reactivity to NRL was observed in 1 of 29 subjects with NRLA (3.4%) and 16 of 35 with NRLS (45.7%) with previous skin test reactions (P < .001). Among those subjects who demonstrated a kU/L level (CAP class) equal to or greater than class I to NRL at the initial examination, NRL-specific IgE was absent at the last follow-up in 8 (32.0%) of 25 subjects with NRLA and 14 (38.9%) of 36 with NRLS. At the final examination, we could no longer demonstrate sensitization to NRL by any method in 24 (27.3%) of 88 health care workers. Complete loss of NRL sensitization was less frequent in subjects with NRLA than in those with NRLS (1 of 33 or 3.0% vs 23 of 55 or 41.8%; P < .001). Implementation of simple preventive measures lowers markers of sensitization to NRL quickly in many health care workers with NRLA or NRLS.

Dermatological problems in dental health personnel.

Occupational skin diseases among dental health personnel, particularly involving the hands, have been an issue in recent years. Dental personnel come into contact with (meth)acrylate, which can cause skin irritation as well as contact allergy. In addition, they frequently wash their hands and use natural rubber latex (NRL) gloves, increasing their susceptibility to hand dermatitis. We surveyed the staff members of a university dental college and hospital.

Occupational skin diseases among dental nurses.

Out of 923 female dental nurses in the Helsinki district, 799 were interviewed using a computer-assisted telephone interview. A structured questionnaire was used to inquire about skin, respiratory symptoms, atopy, work history and methods, and exposure at work. The 328 nurses, who reported work-related dermatitis on their hands, forearms or face, were invited to an interview by an occupational physician; 245 nurses participated. 31 nurses had previously been diagnosed with an occupational skin disease (OSD). 133 nurses with a suspected OSD were selected for further clinical examinations with prick and patch testing. Among the 107 nurses examined, 22 new cases of OSD were diagnosed. There were altogether 29 cases of allergic contact dermatitis, 15 of contact urticaria, 12 of irritant contact dermatitis, and 1 case of onychomycosis. Rubber chemicals and natural rubber latex (NRL) in protective gloves, as well as dental-restorative plastic materials [(meth)acrylates], were the most common causes of allergy. 42% of the OSD cases in the studied population had been missing from the statistics (Finnish Register of Occupational Diseases). Plastic gloves or NRL gloves with a low-protein content are recommended for dental work. Skin exposure to (meth)acrylates should be avoided.

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

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.

Binding and Measuring Natural Rubber Latex Proteins on Glove Powder

Cornstarch used as a donning powder on natural rubber latex (NRL) gloves adsorbs NRL proteins. During glove use, powder‐carried proteins can be aerosolized and can cause allergic reactions in NRL sensitized individuals. The amount of NRL proteins bound to glove powder and its relative relationship to the total amount of proteins on the glove has not been studied, due to the difficulty in measuring proteins on powder. Using the ELISA inhibition assay for NRL proteins [Standard test method for the immunological measurement of antigenic protein in natural rubber and its products. In: The Annual Book of ASTM Standards; ASTM: West Conshohocken, PA, 2000; ASTM D 64‐0] we have investigated possible protocol modifications in order to include measurement of proteins bound to glove powder, as well as the water‐extractable glove proteins. Possible interference of the starch itself was evaluated by adding clean cornstarch to the assay. No significant interference was observed with powder concentrations below 5 mg/mL. We analyzed 19 extracts of powdered surgical and examination gloves before and after removal of the particulate component. Comparison of NRL glove extracts with, and without, the cornstarch powder fraction indicated significant variations in the ratios of powder‐bound protein and corresponding water‐extractable protein. The ratios did not appear to correlate with either the total protein on the glove, the glove weight, or the total amount of powder on the glove. However, when virgin glove powders were exposed to NRL proteins, binding was proportional to the protein concentration in the suspension. Temperature in the range from 4°C to 37°C, did not affect binding intensity, while a higher pH resulted in a higher level of protein associated with, or bound to, the starch. The major differences in the propensity for NRL protein binding were observed among different glove powders. The data indicate that the amount of protein that binds to glove powder does not depend only on the initial protein levels in the raw NRL. More likely, other physical or chemical factors introduced during the manufacturing process, as well as the properties of the donning powder itself, may influence protein binding. Moreover, we demonstrated that the ELISA inhibition assay could be successfully modified for quantitation of proteins adsorbed on the glove powder, together with water‐extractable proteins.

A review of natural-rubber latex allergy in health care workers.

This brief review of natural-rubber latex (NRL) allergy in health care workers (HCWs) includes the definition of NRL allergy and data on its epidemiology, pathogenesis, diagnostic algorithm, management, long-term outcomes, economic impact, cost-effectiveness of changing facilities to a latex-free environment, and prevention. The data presented suggest that an individual with type I or type IV hypersensitivity to NRL should be able to continue to work in the workplace with careful evaluation and reasonable accommodations. Reducing exposure to latex is a safe and more economical alternative to complete removal of the individual from the place of employment. The use of low-allergen, nonpowdered NRL gloves substantially reduces airborne exposure to latex in most health care settings.