Elsevier

Methods

Volume 27, Issue 1, May 2002, Pages 15-21
Methods

Natural rubber latex allergy in the occupational setting

https://doi.org/10.1016/S1046-2023(02)00047-6Get rights and content

Abstract

Over the last decade, the prevalence of natural rubber latex (NRL) allergy has reached epidemic proportions among workers who use or who are exposed to powdered latex products. NRL-associated occupational asthma is confined largely to those exposed to powdered latex glove use or other latex aerosols. The most frequent presenting symptom of NRL allergy is contact urticaria; inhalation may cause symptoms of allergic rhinitis and asthma. Skin prick testing is the most accurate tool for diagnosis of NRL allergy. The cornerstone of management is cessation of exposure; substitution with non-NRL or nonpowdered NRL gloves results in predictable rapid disappearance of latex aeroallergen.

Introduction

Natural rubber latex (NRL), commonly referred to as “latex,” has been widely used in medical devices for more than a century owing to an attractive combination of properties: strength, flexibility, tear resistance, elasticity, and barrier qualities. Latex gloves were developed by the latter half of the 19th century due to the ease of manufacturing dipped latex products and the superior tactile qualities of the resultant product. The advent of “universal precautions” in the 1980s expanded the use of nonsterile (exam) NRL gloves—more than 20 billion pairs were sold in the United States alone in 1999 [1].

During most of the last century the only problem encountered with NRL glove use was the increased prevalence of contact dermatitis. This was due either to an allergic contact dermatitis sensitivity to a chemical additive used in NRL manufacture or to a nonspecific irritation associated with glove use rather than a hypersensitivity response to the NRL proteins. Hence, reports of anaphylactic reactions to NRL products, including some fatalities, that appeared little more than a decade ago were unanticipated. Three distinct groups at high risk were initially identified: children with spina bifida; patients who had undergone radiological examinations that used latex rubber barium enema retention balloons; and individuals using NRL gloves frequently at work, especially health care workers. Later it became apparent that the risk included other individuals who underwent frequent surgical procedures and those with other occupational exposures to NRL. Fortunately, many such nonoccupational reactions have been prevented by institution of prophylactic safety measures such as avoidance of NRL products from birth in children with spina bifida/congenital urological abnormalities and removal of NRL from radiological catheter tips.

Reports of allergic reactions in health care workers began appearing in the early 1990s and generated an ongoing discussion regarding the risk of occupational disease associated with chronic exposure to latex products [2]. What is the nature of the risk of sensitization to latex among health care workers and others who wear latex gloves? Is this sensitization clinically relevant? Do clinical symptoms of contact hives, rhinoconjunctivitis (“hay fever”), asthma, and anaphylaxis occur more frequently than in nonexposed individuals? Which latex products are responsible for causing symptoms? Most importantly, since the diagnosis of occupational allergy and asthma implies significant human, legal, and economic costs, how and at what cost can a safe workplace be established?

Many of the answers to these questions have become available through international efforts. Studies from several groups working independently demonstrate remarkably consistent findings concerning the occupational nature of this problem [3], [4], [5].

Section snippets

Risk factors for allergic sensitization

Atopic individuals are predisposed to sensitization and clinical allergy as compared with nonatopic individuals—a generalization as true for latex as for other allergens. Nonetheless, the chief risk factor for latex allergy is clearly related to exposure. Population prevalence studies that use skin prick testing, the most accurate assessment tool, report positive tests in 5–12% of NRL-exposed workers [6], [7], [8]. Nearly half of these sensitized health care workers report a history of allergic

Sources and routes of exposure

Most patients allergic to latex have significant exposure to rubber products made by a dipping method. While only a minority of latex products are made by this method, most allergic reactions to latex are associated with products of this type, such as latex medical gloves, condoms, bladder catheters, and tourniquets. The manufacture of these items uses a lower temperature and a shorter duration of heat vulcanization when compared with latex products made from coagulated or dry rubber. This

Presentations and diagnosis of latex allergy

The diagnosis of contact dermatitis should be considered for patients who describe skin rashes that persist beyond several hours or that are chronic. In our experience, most of these patients have a nonspecific irritant dermatitis. However, cases of allergic contact sensitivity to rubber accelerators, such as thiuram, are not infrequent, and patch testing can provide a definitive diagnosis. Physicians should be aware that contact dermatitis and type I latex allergy are not mutually exclusive

Psychological aspects

In some patients, presumed or real latex allergy may pose psychological diagnostic challenges for the clinician. Consideration of an anxiety disorder should be included in the differential diagnosis for those patients who exhibit symptoms of pervasive or acute sensations of shortness of breadth, chest tightness, and difficulty breathing that do not appear to be satisfactorily explained by the severity of their latex-induced asthma. It is worth emphasizing that many of these patients do have

Management of NRL-allergic patients

The cornerstone of successful management of occupational latex allergy and asthma rests on the institution of cessation of exposure. Powdered latex gloves are the major and perhaps only significant source of workplace latex aeroallergen. Prior to the introduction of “standard precautions” for protection against communicable disease from blood and bodily fluids, protective devices such as gloves were used only in selected settings. The almost 10-fold increase in examination glove (not surgical

References (49)

  • B.L. Charous et al.

    J. Allergy Clin. Immunol.

    (1994)
  • S.M. Tarlo et al.

    J. Allergy Clin. Immunol.

    (1990)
  • G. Pisati et al.

    J. Allergy Clin. Immunol.

    (1998)
  • D. Hadjiliadis et al.

    J. Allergy Clin. Immunol.

    (1995)
  • S. Archambault et al.

    J. Allergy Clin. Immunol.

    (2001)
  • X. Baur et al.

    J. Allergy Clin. Immunol.

    (1998)
  • V.J. Tomazic et al.

    J. Allergy Clin. Immunol.

    (1994)
  • D.K. Heilman et al.

    J. Allergy Clin. Immunol.

    (1996)
  • S.M. Tarlo et al.

    J. Allergy Clin. Immunol.

    (1994)
  • B.L. Charous et al.

    Ann. Allergy Asthma Immunol.

    (2000)
  • S. Tarlo et al.

    J. Allergy Clin. Immunol.

    (2001)
  • D. Ebo et al.

    J. Allergy Clin. Immunol.

    (1997)
  • D. Hadjiliadis et al.

    J. Allergy Clin. Immunol.

    (1996)
  • K.J. Kelly et al.

    J. Allergy Clin. Immunol.

    (1993)
  • R. Hamilton et al.

    J. Allergy Clin. Immunol.

    (1999)
  • H. Yeang

    Ann. Allergy Asthma Immunol.

    (2000)
  • O. Vandenplas et al.

    J. Allergy Clin. Immunol.

    (2001)
  • R. Carr

    J. Psychosomat. Res.

    (1998)
  • G. Davey

    Adv. Behav. Res. Ther.

    (1992)
  • M. Primeau et al.

    J. Allergy Clin. Immunol.

    (2000)
  • B.L. Charous et al.

    J. Allergy Clin. Immunol.

    (2002)
  • US Food and Drug Administration (US FDA) Fed. Regist. 64 (1994)...
  • O. Vandenplas et al.

    Latex Allergy

  • Cited by (0)

    View full text