A review of current literature on epidemiology of immediate glove irritation and latex allergy.

Natural rubber latex (NRL) allergy has attained world-wide importance with the diagnosis of glove hypersensitivity, contact urticaria, rhinitis, conjunctivitis, asthma and anaphylaxis. In the present report, the latest literature of the epidemiology of NRL allergy is reviewed, an account on the incidence of NRL allergy (19 new cases of contact urticaria/100,000 workers per year) among health care workers is given and the prevention of NRL allergy is discussed. Among health care workers, NRL allergy has gained prominence particularly with the spread of AIDS and an increase in the use of rubber gloves for barrier protection. For screening NRL allergy, a simple and quick test based on a self-administered questionnaire has been presented, but it needs further evaluation before routine use can commence. Further analytic studies will show if the use of low allergen gloves reduces the incidence of NRL allergy.     

Glove-related rhinopathy among hospital personnel

Hypersensitivity to natural rubber latex (NRL) in health care personnel exposed to powdered latex gloves appears as conjunctivitis, rhinitis, nasal congestion, cough, dyspnea, or bronchial asthma in approximately 30% of all cases with latex allergy while most of the patients have contact urticaria. The purpose of the present study was to determine the prevalence of latex-induced allergic rhinitis in health care workers using NRL gloves on a daily basis. Clinical examination accompanied by skin prick test (SPT) with latex glove extracts and common aeroallergens, measurements of specific IgE to NRL, and lung function tests were performed in 25 symptomatic workers and 11 latex-exposed asymptomatic controls. Sensitization to NRL was detected using SPT in one (4%) of 25 symptomatic workers but not in any of the asymptomatic controls. Positive SPT to aeroallergens was demonstrated in 8/25 symptomatic workers and 6/11 controls. Measurements of forced vital capacity, forced expiratory volume in 1 sec, and bronchial methacholine challenge did not show any significant differences between the study groups. In conclusion, NRL-aeroallergen-induced occupational rhinitis may occur among physicians and nurses who have a frequent use of latex gloves on a daily basis at hospital work. However, a relatively low prevalence of NRL-induced occupational rhinitis is associated with profuse consumption of no-powder sterile gloves. © 1996 Wiley-Liss, Inc.     

Latex allergy symptoms among health care workers: results from a university health and safety surveillance system

We sought to describe risk factors for latex glove allergy symptoms among health care workers by combining data from an active clinical surveillance program and a comprehensive occupational health surveillance system. A total of 4,584 employers completed a latex allergy questionnaire. Six percent (n = 276) of subjects reported symptoms consistent with latex allergy. Years of latex glove use was a significant risk factor for latex allergy symptoms even after controlling for the effects of atopy, gender, age, race, fruit, and other allergies. Nurses, medical or lab technicians, physician's assistants, other clinical professionals, and housekeepers had the highest prevalence of latex glove allergy symptoms. Forty subjects (0.87%) who were confirmed as having latex sensitization. Sensitizsation may have been underestimated due to use of specific IgE antibody, less sensitive than skin-prick testing, and tiered design leading to laboratory assessment on a subset of the cohort. This surveillance program identified risk factors for latex allergy symptoms. Our findings provide a basis for tailoring future prevention strategies.     

The German experience 10 years after the latex allergy epidemic: need for further preventive measures in healthcare employees with latex allergy

Objectives

Powdered latex gloves or latex gloves with high allergen content are forbidden in Germany since 1998. It was the aim of this study to test the hypothesis that nationwide preventive measures enable health care workers with latex allergy to work without health risks about 10 years afterwards.

Methods

Ninety-one health care workers who had been reported to the accident insurance between 1996 and 2004 for occupational latex allergy were examined in 2007. The survey included a questionnaire, a physical examination, spirometry, methacholine testing, skin prick testing and serum IgE measurements to latex and environmental allergens.

Results

Recent work-related possibly allergic symptoms were reported by 32 subjects (35%), among them 18 subjects (20%) with symptoms of the eyes, nose or airways. Current sensitization to latex was detected in 61 subjects (67%), and 60 subjects (66%) were atopic. Eleven subjects (12%) showed mild airway obstruction, and 27 subjects (30%) were considered hyperresponsive to methacholine. Whereas overall recent symptoms of the eyes, nose or airways were associated with current latex sensitization (OR 4.5; 95% CI 1.3–16.2), this was not the case for objective outcome parameters (spirometry, bronchial hyperresponsiveness).

Conclusions

Although most subjects had only mild disease, ongoing work-related symptoms of the eyes, nose or airways in a substantial number of subjects with latex allergy suggest the need for further secondary preventive measures in German healthcare.     

Pseudo-latex allergy associated with "latex" paint exposure: a potential cause of iatrogenic disability

OBJECTIVE: We sought to describe outcomes for three health care workers with natural rubber latex (NRL) allergy reporting illness after exposure to latex paint. METHODS: We undertook a retrospective review of medical and occupational histories, diagnostic, treatment, and work recommendations. Outcomes included lost time, workers compensation indemnity costs, and return to work. RESULTS: None of the paints contained NRL. Cases 1 and 2 initially were misdiagnosed as suffering allergic reactions to NRL, resulting in 7 and 23 months lost time, $15,790 and $139,000 indemnity costs, respectively, and both failing to return to work. Case 3 was correctly diagnosed as not exposed to NRL, with only several lost days, no indemnity costs, and continued to work. CONCLUSIONS: The failure to recognize that synthetic paints do not contain NRL can lead to misdiagnosis, inappropriate exposure, and work avoidance recommendations and iatrogenic disability.     

Latex Allergy Symptoms among Health Care Workers: Results from a University Health and Safety Surveillance System

Abstract

We sought to describe risk factors for latex glove allergy symptoms among health care workers by combining data from an active clinical surveillance program and a comprehensive occupational health surveillance system. A total of 4,584 employers completed a latex allergy questionnaire. Six percent (n = 276) of subjects reported symptoms consistent with latex allergy. Years of latex glove use was a significant risk factor for latex allergy symptoms even after controlling for the effects of atopy, gender, age, race, fruit, and other allergies. Nurses, medical or lab technicians, physician's assistants, other clinical professionals, and housekeepers had the highest prevalence of latex glove allergy symptoms. Forty subjects (0.87%) who were confirmed as having latex sensitization. Sensitizsation may have been underestimated due to use of specific IgE antibody, less sensitive than skin-prick testing, and tiered design leading to laboratory assessment on a subset of the cohort. This surveillance program identified risk factors for latex allergy symptoms. Our findings provide a basis for tailoring future prevention strategies.     

Occupational allergy in health personnel

BACKGROUND: Health care workers are exposed to many agents that can cause irritant or allergic contact dermatitis. In nurses with eczema of the hands latex sensitivity can play an important role in the occurrence of urticaria, rhinitis and asthma. OBJECTIVES: To determine the prevalence of irritant and allergic contact dermatitis and contact urticaria and the role of skin sensitization to common and occupational haptens and allergens in a group of health care workers with skin problems. METHODS: Retrospective review of 204 health care workers assessed by prick and patch testing in an occupational health clinic. RESULTS: The diagnoses included 35.3% with irritant contact dermatitis, 64.7% with allergic contact dermatitis and 7.3% with contact urticaria to latex. Three workers complained of asthma and 5 complained of rhinitis related to latex sensitization. At present 12.9% of atopic subjects were sensitized to latex by skin prick against 21.9% in 1998, so sensitization showed a decline in the years considered. CONCLUSIONS: Contact dermatitis and sensitization to natural rubber latex is a significant problem and nurses should be tested for both types of hypersensitivity, as well as being patch tested to standard, rubber and disinfectants series. The need is stressed for preventive measures to prevent the onset of contact dermatitis and to avoid latex exposure.     

Quality of life in patients with latex allergy

BACKGROUND: Exposure to natural rubber latex (NRL) may lead to a variety of allergic clinical manifestations that may affect the quality of life (QOL). AIM: To assess QOL of patients with different clinical effects of NRL allergy including rhino-conjunctivitis, asthma, anaphylaxis and skin manifestations. METHOD: A questionnaire to assess QOL was mailed to 56 patients who had been assessed and managed for various clinical manifestations of latex allergy at a university affiliated hospital in Toronto, Canada. RESULTS: Thirty-one questionnaires were completed and returned. Thirty of the respondents were health care workers. Forty-one percent of the respondents had changed their jobs to reduce exposure to latex and 13% had stopped working. However the respondents did not report a great effect on the QOL related to latex allergy. CONCLUSION: The results of this study indicate that the various clinical manifestations of latex allergy can be managed so that there is no significant interference with QOL.     

Longitudinal study of sensitization to natural rubber latex among dental school students using powder-free gloves

BACKGROUND: A high rate of sensitization and clinical allergy to latex proteins has been reported in health care personnel. This is thought to be due to increased occupational exposure especially to natural rubber latex (NRL) gloves with an estimated prevalence varying widely (2.8-18%). OBJECTIVE: This was a longitudinal study to monitor a cohort of first-year dental students throughout 4 study years during exposure to powder-free gloves. Their atopic status was determined by skin prick testing using a panel of common allergens, and any sensitivity to latex proteins and the cross-reacting food allergens assessed. METHODS: Skin prick testing was carried out on the volunteers using latex, avocado, kiwi, banana, grass pollens, tree pollen, house dust mite and cat dander. Each volunteer completed a questionnaire detailing allergic history and any previous latex exposure. RESULTS: Skin prick testing showed a 65% incidence of atopy in the longitudinal study group. Initial latex skin testing was positive in 3 of the 63 students followed throughout their period of study. Subsequent testing gave a negative result in one student and one declined retesting. The third continued to give a positive response on each testing; she wore only nitrile gloves and remained free of clinical NRL allergy symptoms. No student developed latex sensitivity during the 5 yr of this study. CONCLUSION: Exposure to powder-free latex gloves was not associated with subsequent sensitization over 5 yr in a population with a high atopic incidence.     

Couriers of asthma: antigenic proteins in natural rubber latex

Natural rubber latex (NRL) is a milky, white liquid containing the polymer cis-1,4-polyisoprene, derived from the laticifer cells of the rubber tree, Hevea brasiliensis. Reports of allergic reactions to NRL, ranging in severity from skin rashes to anaphylaxis and death, have been increasing. High rates of latex allergy are seen in children with spina bifida. Healthcare workers, especially those who frequently use powdered latex medical gloves, can develop NRL allergy and asthma, often resulting in considerable disability. Atopy and, possibly, pre-existing dermatitis predispose to sensitization and allergic symptoms. NRL protein antigens are found in many NRL products and also have been shown to bind to cornstarch glove-donning powders. Of the approximately 240 polypeptides in NRL, nearly 60 are antigenic, and nine have been identified and registered (Hev b 1&ndash9). Many natural latex antigens share epitopes with structural proteins and enzymes from other plant species. Current knowledge indicates that proposed reductions in total glove protein and limitations on the use of powder on NRL gloves are likely to result in a decline in the prevalence and severity of NRL allergies among healthcare workers.     

Latex allergy in health care workers: frequency, exposure quantification, efficacy of criteria used for job fitness assessment

BACKGROUND: The main purpose of this study was to evaluate the latex allergy prevalence in a large population of health care workers, to quantify latex exposure deriving from use of gloves and to verify the efficacy of job fitness evaluations in allergic workers. METHODS: In the period 2001-2002, latex allergy prevalence was evaluated in 1962 health care workers by means of a self-administered questionnaire, clinical evaluation and specific allergological tests. Also, the total protein content (by means of Lowry method modified EN455-3: 1996) and the antigenic latex proteins (by means of RAST inhibition) in 4 different types of gloves were measured. Job fitness assessments for latex allergic workers were made in accordance with the criteria established by the Italian Association of Preventive Medicine for Health Care Workers criteria. The efficacy was verified one year later. RESULTS: 1557 questionnaires out of 1962 (79.35%) were completed; 504 (32.4%) reported work-related symptoms, in particular 283 subjects had probable irritant contact dermatitis, 66 allergic contact dermatitis and 118 reported irregular non-specific symptoms related to the use of both vinyl and latex gloves; 20 subjects out of the remaining 37 had a latex allergy (1.3% out of the 1557 workers responding to the questionnaire), 8 subjects had only urticaria while 12 subjects had urticaria associated with respiratory symptoms and/or angioedema. The measurement of total protein and antigenic protein content showed the highest levels in powdered latex examination gloves, the lowest levels in surgical powder-free latex gloves. Low concentrations of antigenic proteins were also found in nitrile gloves. Job fitness evaluations were efficacious in 11 out of 20 workers, and inefficacious in 3 cases (6 workers had resigned). CONCLUSIONS: This study revealed a very low prevalence of latex allergy probably due to the fact that we examined an unselected population, and only symptomatic subjects were considered; moreover, in our hospital, vinyl examination gloves had been prevalently used during the last ten years. The criteria followed for job fitness assessment seem to be efficacious on the whole. In spite of a low prevalence of latex allergy, we found a high frequency of irritant contact dermatitis in the examined workers, mainly due to the lubricant powder in both synthetic and natural rubber gloves. Most workers made a complete recovery when they started using powder-free gloves. The high biocompatibility of powder-free gloves was confirmed by the measurement of total protein and latex antigenic protein content in the gloves used in the hospital. Moreover, it should be noted that latex antigenic proteins were also demonstrated in nitrile gloves, this is a relevant information since nitrile gloves are often used as an alternative in latex allergic workers.     

Usefulness of a questionnaire and RAST in screening of health care workers allergic to latex

BACKGROUND: The prevalence of latex mediated IgE allergy in health care workers varies, according to the various studies, from 0.5% to 16. 7%. The onset of latex allergy involves aspects concerning the worker's health, the need for job transfer and possible retraining. In any case, the use of latex gloves in health care environments cannot be discarded, since they offer more efficacious protection from biological agents, compared to gloves of different materials. OBJECTIVES: Our objectives were to verify the prevalence of latex allergy in a sample of 515 health care workers and evaluate the usefulness of RAST and a questionnaire especially organized to identify potentially allergic subjects, at the same time limiting the number of false positive and false negative results. METHODS: 515 health care workers of the ASUR Zone7-Ancona local health unit accepted to answer to a questionnaire and to undergo a RAST testfor latex. Those with positive responses to the questionnaire or to RAST were later invited to undergo further allergological tests (prick and prick by prick). The questionnaire was revised according to the results obtained, thus increasing its positive predictiveness. RESULTS: Prevalence of latex allergy in our sample was 1, 7%, positive predictiveness of RAST was rather low (31.3%), but increased considerably if combined with the modified questionnaire (62.5%). The Prick by Prick test gave more specific results than the Prick test. CONCLUSIONS: The proposed questionnaire can reduce the number of false positive workers needing to undergo further allergological tests and may be usefully applied in the screening of latex mediated IgE allergy in health care workers.     

Latex allergy in health care workers in Taiwan: prevalence,clinical features

Background Latex allergy is becoming a major health concern among healthcare workers, of whom approximately 2.8 to 18% are reportedly sensitized. Objective The purpose of this study was to analyze the results of a natural rubber latex (NRL) allergy screening program to identify sensitized hospital employees. Methods Nurses (n = 130) assigned to operating theaters and intensive care units were evaluated using a written questionnaire for symptoms of atopy (asthma, rhinoconjunctivitis, and atopic eczyma), possible reactions to latex gloves, other medical devices and previous surgery. Serological testing for total immunoglobulin E (IgE), latex-specific IgE, and specific-IgE to melon, banana, kiwi, tomato, and chestnut were performed using Pharmacia CAP radioallergosorbent tests. Skin pick test (SPT) for latex allergen was also performed. Results Elevated serum total IgE was found in 22(16.9%) of the 130 nurses, 3(16.7%) of whom had increased latex-specific IgE further confirmed by SPT. The overall prevalence of latex allergy was 2.3% (3/130). No cross reactive fruit-allergy was found among the latex-sensitized nurses. Conclusion This study supports the existence of other forms of atopy are related to an increased risk of latex sensitization. The NRL screening program used in this study is feasible for use in identifying latex-sensitized employees     

Fragrance as an occupational allergen

Sensitization to fragrance is believed to occur mainly outside the workplace. This study addresses the frequency of fragrance allergy in patch test patients of differing occupations during a 15 year period. The occupation most strongly associated with fragrance allergy in both sexes was health care work (positive tests in 11.7% of males and 10.4% of females). Retired individuals also had high rates of fragrance allergy (11.6% of males and 14.5% of females), and the prevalence of sensitization increased with advancing age. Health care workers and metal workers had statistically significantly higher rates of allergy to eugenol than did workers in other occupations. Food handlers had significantly higher rates of allergy to cinnamal and cinnamic alcohol. These findings suggest that sensitization to fragrance occurs more frequently in an occupational setting than is generally understood and could have implications for preventive measures.     

Test-retest reliability of the Work Ability Index questionnaire

The goal of the study was to assess the test-retest reliability of the Work Ability Index (WAI) questionnaire. Reliability was tested using a test-retest design with a 4 week interval between measurements. Valid data were collected among 97 elderly construction workers aged 40 years and older. We analysed the test-retest reliability of the WAI score itself (range 7-49 points) and classification in one of the four WAI categories based on this score: poor (7-27 points); moderate (28-36 points); good (37-43 points); and excellent work ability (44-49 points). Exactly the same WAI score on both measurements was reported by 25% of the subjects and 95% of the individual differences between measurements were found to be <6.86 points (two times standard deviation). Despite the individual changes between measurements, no significant difference was reported in the mean WAI score at group level between test and retest measurements (40.4 versus 39.9). The percentage of observed agreement for the classification of subjects in one of the four WAI categories on both measurements equalled 66%. The results of this study provided evidence of an acceptable test-retest reliability of the classification of subject's work ability by means of the WAI questionnaire. At group level, the mean WAI score and classification into WAI categories were found to be a stable measure over a 4 week interval. These results give additional support for the applicability of the questionnaire in occupational health research and the daily practice of occupational health care.     

Latex allergy in Polish nurses

BACKGROUND: Reports on the studies conducted in Western Europe and North America revealed that from 2.8 to 16.9% of the health care personnel were allergic to latex. No respective data are available from Eastern European countries. METHODS: A postal questionnaire inquiring about the history of latex-induced allergic reactions was distributed among 3,750 nurses. The participation rate was 77.3%. To verify the results of the survey, in randomly selected nurses, skin prick tests with latex and tropical fruit allergens, evaluation of total IgE, and specific anti-latex IgE, skin and nasal provocation with latex were performed. RESULTS: Allergic symptoms in the workplace were reported by 1,016 subjects (35%); out of this group 847 (29.2%) persons associated the symptoms with latex exposure. The group of cases with self-reported latex allergy revealed a significantly increased frequency of history of atopy, allergy to beta-lactam antibiotics and tropical fruits. Allergy to latex was confirmed in 33.3% of randomly selected nurses with a positive history of occupational allergy. It was found that 18.6% of nurses working at hospital wards were allergic to latex. The 95% CI was estimated to be 13.5-23.6%. CONCLUSIONS: Latex allergy is an important health problem among nurses in Poland. Atopy, allergy to beta-lactam antibiotics and tropical fruits, are the risk factors for latex allergy.     

Work ability of workers in western China: reference data

BACKGROUND: The Work Ability Index (WAI) is a validated and widely used research tool. Reference data for Chinese workers by age, gender and work content are poorly documented or lacking. OBJECTIVE: To provide reference data for work ability among workers in western China. METHODS: A random sample of 10 218 workers (including manual, professional, clerical and semi-skilled workers) in western China, aged 16-69 years, was taken from several studies and the WAI questionnaire was administered. RESULTS: All the WAI scores were distributed continuously and nearly normally. The WAI for female workers was significantly higher than for males (P < 0.01) and the 'poor' WAI category only accounted for 3% of females, against 6% of males. WAI scores declined with age and changed variably among workers according to work content and age. Mean WAI scores of manual workers declined rapidly beyond the age of 35 years, and beyond age 45 years for professional and clerical workers. WAI scores were distributed differently according to work content and age group (P < 0.01). WAI categories differed by work content and age group both for male and female workers. CONCLUSION: WAI is validated in Chinese occupational practices. Some reference data are different from Finnish data. This study provides gender, age and work-content-specific WAI reference values that will help enable comparison and intervention evaluation in further studies.     

Latex allergy and occupational asthma in health care workers: adverse outcomes

The prevalence of natural rubber latex (NRL) allergy has been estimated to be 5-18% in health care workers, and latex exposure has been one of the leading causes of occupational asthma in the last several years. We present the cases of two nurses who developed sensitivity to NRL, both with dermatologic symptoms and respiratory symptoms that included asthma. They were referred to the University of Maryland for evaluation of their allergies, then for occupational and environmental consults. The patients' allergy to NRL was confirmed on the basis of clinical history, a positive skin test to latex, and the presence of latex-specific immunoglobulin E (IgE) serology by radioallergosorbent test (RAST). Both patients worked in the same community hospital for approximately 20 years; one was an endoscopy nurse and the other worked in the emergency department. Following the diagnosis of allergy to latex, both patients avoided direct skin contact with latex, but they continued to work in the same respective environments, where powdered latex gloves and other potentially sensitizing chemicals were used. Instead of improving, the clinical condition of the patients worsened and they remained symptomatic, even after they were removed from their workplace. Their airways reacted to low levels of a variety of sensitizers and irritants in the environment, and they became depressed. Both nurses were referred for vocational rehabilitation.     

职业紧张对化工工人工作能力的影响

目的　为了解化工工人的职业紧张水平及工作能力状况 ,探讨影响工作能力的相关性因素。方法　应用工作能力指数问卷 (WAI)和职业紧张问卷 (OSQ) ,对某市化工行业10 30名工人 (研究组 4 81名 ,对照组 5 49名 )进行调查和工作能力降低的危险度评价。结果　研究组的WAI和OSQ评分与对照组均有显著性差异 (P <0 0 1)。两组的工作能力与职业紧张均存在显著的负相关关系 (P <0 0 1) ,研究组的相关程度明显高于对照组 ,且工作能力随着紧张程度的增高而降低。研究组工人随年龄的增长工作能力逐渐降低。以工作能力降低为结局变量 ,经多元logistic回归分析显示 ,在研究组中引起工作能力降低的主要紧张危险因素是肌肉骨骼疼痛 (OR =2 884 )、健康状况估计 (OR =2 6 5 1)、疾病的影响 (OR =2 4 98)、情绪情况 (OR =2 4 0 7)、缺乏体育锻炼 (OR =1 95 6 )、体力负荷 (OR =1 2 5 4)等 ,这些紧张因子都与工作能力降低有密切关系。结论　化工工人的职业紧张水平及不同紧张因素对工作能力降低有一定的影响 ,为工人的健康监测和提高工作能力水平提供了有益的帮助。     

Low prevalence of clinical latex allergy in UK health care workers: a cross-sectional study.

The prevalence of natural rubber latex allergy amongst health care workers has been reported to vary between 1 and 40%. This is because different diagnostic criteria have been used on heterogeneous groups of subjects. We have undertaken a cross-sectional study of all 5600 employees in two National Health Service trusts served by one department of occupational health and one department of clinical immunology. The period prevalence (1999-2000) for Type I clinical latex allergy in the clinical health care workers was found to be 17/3500 (0.5%). Difficulties in diagnosis and factors which may have contributed to this low prevalence rate are discussed. No cases were forced to leave health care work as a consequence of their allergy.