Latex Allergy in Health Care Personnel - Statistical Data Included

AORN Journal, July, 2000 by M. H. Baena De Moraes Lopes, R. Aparecida Mendes Lopes

Latex allergy is a current problem in the world's population, and it now has been recognized and widely studied. The increase in the number of type I reactions, which is mediated by immunoglobulin E (IgE) and affects health care employees and patients, is becoming a serious problem. Allergic reactions range from simple contact dermatitis to severe anaphylaxis.

Natural rubber (ie, latex) is obtained from the tropical tree Hevea brasiliensis. It begins as a milky liquid that contains water-soluble proteins, lipids, amino acids, nucleotides, and other substances resistant to chemicals and heat.(1)

The first description of an allergic reaction related to latex use in medical literature was published in Britain 1979.(2) It described the type I reaction, which involves the appearance of urticaria after contact with rubber products. This problem previously had been only suggested m literature, The incidence of latex allergy increased when standard precaution measures were universally established. The increase in world demand for latex gloves resulted in decreased quality, and gloves began to contain more allergens.(3) As the use of latex products increased, the rate of production increased. The time taken for each manufacturing phase consequently was reduced, which resulted in latex being inadequately washed. According to one source, if latex products are not correctly washed during the manufacturing process, water-soluble proteins may be retained and can cause an allergic reaction in some individuals.(4) In 1988, several patients who were administered barium enemas died from allergic reactions to the latex balloon.(5) The incident drew special attention to latex allergy.

Generally, type IV reactions (eg, contact dermatitis, delayed allergic reactions mediated by T lymphocytes) occur because of the presence of chemical residues that are added during vulcanization to give rubber its elasticity.(6) This type of allergy is not life threatening.

From Oct 1, 1989, to Sept 30, 1992, the US Food and Drug Administration (FDA) received 1,118 notifications regarding allergic reactions and anaphylaxis caused by proteins found in latex and 15 patient deaths after exposure to enema tubes. The National Institute of Occupational Safety and Health (NIOSH) issued a warning about latex allergy, and the FDA therefore defined rules and sponsored more profound studies to regulate the use of latex.(7)

REVIEW OF THE LITERATURE

This article presents literature about types of latex allergy, population at risk, and signs and symptoms. This information is intended to help nursing staff members manage problems resulting from latex exposure.

The allergenic components in latex, especially the proteins, are not well known yet. The protein antigens of latex are not well defined and, in the case of gloves, may be in the form of water-soluble proteins, proteins restricted to glove powder, and proteins that are physically or chemically restricted to latex and therefore cannot be removed from it.(8) Peptide antigens have been identified in raw latex as well as in processed latex.(9)

Table 1 shows the four types of allergic reactions that have been classified. Allergy to latex ranges from contact dermatitis to anaphylaxis. Type IV reactions occur because of additives (ie, thiouranium, carbamates) generally used to manufacture latex gloves; therefore, they are not true allergic reactions to latex. These reactions are uncomfortable but are not life threatening, and they can be avoided by using gloves without these additives.(10) Clinical manifestations of a reaction may be contact stomatitis, contact dermatitis, or chronic dermatitis.(11)

Table 1

TYPLES OF LATEX ALLERGY REACTIONS(1)

* Type I: Immediate reaction, which could be local or systemic, mediated by immunoglobulin E antibodies.

* Type II: Cytotoxic reaction mediated by immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies.

* Type III: Immune complex reaction mediated by IgG or IgM antibodies that attach themselves to antigens, creating complexes, generally involving activation of complement.

* Type IV: Contact dermatitis, reactions mediated by sensitized T lymphocytes.

NOTE

(1.) M F Fay, "Hand dermatitis: The role of gloves," AORN Journal 54 (September 1991) 451-467; J Simms, "Latex allergy alert," The Canadian Nurse 91 (February 1995) 27-30.

Type I reactions, on the other hand, are systemic because they are mediated by IgE antibodies.(12) The response has an acute character as an immediate hypersensitive reaction to latex exposure. Symptoms of a type I reaction may include urticaria, rhinitis, conjunctivitis, bronchospasm, or anaphylaxis.(13) Latex exposure may occur through contact with the skin or mucous membranes, by inhalation, or through contact with particles in the air.(14)

RISK POPULATION

There are four groups at a higher risk of developing sensitiveness to latex:

* children with myelomeningocele,

* health professionals,

* patients who have undergone various surgeries, and

* workers in the rubber industry.(15)