Historical Development of Latex Allergy

AORN Journal, July, 2000 by Reuben J. Dyck

Establishing a historical background for latex allergy as well as the development of its use in medical settings is necessary in understanding how this allergy has developed to its present proportions. Historical developments surrounding latex are, to a large degree, responsible for the severity of latex allergy as described in the literature and experienced by thousands of patients and caregivers.

Gloves are universally considered to be a necessity to minimize the risk of infection during patient care and surgery. Historically, glove use may have been chiefly to keep caregivers' hands clean. Scientific data since has proven that gloves serve as a two-way barrier against the transmission of disease. The first glove used in surgery was described in 1758 by Johann Julius Walbaum, MD. It covered only the distal third of the hand, was formed from the cecum of a sheep, and was used primarily in obstetrics.(1) Permeable gloves, such as the sheep cecum glove, were replaced by heavy rubber gloves and used primarily in postmortem examinations. This was made possible by the discovery of rubber. Rubber first was used by the indigenous people of Central and South America during the pre-Colombian era. It was introduced to Europe by explorers of the region.(2) In 1834, Richard Cook used India rubber for surgical gloves. Ten years later, Charles Goodyear developed the process of vulcanization, which made rubber more stable in a variety of temperatures. This provided the impetus necessary for the commercial use of the rubber tree. In 1893, J. C. Bloodgood provided gloves to all members of his surgical team.(3)

Despite these early developments and the fact that other individuals were experimenting with this new invention in the United States and Europe, the invention of the surgical glove has been attributed to William Steward Halstead, MD.(4) Although Halstead may not have invented the surgical glove, he introduced the sterile latex reusable glove into the OR in 1894 and is thus considered by many to be the father of the surgical glove.(5)

As scientific knowledge of infectious agents and their transmission grew, it became evident that extra precautions were necessary to guard against the spread of disease. Latex quickly was recognized as an effective substance to provide a barrier to prevent infections. A significant development occurred in 1928, when the dipping of latex resulted in a thinner, stronger glove.(6) These thinner gloves provided enhanced tactile qualities, which in turn allowed surgeons to perform more delicate surgeries. The gloves' increased strength and elasticity increased their barrier qualities.

Gloves originally were intended to be multiple-use items. They were washed, lubricated, resterilized, and used as long as they appeared to be intact. This practice still is in place in many developing countries where disposable gloves are a luxury. Single-use gloves increasingly became the norm by 1966 and are now standard practice rather than a preference because it is more economical to discard the gloves after each use than risk inadvertent transmission of infections.

Initially, gloves were used to protect the hands of OR nurses. Surgeons began using gloves as well, but they acted on the knowledge that gloves would protect the patient from microorganisms present on surgical team members' hands. Some researchers initially disputed the value of gloves in disease prevention; however, the majority of health care professionals and microbiologists firmly supported the relationship. This acceptance first led to a voluntary implementation of the use of gloves in all surgeries and then to a formalized standard of care requiring the use of gloves.(7)

THE EVOLUTION OF LATEX HEALTH CAR PRODUCTS

One of the most common situations in which an infection may occur involves direct exposure of pathogens to the patient's bloodstream during surgery. Latex gloves provided the ideal barrier to prevent this, while also providing a flexible product that offered maximal tactile sensitivity for the user. These properties, although recognized approximately 100 years ago, are still unsurpassed by any other comparable substance.

The value of latex to the delivery of health care is undisputed. No longer used simply in producing billions of examination and surgical gloves, latex is used in approximately 40,000 other medical and non-medical products. Exposure to latex is almost unavoidable in the course of daily living unless one is astute in recognizing the day-to-day products that contain latex. This requires an informed, disciplined, and observant individual.

The medical industry continues to rely on third world countries to produce latex for use throughout the world. Malaysia, for example, presently is one of the biggest suppliers. Liberia was a prominent supplier until internal conflict destroyed the infrastructure for producing and exporting during the late 1980s.(8)

Latex composition. Latex commonly is referred to as natural rubber latex or by the simplified term rubber. Latex is a product produced by specialized cells of the tree Hevea brasiliensis. It is composed of a complex mixture of polyisoprene, lipids, phospholipids, and proteins.(9) It is a milky substance that is harvested by tapping the tree, a process similar to the harvesting of maple syrup. This milky substance is the cytoplasm of the cells of the lactiferous system of the tree.(10)