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A review of latex sensitivity related to the use of latex gloves in hospitals

AORN Journal, July, 2004 by Rosimeire Aparecida Mendes Lopes, Maria Cecilia Cardoso Benatti, Ricardo de Lima Zollner

Skin and respiratory allergies are known occupational problems for health care workers. (1) Powdered latex gloves have been identified as a major source of occupational allergenic exposure because they contain water-soluble proteins responsible for antigenic sensitization. (2) Latex gloves used during surgical and clinical procedures have proven to be effective in preventing the transmission of infectious diseases to health care workers. Increased use of latex gloves, however, has corresponded to an increase in the number of reported cases of latex sensitivity. Until the late 1980s, latex gloves were thought to be innocuous, but currently, they are considered to be major sensitizing agents. (3)

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MANUFACTURE OF NATURAL RUBBER LATEX GLOVES

Latex is a milky, viscous, cytoplasmic exudate that is extracted from the tropical tree Hevea brasiliensis. It is produced in the cytoplasm of lactiferous cells along with amino acids, phospholipids, carbohydrates, and proteins (ie, 2% to 3%). (4) The essential functional unit of latex consists of cis-1,4-polyisopropene covered by a layer of lipidic and phospholipidic proteins that ensure its structural integrity. (4,5) The proteins present in latex serum are the antigens considered to be responsible for causing type I hypersensitivity to latex. Sixty percent of these proteins are linked to rubber and ispropene polymers, and 40% are in the latex cytosol. (5)

Latex is extracted from the trunk of the Hevea brasiliensis tree, and ammonia, tiuram, or sulfides are added immediately to prevent bacterial contamination and coagulation of the extract. The liquid portion then is separated by centrifuge, which concentrates up to 60% of the solid portion and removes the serum containing the hydrosoluble proteins. Later, other concentrated chemicals, such as catalysts (eg, tiuram, carbamates) and antioxidants (eg, phenylenediamine) are added to obtain the desired properties of rubber (ie, tension force, elasticity, durability, tactile sensitivity). (5,6) Gloves are made by immersing molds in an extract of natural rubber latex. In response to the AIDS epidemic that began in the 1980s, the Centers for Disease Control and Prevention issued universal precautions that recommend glove use to protect health care workers against exposure to blood and body fluids. (7) High demand for natural rubber latex gloves after the introduction of universal precautions caused many manufacturers to alter their manufacturing processes, either shortening or eliminating important phases that removed proteins and chemical residues. This resulted in poor quality products with high allergen concentration. (2)

LATEX EXPOSURE

Exposure to latex antigens occurs via direct contact with the skin or mucous membranes or through inhalation of aerially transported protein particles that adhere to the powder in latex gloves. Absorption of latex proteins through the skin is considered to be the main pathway of sensitization and also is mainly responsible for local urticaria manifestations that eventually may become systemic. (2,8) The inhalation of protein particles dispersed in the air is capable of triggering nasal, ocular, and respiratory symptoms, (9) and in sensitized individuals, they may lead to rhinitis, conjunctivitis, and asthma, as well as to more severe manifestations, such as systemic anaphylaxis, tachycardia, angioedema, nausea, vomiting, abdominal discomfort, and hypotension. (2)

CLINICAL MANIFESTATIONS

Clinical manifestations of latex sensitivity are irritant contact dermatitis, allergic contact dermatitis, and type I hypersensitivity. Contact dermatitis is an inflammatory response to one or more external agents that may behave as skin irritants when immunologic mechanisms are not involved or as allergens when hypersensitivity is mediated by T cells. (10) Irritant contact dermatitis is an occupational rather than an immunologic dermatosis, which occurs when exogenous substances directly damage the skin. This condition often is related to the use of latex gloves. The predominant immunologic response is allergic contact dermatitis or type IV hypersensitivity resulting from an immune response to the allergen mediated by T lymphocytes that in this case are chemical substances, mainly accelerators and antioxidants, that are added to latex during its manufacture."

Although, type I hypersensitivity occurs less frequently than type IV hypersensitivity, if is the most severe reaction provoked by latex. In previously sensitized individuals, it is characterized by a systemic reaction mediated by immunoglobulin E (IgE) anti-latex after exposure to latex antigens. Reactions range from mild urticaria to systemic anaphylaxis. The development of type I hypersensitive symptoms to latex involves a series of interactions mediated by specifically activated T lymphocytic products and B lymphocytes that trigger the production of the antibody mechanism. These antibodies play a fundamental role in allergic reactions and are an integral part of the pathophysiology of latex allergy, as well as of other allergic diseases. (12)

Health Care Industry

A review of latex sensitivity related to the use of latex gloves in hospitals

AORN Journal, July, 2004 by Rosimeire Aparecida Mendes Lopes, Maria Cecilia Cardoso Benatti, Ricardo de Lima Zollner

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