LATEX ALLERGY: STILL A CHALLENGE?

Canadian Operating Room Nursing Journal, Sep 2004 by Badger, Barbara

Although latex products have been in use for over a century, allergic responses to latex proteins have only been recognized as a serious health problem for about the past 15 years.1 In 1987, when the Occupational Safety and Health Administration (OSHA) introduced Universal Precautions, the demand for examination gloves increased significantly. Since everyone who came in contact with blood or body fluids was then expected to wear hand protection, glove use increased from fewer than 1 billion pairs per year (prior to 1987) to over 20 billion pairs of gloves by 1996.2 Latex sensitization is caused by exposure to latex proteins over time, and, although stated sensitization rates vary, it has been estimated that 8 - 12% of healthcare workers are latex sensitive.3

RISK GROUPS

When it comes to latex allergy certain risk groups are examined. Anyone who frequently wears latex gloves in their line of work is potentially at risk of developing this allergy. The major source of workplace exposure is natural rubber latex (NRL) gloves.4 The groups at risk include healthcare workers, dental workers, EMS workers, as well as non-healthcare workers such as law enforcement personnel, firefighters, gardeners, and painters. Other groups that may be at risk are people who have spina bifida, those who have had multiple surgeries and those who are atopic (genetically predisposed to allergy).5

TYPES OF RESPONSES

The three main potential responses to the use of natural rubber latex gloves are: an irritant response (non-allergic), Type IV allergy (localized response) and Type I allergy (systemic response). Let's look at each response separately.

Irritant response, or irritant contact dermatitis, is the result of mechanical or thermal damage to the skin but is not an allergic reaction. This reaction is caused by skin irritation from using gloves and, possibly, by exposure to other workplace products and chemicals. The reaction can also result from repeated hand washing and drying, incomplete hand drying, or exposure to powders added to the gloves.6 Chronic exposure leads to dry, thickened, and cracked skin. Management of this problem may include identifying and eliminating the irritant, using proper hand hygiene, thoroughly drying hands and changing glove types.7

Type IV allergy, or allergic contact dermatitis, is T-cell mediated and is a localized response. This response is an allergic reaction to chemicals that are used in the glove manufacturing process. It is a true allergic response as it involves the immune system.8 Many individuals mistake this response for a latex allergy mainly because they have the reaction while wearing latex gloves. Some of the signs and symptoms of a Type IV reaction include but are not limited to erythema, pruritis, and edema. These symptoms can be delayed from 6 to 48 hours. It is important to understand this delay because if one wants to discontinue use of the problem glove they are currently wearing and try a new brand of glove, they should give themselves at least 48 hours without wearing gloves at all. This may allow their body to recuperate somewhat from the offending chemical before they try another brand of glove.9

Diagnosis for this allergy is usually a patch test using commercially available chemical reagents. Management for this allergy includes using a latex or non-latex glove without the offending chemical. be aware that synthetic products can contain the same chemicals as those in latex products. It is important to know exactly which glove component one is allergic to, rather than simply assuming that latex is the allergic component.10

Type I Allergy, or immediate hypersensitivity, is potentially the most serious response to latex products. Between 1989 and 1997, there have been over 2,300 allergic responses to latex products and 28 deaths resulting from latex protein-induced anaphylaxis reported to the US FDA.11 The reaction occurs when a latexallergic individual comes in direct contact with latex proteins. Reactions usually begin within minutes of exposure. Symptoms run from mild (skin redness, hives, itching) to more severe (cough, hoarse voice, chest tightness, runny nose, itchy or swollen eyes) to life threatening (bronchospasm and shock).12

Diagnosis of this allergy requires a careful recording of medical history followed by serologie testing (RAST) and/or skin prick testing. Management of this allergy means that the individual has to avoid contact with latex proteins at all cost. They should use non-latex products and, ideally, should work in a powder-free environment. Starch powder is responsible for aerosolization of the latex proteins that may cause an allergic reaction in sensitized individuals.13

POWDER ISSUES

When natural rubber latex gloves were first introduced over 100 years ago, they were sterilized by boiling and donned over wet hands. Later on, when dry sterilization was introduced, it was necessary to use a dusting powder agent to facilitate donning. The first agents used were lycopodium powder, talcum powder or a mixture of the two. Over time, these agents were found to cause peritoneal granulomas.14 Therefore an absorbable alternative was needed.