Latex allergy

Latex*
Latex Allergy–
For many allergic workers the common
Allergy in
Symptoms and Causes
denominator is, “I have been using
latex gloves for years, why is this a
Since 1987, when the Centers for
Health Care
problem now?” The number of expo-
Disease Control and Prevention
sures necessary for sensitization varies
(CDC) recommended universal pre-
depending on the individual. A health
Fact Sheet
cautions, the increased use of natural
care worker can use latex gloves for
*natural rubber latex
rubber latex gloves in health care set-
many years before developing a latex
tings has been associated with an
allergy.
increase in reported natural rubber
Prepared cooperatively by the
Massachusetts Nurses Association
latex allergies among both patients and
For most sensitized people, the symp-
and HCWH.
workers. Prevalence studies indicate
toms of skin rashes, runny nose, and
that 6-17% of the exposed health care
itchy eyes persist for a very long time.
workforce has become allergic to
For others, the rashes and runny nose
latex.1 Symptoms range from irritating
quickly become breathing problems
to life-threatening.
such as asthma, airway obstruction, and
extreme spasms in the throat (laryn-
Ten years later, in June 1997, the
gospasm). For still others, the first
National Institute for Occupational
symptom may be life-threatening shock
Safety and Health (NIOSH) published
(anaphylaxis). No immunotherapy or
an Alert – “Preventing Allergic
desensitization exists for latex allergy.
Reactions to Natural Rubber Latex in
Each systemic reaction comes with less
the Workplace” — which, among other
provocation; each reaction is worse.
recommendations, called for education
For a summary of the reactions associ-
to inform workers of the symptoms of
ated with latex gloves, see Table 1.
latex allergy. These symptoms include
dermatitis, urticaria, rhinitis, nasal, eye
Patients with spina bifida, and patients
or sinus symptoms, asthma, and ana-
with congenital genitourinary abnor-
phylaxis.2 Deaths have been reported
malities who are heavily exposed to
as well.3 Latex is recognized by
natural rubber latex through surgical
NIOSH as a hazard to the health of
procedures and contact with latex
exposed workers.
catheters show sensitization rates as
high as 18-73%.4, 5 Patients who have
Latex allergy has become an increas-
undergone as few as three surgical pro-
ingly serious threat to health care
cedures may be at a higher risk of
.
workers (housekeepers, lab workers,
developing latex allergy.
dentists, nurses and physicians) who
et a
experience frequent or prolonged
Not only direct contact with latex, but
ow to g
exposure to natural rubber latex
also exposure to the airborne latex pro-
through inhalation and exposure to
teins carried on powder can sensitize
d out h
g.
mucous membrane or disrupted skin.
an individual and elicit an immune
Sensitization occurs through contact
response (allergic reaction). Therefore,
ollution Prevention in Health Care
oharm.or
.n
with latex proteins. Powder on gloves
or P
e kit, or to fin
only avoidance of exposure to latex
is a vehicle for sensitization. Powder
material and aeroallergens will prevent
ed in th
d
increases the probability of sensitiza-
eb at www
latex allergy from developing in work-
clu
e W
tion as it allows direct contact of
ers and patients.6
s in
on
aerosolized latex proteins with
cati
arm on th
mucous membranes of the eyes and
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Table 1. Types of reactions associated with latex gloves
Cause of Reaction
Terms Used or Description
Signs and Symptoms
Cause(s)
Irritant contact
Irritation
Dry, crusty, hard bumps, sores,
Direct skin irritation by
CT SHEET
dermatitis
(non-allergic irritation)
and horizontal cracks on skin may
gloves, powder, soap/deter-
A
manifest as itchy dermatitis on
gent, scrubs, and/or incom-
the back of hands under the
plete hand rinsing and dry-
gloves
ing
Allergic contact
Type IV delayed
Red, raised, palpable area with
Exposure to chemicals used
dermatitis
hypersensitivity
bumps, sores, and horizontal
in latex manufacturing,
cracks may extend up the forearm.
including accelerators, bio-
TH CARE F
Allergy contact sensitivity
Occurs after a sensitization peri-
cides, antioxidants (e.g.,
od. Appears several hours after
thiurams, carbamates, and
glove contact and may persist
benziothiazoles)
many days.
Allergy to latex
Type I hypersensitivity
Wheal and flare response or itchy
Exposure to proteins in
proteins
redness on the skin under the
latex on glove surface
IgE/histamine mediated
glove. Occurs within minutes,
and/or bound to powder
reaction
fades away rapidly after removing
and suspended in the air,
the glove. In chronic form may
settled on objects, or trans-
mimic irritant and allergic contact
ferred by touch.
dermatitis. Symptoms can include
facial swelling, rhinitis, eye symp-
toms, generalized urticaria, respi-
ratory distress, and asthma. In
rare cases, anaphylactic shock may
occur.
TEX ALLERGY IN HEAL
Source: American Nurses Association. Latex Allergy: Protect Yourself, Protect Your Patients (brochure). Washington, D.C. ANA, 1996.
LA
Worker Protection
3. Identify products that contain
?
submit written reports (retain-
latex, including surgical gloves and
ing copies) of their symptoms to
According the Occupational Safety
other medical devices:
their supervisors and the occu-
and Health Law of 1970, employers
pational health department
have a responsibility to provide a
?
locate non-latex alternatives
(when available); and
workplace free from recognized haz-
and
ards that are causing or are likely to
?
plan, evaluate and implement
?
report adverse health effects
cause death or serious physical harm
the use of non-latex alterna-
resulting from the use of latex
to employees.
tives.
gloves and other latex medical
devices to the FDA MedWatch
4. Provide education for nurses and
Program: tel: 1-800-FDA-1088
other health care workers to ensure
Recommendations
or fax: 1-800-FDA-0178.
an understanding of latex allergy,
for a Latex Safe
including:
5. Provide education for nurses and
physicians to:
Work Environment7
?
routes of exposure, sensitization
?
recognize signs and symptoms
1. Use non-latex — and non-chlorine
and reactions;
of latex allergy in patients;
(non-vinyl and non-neoprene)
?
procedures for reporting acute
?
containing8 — examination gloves
and chronic occupational ill-
safely care for latex allergic
in all health care settings.
ness;
patients; and
?
2. Use latex-free equipment in resus-
?
protocols for treatment and
learn treatment protocols for
citation and invasive procedures.
accommodation of sensitized
patients with acute allergic
workers;
reactions to latex.
2

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LA
6. Identify health care providers with
expertise in treating latex allergy to
Table 2. Non-latex and non-chlorine (non-vinyl and
TEX ALLERGY IN HEAL
provide care for latex allergic nurs-
non-neoprene) containing gloves
es, other health care workers, and
patients.
Manufacturer
Glove
7. In some states it is the law to
report cases of latex-induced occu-
Ansell-Perry
Nitra-Tex™ nitrile exam glove
pational asthma to the Department
800-321-9752
Nitra-Touch® nitrile exam glove
of Public Health, as in
www.ansellhealthcare.com
Elite™ polyurethane surgical glove
Massachusetts, where all cases
must be reported to the
Best Manufacturing Co.
N-DEX® and Nitra-Care® gloves
Department of Public Health,
800-241-0323
Occupational Health Surveillance
www.bestglove.com
Program (tel: 617-624-5637).
ECI Medical Technologies,Canada
Elastyren® family of synthetic copoly-
902-543-6665
mer medical gloves
www.ecimedical.com
Non-latex Gloves with
Barrier Protection Equal
TH CARE F
Maxxim Medical
SensiCare™ Nitrile exam glove
800-727-7951
SensiCare™ NXP exam glove
to or Better Than Latex
www.maxximedical.com
SensiCare™ polyurethane exam glove
A variety of non-latex gloves made of
SensiCare™ polyisoprene surgical glove
alternative materials, with barrier pro-
tection equal to or better than latex
Safeskin Corporation
Safeskin Blue Nitrile
gloves, are available (see Table 2).
800-462-9993
Safeskin Purple Nitrile™
The protective characteristics of each
www.safeskin.com
material must be taken into considera-
A
tion in relationship to the purpose for
SmartCare Inc.
Nitra PF™
CT SHEET
which the glove will be used.
800-822-8956
Information on how to select medical
www.smartcare.com
gloves and a list of non-latex glove
Tillotson Healthcare Corporation
Dual Advantage
alternatives are available from the
800-445-6830
Pure Advantage
Sustainable Hospitals Project (SHP) at
www.thcnet.com
the University of Massachusetts
Lowell. This information can be found
Source: Sustainable Hospitals Project Clearinghouse, www.sustainablehospitals.org
online at www.sustainablehospitals.org
or contact the SHP directly at 978-
If you or anyone has the signs and
Health care practitioners and employ-
934-3386 or shp@uml.edu.
symptoms of latex allergy:
ers will not be able to prevent them-
selves, their employees, and patients
In summary, health care practitioners
?
report the signs and symptoms to
from sensitization and potentially life-
and their employers must protect
supervisors, managers, and occupa-
threatening latex reactions unless latex
themselves and others against latex
tional health providers immediately;
is removed from the workplace.
sensitization and allergy. Important
?
inform all your healthcare
Increasing attention to latex allergy
steps include:
providers — physicians, dentists,
education and latex-safe protocols for
?
Use non-latex and non-vinyl gloves
nurses — that you have latex aller-
patient care is essential for a safe envi-
that offer barrier protection equal
gy and that you must avoid expo-
ronment for workers and patients alike.
to or better than natural rubber
sure to all latex products including
latex.
latex gloves; and
?
Learn to recognize the signs and
?
wear a medical alert bracelet.
symptoms of latex allergy in your-
self, co-workers and patients.
Only with increased awareness, educa-
tion, reporting, and support will health
care practitioners be enabled to protect
themselves, their co-workers, and their
patients from sensitization and poten-
tially life-threatening reactions to latex.
3

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References
1 & 2. US Department of Health and Human
Services. Public Health Service. Centers for
Disease Control and Prevention. NIOSH
Alert. Preventing allergic reaction to natural
rubber latex in the workplace. June, 1997;
NIOSH publication, pp 97-135.
3.
US Department of Labor. Occupational
Safety and Health Administration.
Technical Information Bulletin: Potential for
Allergy to Natural Rubber Latex Gloves and
Other Natural Rubber Products.
Washington, DC: OSHA, April 12, 1999.
4.
Meeropol, E., Kelleher R., Bell Sl, & Leger
R., 1990. Allergic reactions to rubber in
patients with myelodysplasia. New England
Journal of Medicine, 1990: 323:2072.
5.
Kelly, K., Pearson, M., & Kurup, V. A clus-
ter of anaphylactic reactions in children
with spina bifida during general anesthesia:
Epidemiologic features, risk factors, and
latex hypersensitivity.
6.
Poley, GE, Slater JE, Latex Allergy. J
Allergy Clin Immunol 2000:105(6):1054-
1062.
7.
Source of recommendations: Massachusetts
Nurses Association, Latex Allergy Position
Statement, (1997).
8.
Polyvinyl chloride (also known as PVC or
“vinyl”) and polychloroprene (“neoprene”)
are the chlorine-containing materials used
to manufacture examination gloves.
Chlorinated materials are of concern
because they can contribute to dioxin emis-
sions from incinerators.
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