Use Of Latex Gloves Research Articles

Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Context: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice.Case Presentation: A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time.Discussion: The patient’s presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work.Relevance to Clinical or Professional Practice: The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.

A Review of Latex Sensitivity Related to the Use of Latex Gloves in Hospitals

Beginning in the 1980s, use of latex gloves to protect health care workers against exposure to blood and body fluids increased. Since then, the number of reported cases of latex sensitivity also has increased. Reactions to latex range from contact dermatitis to anaphylactic shock. Low-powder, powder-free, and non-latex gloves provide alternatives to protect health care workers from occupational latex exposure.

P51 Occupational contact dermatitis among operating room nurses

Background: Occupation related dermatitis is a common problem in health care workers, especially in nurses, who are exposed to a wide variety of allergenic and irritant substances. The aim of this study was to assess the prevalence rate of skin symptoms among personnel handling chemical disinfectants and to examine which allergens were important.Methods: We investigated 460 randomly selected health care workers (HCW), who had constant contact with chemical disinfectants during their work. The study was performed by means of a questionnaire, a medical examination, skin patch test using Finn chambers and glutaraldehyde, benzalkonium chloride, hydrogen peroxide and chlorine compounds at 0,1, 0,5 and 1,0% wat.Results: 241 HCW (52,5%) described various skin symptoms they attributed to disinfectant exposure. Generally, these symptoms were mild and ranged from pruritis to hand eczema. Of these 66 (14,4%) tested were skin patch test positive. Of the 460 HCW tested, 37 (8%) had positive patch test reactions to benzalkonium chloride, 22 (4,8%) to chlorine compounds, 18 (4%) to glutaraldehyde, 6 (1,2%) to hydrogen peroxide. 5 HCW (7,6%) testing positive to disinfectants gave no history of reactivity to them. History of atopic dermatitis was found in 50 (10,9%) and it was associated with diagnosis of allergic contact dermatitis and positive patch test reactions to benzalkonium chloride. Also positive patch tests reactions were associated with frequent use of latex gloves in contrast to those, which used latex gloves while working constantly or didn’t use them at all.Conclusions: 1. Skin symptoms related to work with chemical disinfectants are common, but mostly mild. 2. Benzalkonium chloride is one of the strongest sensitizing disinfectants used in health care professions, especially for atopic persons who do not take measures of protection during exposure to it.

FC03.1 Experience from joint occupational health/dermatology clinics

Background: A monthly consultant led occupational health/dermatology clinic was started in 1999 providing rapid access to staff with suspected occupational skin disease including natural rubber latex (NRL) allergy and teaching for the occupational health staff.Objectives: To evaluate the characteristics and outcome of staff attending this clinic and to assess patient satisfaction.Methods: A retrospective case note survey was performed from staff attending the clinic from 1999 to 2002. A questionnaire was sent to them >3 months following consultation.Results: A total of 116 patients were identified (12 male, 104 female), and 85 (73%) were nurses. 77 (66%) patients were referred with hand eczema (HE). Of the 45 patients referred with adverse reactions or exacerbation of hand dermatitis following the use of latex gloves, only 4 had positive prick tests and were considered to have NRL allergy. Patients with significant HE or occupational exacerbation of HE were referred for patch testing (n = 36). Of the remainder, most could be discharged after a single visit. 49/95 (52%) questionnaires were returned, 34/45 (76%) patients found the consultation useful. As a separate study, the data recorded within the patch test clinic looking at health care workers (HCW) referred both from this clinic and from other sources was analysed. This showed relevant positive patch tests in 16/49 (33%) patients. In 55/99 (56%), an occupational cause was likely.Conclusion: Occupational skin disease in HCW is common, attendance at the clinic was beneficial and a single visit was sufficient in most cases.

FC01.6 Hand dermatitis of hairdressers. Study of protective gloves permeation

Contact dermatitis among hairdressers is common and is one of the most frequent occupational dematoses due to continual exposure to water, detergents, hair dyes, permanent waves and metal equipment. Use of individual protection systems – as gloves – is considered a good measure of prevention. Few data exist about the real permeation resistance (PR) of gloves, also in term of time of PR. We tested two types of djsposable latex gloves different by thickness and density of the manufacture material. We used a permeation cell composed of two separated parts: in the upper part we introduced the hair colouring formulation and in the lower one the collection medium (NaHSO3 1% in water); the two parts were separated by a portion of the glove material. A 100 microL volume of the collection medium was collected and injected onto a HPLC apparatus after 1, 2, 4 and 24 hours. A diode array detector was utilised selecting two wavelengths in the UV range (240 and 275 nm) with a linear concentration gradient up to 60% of methanol/acetonitril mixture. We can simultaneously analyse 9 oxidation dyes and the detection limits were sufficient to determine these substances at very low concentrations. We obtained respectively a breakthrough time less than 24 hours for the lower thickness glove and of over 24 hours for the other one; the latex gloves are suitable for prevent the skin contamination during the preparation of the colourings mixture in the hairdresser activity. The obtained data show those latex gloves, of both thickness, have a very high PR. On the other hand, the use of latex gloves has been associated with the more frequent recognition of immediate‐type hypersensitivity responses related to latex products. The prosecution of the study will evaluate the PR of latex‐free gloves.

Latex hypersensitivity in Department of Veterans Affairs health care workers: glove use, symptoms, and sensitization

This report of the prevalence of latex glove allergy in 3 Department of Veterans Affairs (VA) medical centers was a collaboration of the VA, the Centers for Disease Control and Prevention, and the National Institute for Occupational Safety and Health. To enroll and evaluate personnel from across the entire hospital workforce for latex hypersensitivity and to determine the type and extent of latex glove use. A questionnaire was administered that covered demographics, job category, latex glove use, and current latex glove allergic symptoms. Skin testing to aeroallergens was performed to evaluate the presence of atopy. Blood was drawn for analyses of serum antilatex IgE antibody by CAP assay. Of 1,959 subjects, 158 (8.1%) had latex glove-allergic symptoms, a positive latex CAP assay result, or both. In 1,003 subjects who reported latex glove use, 915 (91.4%) used nonpowdered gloves. A total of 133 subjects reported latex glove allergic symptoms, and 36 subjects had positive CAP assay results. Latex sensitization was correlated with atopy, race, and latex glove exposure. Latex symptoms were correlated with atopy, a positive CAP assay result, and latex glove exposure. Of the 133 subjects with latex glove allergic symptoms, only 11 had positive CAP assay results, giving a prevalence of confirmed latex glove allergy of 0.6%. Symptoms attributed to latex gloves and/or latex sensitization occurred in 8.1% of the employee population, with exposure, race, and atopy being the major risk factors. Few symptomatic individuals were sensitized to latex (0.6%). This low rate of confirmed latex glove allergy may have been related to nonpowdered glove use.

Accommodating Latex Allergy Concerns in Surgical Settings

CONCERN ABOUT ALLERGIC REACTIONS to natural rubber latex gloves has increased during the past 15 years. These reactions have been attributed mainly to an influx of high-powder, high-protein gloves in response to increasing concerns about AIDS transmission beginning in the late 1980s. THIS ARTICLE REPORTS ON AVAILABLE RESEARCH that details the types and prevalence of potential allergic reactions, supports the use of natural rubber latex gloves in the OR, and recommends strategies to enable health care who are not latex sensitive to continue wearing natural rubber latex gloves in the OR.

Prevention of latex allergy among health care workers: evaluation of the extractable latex protein content in different types of medical gloves.

Since the 1980s, there has been increased use of latex gloves by health care workers and a concomitant increase of irritant and allergic reactions. The total protein content and the latex allergenic protein content in different types of medical gloves commonly used in our hospital were evaluated to acquire information useful for preventing latex allergy in our hospital personnel. The total protein content and the allergic latex protein contents were evaluated with Lowry modified method and RAST inhibition assay in samples and extracts of 29 different types of medical gloves. The highest concentrations of total proteins and allergenic latex proteins were found in examination powdered latex gloves and in surgical powdered latex gloves; a significant amount of latex proteins was found in some brands of nitrile gloves. The clear association between the total protein levels and the allergenic latex protein levels suggests that the gloves with highest total protein content have the greatest allergenic potential. Therefore, it is recommended that manufacturing companies should provide package inserts including the total protein contents and possibly allergenic latex protein levels. They should declare whether they have added latex to their nitrile glove formulation. RAST-inhibition assays directly on glove samples instead of glove extract seems to be a good reliable and faster alternative for the evaluation of the allergenic potential of latex gloves.

Specific immunotherapy with a standardized latex extract in allergic workers: A double-blind, placebo-controlled study

Background: Preventive measures have been proposed to reduce the risk of sensitization to natural rubber latex (NRL), but this is not always feasible. Objective: The aim of this study was to determine the efficacy and safety of specific immunotherapy with a standardized latex extract in sensitized workers. Methods: Twenty-four patients allergic to NRL with contact urticaria (n = 8) and rhinitis or asthma (n = 16) were included (16 in the active group and 8 in the placebo group). Treatment started in a cluster immunotherapy protocol, with injections every week for 3 months and then every other week for another 3 months. Results: Patients in the active group had significantly lower values than patients in the placebo group in skin terms of reactivity to NRL (P < .01), rubbing test results (P = .047), and latex glove use test results (P = .046) after 6 months of treatment. There were no significant differences between the active and placebo groups in symptom scores, use of medication, self-assessment, or methacholine test results either before or after treatment. Differences in nasal and bronchial symptoms during specific inhalation challenges (P = not significant and P = .05, respectively) were observed in favor of the active group. In the active group 32 systemic reactions were observed (8% of doses), mostly during the build-up period, being more frequent in patients with respiratory symptoms (P = .004). All reactions responded promptly to treatment. Conclusion: Clinical efficacy was shown mainly on cutaneous symptoms, although an improvement in rhinitis and asthma symptoms was also observed during specific inhalation challenges. Latex-specific immunotherapy might be a useful approach for the treatment of latex allergy in sensitized workers. (J Allergy Clin Immunol 2003;111:985-94.)

Physician diagnosed asthma, respiratory symptoms, and associations with workplace tasks among radiographers in Ontario, Canada

Background: Medical radiation technologists (MRTs) or radiographers have potential exposure to chemicals including sensitisers and irritants such as glutaraldehyde, formaldehyde, sulphur dioxide, and acetic acid. Aims: To determine the prevalence...

How health care organizations can establish and conduct a program for a latex-safe environment.

The advent of universal precautions brought about a dramatic increase in the use of natural rubber latex gloves, and reports of rubber latex allergies began appearing in the literature. In 1997 the Johns Hopkins Hospital created the interdisciplinary Latex Task Force to address the issue of creating, implementing, and evaluating a latex-safe environment. When suitable alternatives were available, all medical products that contained latex were to be removed from the hospital and nonlatex alternatives substituted. Latex medical gloves, especially powdered latex examination gloves, which were used in all patient care areas, were replaced by vinyl gloves. Yet because of the ongoing concern about strike-through and the minimal level of acceptance of fit with the vinyl gloves, the search for alternatives to the vinyl gloves continued. The task force recommended switching to nitrile examination gloves throughout the hospital. To facilitate the transition to another examination glove, new educational pamphlets about the nitrile gloves were developed. The switch to nitrile examination gloves was successfully completed, but conversion to nonlatex surgical gloves was less successful, with costs being the overwhelming impediment. Monitoring of latex-containing products and ongoing evaluations of alternatives are crucial in ensuring patient and health care worker safety.

Latex allergies in the health care worker

A dramatic increase in the incidence of latex allergies in health care workers followed the surge in latex glove use accompanying the rise of human immunodeficiency virus (HIV) in the early 1980s. This increase in latex glove use was driven by the release of Universal Precautions issued by the Centers for Disease Control (CDC) in response to the rise of HIV and other blood-borne pathogens. Efforts to stem allergic responses in the workplace have relied on the substitution of other materials for latex. Unfortunately, there is so much latex in everyday life that avoiding this allergen is exceedingly difficult once one is sensitized. Additionally, there are numerous cross reactants that are present in the environment. The situation is further confounded by the introduction of genetically manipulated foods and agricultural products that contain defense proteins genetically inserted to protect plants from pests and pathogens. Many of these defense proteins are antigens that will cross react with latex. Sensitivity reactions, once developed, may progress to the point at which the health care worker is excluded from working. This report provides an overview of rubber products and cross reactants, allergic reactions, and latex sensitivity for the health care worker. © 2003 by American Society of PeriAnesthesia Nurses.

Latex glove sensitivity amongst diagnostic imaging healthcare personnel: a self-reporting investigation

The use of latex gloves has risen dramatically among healthcare workers resulting in an increase in the number of workers experiencing reactions to gloves. Little evidence of reactions among Irish healthcare workers is available. The current, self-reporting study investigated the prevalence to latex gloves amongst four professional groups within three Diagnostic Imaging Departments. Prevalence is similar to that demonstrated elsewhere with 18.3% of individuals expressing latex associated symptoms. Symptoms included itching and redness of hands, dry cracked skin, soreness of eyes and upper respiratory tract complaints. These results indicate that latex hypersensitivity is a real problem amongst Irish healthcare workers. This preliminary work provides the basis of a much larger controlled study currently being planned.

The appropriate use of gloves to reduce allergies and infection.

Twenty years ago, the wearing of gloves for non-sterile procedures was viewed as insulting to the patient as it made him/her feel 'unclean'. Today, gloves are worn for all procedures and are often wastefully used. There must be a fine balance between inappropriate and appropriate use of gloves and between the use of latex gloves for comfort and fine movements vs the potential for latex allergies. This article will review the use of synthetic and latex gloves and examine some of the related issues.

Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987-1998.

BackgroundOccupational reaction to natural rubber latex (NRL) glove use by healthcare employees has been an area of increasing concern. Unfortunately, there is little data demonstrating the prevalence and severity of actual reactivity to NRL.MethodOccupational reaction to NRL was estimated using workers' compensation claims filed by healthcare employees in Oregon for the period of 1987–1998. For the first ten years, these claims were estimated by source and conditions consistent with NRL glove reactions, while in the last two years a specific code developed in 1997 for NRL glove reactions was also employed.ResultsThe claim rate was on average 0.58 per 10,000 healthcare workers annually, which constituted 0.29% of all workers' compensation claims. The most common condition experienced was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions were minor in nature, although one fatality was reported. The average NRL claim cost was $8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per year. The occupational groups with the highest number of claims were nurses (30.8% of claimants) and nursing aides and orderlies (24.6% of claimants).ConclusionsIn comparison with other workers' compensation claims filed by healthcare workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or conjunctival reactions to NRL gloves are common.

Allergic reactions to natural rubber latex at home, to rubber products, and to cross-reacting foods.

The prevalence of clinical sensitivity to natural rubber latex (NRL) has increased dramatically in the last 15 years. In the health care setting this has been associated with the increased use of latex gloves. It does not, however, explain the observation that IgE antibodies to NRL are detected in equal rates in both health care workers and the general population, with the numerous reactions occurring in homes and in health care settings in non-health care workers. This increase in NRL sensitivity has occurred at the same time as our observation of an increase in atopy. In addition, atopy is a definite risk factor that has been associated with NRL sensitivity in all studies. Exposure to NRL products outside the health care environment is significant and ubiquitous. Exposure to NRL epitopes also occurs by ingestion of foods, food additives, and pollen. This exposure is sufficient to induce IgE antibodies to both the food and NRL proteins. It is therefore difficult in an individual patient to implicate any single product as the cause of NRL sensitization leading to the development of symptoms. Outside of the health care environment there does not appear to be an increase in exposure to NRL products or to cross-reacting materials. This would suggest that there is an increase in the susceptible population, which clearly appears to be the atopic individual. A great deal of attention is devoted to reducing exposure to latex gloves in the health care setting, which may be only the visible portion of the iceberg. More attention should be devoted to reducing the antigens present in all NRL products and consideration given to developing vaccines for the food-sensitive individuals.

Epidemiology of latex sensitization and allergies in health care workers.

Although it is often claimed that health care workers are at increased risk of latex sensitization and type I allergies, there has been no systematic analysis of the epidemiologic studies that are relevant to this conclusion. A systematic analysis of the epidemiologic literature found that, in the past 14 years, there have been 48 epidemiologic studies of type I latex allergy among health care workers. Of these, 2 cohort studies estimated the incidence of latex sensitization by skin prick testing at between 1% and 2.5% per year. Neither compared the risk to that in the general population. The prevalence of sensitization in health care workers varied between 0% and 30%, yet this large variation was unexplained. Increased risk of sensitization was not clearly associated with the duration of work in health care, the time spent wearing latex gloves, the frequency of exposure, the specific job categories, the use of powdered versus nonpowdered latex gloves, the use of latex versus nonlatex gloves, or any measurements of ambient exposure to latex proteins. The epidemiologic studies do not support a conclusion that health care workers are at clearly increased risk of latex sensitization or type I allergies compared to other occupations in the United States. The role of latex gloves in causing latex sensitization and type I allergic symptoms remains poorly defined because of the inconsistent results across studies. Future epidemiologic studies are needed that include measured exposures to latex antigens, that compare health care workers to appropriate referent groups, and that address confounding by atopy, age, sex, and race.

Long-term outcome of 160 adult patients with natural rubber latex allergy.

Allergy to natural rubber latex is a major occupational problem in the health care sector and a problem even in other occupations in which protective gloves are used. There is little information available about the long-term outcome at work in large patient populations. To study the occupational outcome when all gloves in the working environment were changed either to low-allergen latex or non-latex gloves, in 1995 to 1996 we re-examined 160 of 174 adult subjects who were diagnosed with natural rubber latex allergy between 1982 and 1994 after a median of 3 years (range, 0.5 to 24 years) after the diagnosis. The outcome in daily work or as a patient in health care was investigated with the use of a questionnaire. Special attention was paid to the assessment of the occurrence of hand eczema. Glove selection policy as an intervention in the treatment of natural rubber latex allergy is described. Of 71 health care workers and 89 non-health care workers, 72% and 83% were atopic; 54% and 65% had hand eczema at the time of diagnosis, and 89% and 19% had work-related allergy to natural rubber latex, respectively. On re-examination, none of the health care workers had changed work because of natural rubber latex allergy, and only 38% had hand eczema (significant decrease). Ninety-eight percent of the non-health care workers, of which 58% had hand eczema, continued with their previous jobs. The use of low-allergen latex or non-latex gloves throughout the health care sector seems to be an adequate step for health care workers who have natural rubber latex allergy; nonhealth care workers get along with personal avoidance of latex gloves if they are not working directly with natural rubber latexcontaining materials in production.

Latex glove disorders: a management strategy for reducing skin sensitivity.

The use of latex gloves by health care workers has increased over recent years. Proteins within the latex gloves and chemical additives during the manufacturing process have been linked to allergic skin and systemic disorders. Evidence suggests that latex-related skin disorders are increasing. Unless more stringent measures to control prolonged contact with latex gloves are implemented, skin disorders will continue to increase. While employees have a professional responsibility to reduce longer contact with latex gloves and use other safer alternatives, employers may also contribute through better education provisions, more strict monitoring and control of glove usage and purchasing gloves that are safer. An Infection Control Nurse can support both employees and management by developing and supporting better education and guidance for glove usage and an Employee Health Nurse could provide better care and support to affected workers. Glove manufacturers should identify the level of each protein in their gloves, the health risks involved and undertake new research to produce more hypoallergenic gloves. Collaborative efforts among employees, employers, researchers and glove manufacturers are needed to prevent the spiraling latex health risks to health care workers getting worse.

Natural rubber latex allergy in the occupational setting

Over the last decade, the prevalence of natural rubber latex (NRL) allergy has reached epidemic proportions among workers who use or who are exposed to powdered latex products. NRL-associated occupational asthma is confined largely to those exposed to powdered latex glove use or other latex aerosols. The most frequent presenting symptom of NRL allergy is contact urticaria; inhalation may cause symptoms of allergic rhinitis and asthma. Skin prick testing is the most accurate tool for diagnosis of NRL allergy. The cornerstone of management is cessation of exposure; substitution with non-NRL or nonpowdered NRL gloves results in predictable rapid disappearance of latex aeroallergen.