Dental surgeons with natural rubber latex allergy: a report of 20 cases.

Latex allergy is becoming a major occupational health issue and dental surgeons are at risk from becoming sensitized to natural rubber latex. A study was conducted to investigate risk factors and glove-related symptoms reported by dentists with natural rubber latex allergy. Twenty dentists, who had undergone serological or dermatological testing for a Type I allergy to latex, were identified from a questionnaire survey. Risk factors investigated were: gender, years in clinical practice, exposure to latex gloves, atopic history and food allergy. The majority of dentists (75%) gave an atopic history. Glove-related adverse reactions ranged from cutaneous to systemic manifestations. All twenty dentists reported itching of the hands in response to latex gloves. One respondent was unable to continue in dental practice because of her glove-related allergies; nineteen dentists were able to continue by using synthetic, non-latex gloves.     

Glove powder in the hospital environment – consequences for healthcare workers

OBJECTIVE: Exposure to starch powder from natural rubber latex medical gloves can cause allergy symptoms among healthcare employees and impair working conditions, due to the absorption of latex protein antigens onto the starch powder on the gloves. To evaluate and take care of this problem at Stockholm S?der Hospital we carried out this study. METHODS: A questionnaire was distributed to all employees working within the medical centre. The procedure was repeated after the centre had been changed to a powder-free working environment. The focus of the questions was to determine the extent of symptoms that could be associated with glove powder or latex proteins. RESULTS: Responses were compared before and 8 months after a new powder-free glove policy was fully implemented. The study pointed out that a relatively high percentage of the hospital workers were suffering from glove-related symptoms. A significant reduction of itching on the hands, hand eczema and upper respiratory-tract disorders was found after the change to a powder-free environment. CONCLUSION: It is not acceptable to use powdered medical gloves within health care. In spite of the risk of allergy and impairment of the working environment from powdered gloves, there is still only a minority of hospitals working according to a strict general powder-free policy. This study has pointed out that the reduced cost resulting from reduced absence through sickness further adds an argument for omitting glove powder and can justify the higher cost of using powder-free medical gloves.     

Latex allergy in a hospital environment: results of a study in Sousse (Tunisia)

Immediate allergy to natural latex has been on the icrease for the last decade in exposed persons and particularly the health personnel. Its prevalence is variable from one study to another. To evaluate the prevalence of later allergy in our nursing staff, we carried out an inguiry in two hospitals in Sousse. It's a prospective study involving 300 subjects and based on an anonymous questionnaire and a cutaneous prik test for latex allergy and atopy. The population was composed of 188 women an 112 men ith an average age of 35 years. There were 97 nurses of either sex, 65 doctors, 58 workers, 30 with technicians, 27 anesthetists, 17 midwives and 6 pharmacists. Sixty subjects (5.3%) showed a positive prick test ot latex: 11 women and 5 mon of different professional groups. The prevalence of atopy in this latex positive population (81%) was greater than in the latex negative population (25%). An associate alimentary allergy was identified in 10 patients allergic to latex. A study of specific immunoglobulins to latex carried out in 12 cases was positive in three patients. The provocation test for gloves was positive in 38% of cases.     

Work-related anaphylaxis to wasp sting

OBJECTIVE: To describe the frequency and epidemiological features of wasp venom allergy in the workplace. METHODS: Retrospective review of 98 adult patients (age 18-65) who suffered an anaphylactic reaction to a wasp sting. Patients were asked about reactions during working hours. Personal history of atopy and previous wasp stings as well as the season, month and type of locality (urban or rural) at the moment of the sting were recorded. Serum-specific IgE levels to venoms from Vespula, Polistes and Apis were measured. RESULTS: Eighteen patients (18%) suffered a reaction to wasp venom during working hours. The average age was 37.4 years, 89% were men and 94% had a personal history of atopy. All patients but one reported more than three previous stings, the last sting occurring at least 1 year previously in 61%. Previous systemic reactions had occurred in 17%. Gardening was the most frequently reported occupation (39%). Most reactions occurred during the summer season (61%) and took place in rural areas (56%). Serum-specific IgE was positive to Vespula in all patients, Polistes in 78%. In the 80 cases occurring outside of working hours, the mean age was 40.6, the male/female ratio was 35/45 and 23% of these patients were atopic. CONCLUSION: Most anaphylactic reactions were not work related. Gardeners were the most frequently involved workers. Workplace anaphylactic reactions showed higher prevalences of atopy (94%) compared to those outside working hours (22%).     

Practising evidence-based occupational health in individual workers: how to deal with a latex allergy problem in a health care setting

BACKGROUND: Natural rubber latex, mainly contained in disposable medical gloves, is an important cause of occupational allergy in health care workers. Management of latex allergy includes education, reduction of cutaneous or mucosal contact with rubber products and minimization of exposure to latex allergens in the work environment. METHODS: This paper reports a case study dealing with the latex allergy health problem of an operating theatre nurse. The examination was required because of a recent onset rhino-conjunctivitis crisis and asthma during usual working activities. The case was investigated and a solution provided according to the evidence-based medicine (EBM) paradigm using the PICO model. RESULTS: The literature search was conducted using Medline and the Cochrane Library. Twenty-one papers were considered to offer appropriate solutions. Two main types of interventions were suggested: (i) changing the work setting, (ii) limiting the work activities. The evidence obtained was discussed with the nurse, who was considered unfit to continue her work in the operating theatre where her colleagues used latex gloves. The resident proposed that she could relocate to a work environment where only non-latex gloves were used and latex medical devices were not present. CONCLUSION: The case study shows that, as for other clinicians, the occupational physician can use the EBM paradigm according to the PICO model as a tool for providing appropriate solutions for the individual worker.     

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     

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.     

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.     

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.     

Latex allergy: epidemiological study of 1351 hospital workers.

OBJECTIVE: To determine the prevalence of latex sensitisation among a large group of healthcare workers, study the occupational and non-occupational factors associated with latex allergy, and characterise latex exposure in air and by gloves. METHODS: All 2062 employees of a general hospital in Hamilton, Ontario, Canada who regularly used latex gloves were invited to participate in a cross sectional survey, representing the baseline phase of a prospective cohort morbidity study. Attempts were made to recruit employees who were diagnosed with latex allergy before the survey. Glove extracts were assayed for antigenic protein, and area and personal air samples were obtained on two occasions (summer and winter) to estimate exposure to airborne latex protein. A questionnaire on medical and occupational information was administered by an interviewer. Skin prick tests were performed with latex reagents, three common inhalants, and six foods. RESULTS: The mean (SD) latex protein concentrations were 324 (227) micrograms/g in powdered surgical gloves and 198 (104) micrograms/g in powdered examination gloves. Personal latex aeroallergen concentrations ranged from 5 to 616 ng/m3. There was a total of 1351 (66%) participants. The prevalence of positive latex skin tests was 12.1% (95% confidence interval (95% CI) 10.3% to 13.9%). This prevalence did not vary by sex, age, hospital, or smoking status but subjects who were latex positive were significantly more likely to be atopic (P < 0.01). Participants who were latex positive were also significantly more likely to have positive skin tests to one or more foods (Mantel-Haenszel odds ratio (OR) adjusted for atopy 12.1, 95% CI 7.6 to 19.6, P < 10(-9)). Work related symptoms were more often reported among latex positive people, and included hives (OR 6.3, 95% CI 3.2 to 12.5), eye symptoms (OR 1.9, 95% CI 1.2 to 2.8), and wheezy or whistling chest (OR 4.7, 95% CI 2.8 to 7.9). The prevalence of latex sensitivity was highest among laboratory workers (16.9%), and nurses and physicians (13.3%). When the glove consumption per healthcare worker for each department was grouped into tertiles, the prevalence of latex skin test positivity was greater in the higher tertiles of glove use for sterile (surgical) gloves (P < 0.005) but not for examination gloves. CONCLUSIONS: In this large, cross sectional study of healthcare workers, the prevalence of latex sensitisation was 12.1% (9.5% among all those eligible), and there were significant associations with atopy, positive skin tests to certain foods, work related symptoms, and departmental use of gloves per healthcare worker. This cohort is being followed up prospectively and will be retested to determine the incidence of development of latex sensitivity.     

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.     

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.     

Latex symptoms and sensitisation in health care workers

Background: Natural rubber latex has become an important occupational health concern, particularly among health care workers, who for protection are required to wear latex gloves when at work. This study evaluated the prevalence of latex-related symptoms and sensitisation among a large group of health care workers in Trieste hospitals. Methods: We evaluated the prevalence of latex-related symptoms in 1,165 health care workers, by means of a questionnaire, a medical examination, skin prick tests and IgE-specific evaluation. We determined atopy and latex sensitivity by skin prick tests using a battery of common inhalant allergens, a commercial latex extract (Lofarma Allergeni, Milan) and individual skin puncture tests for each of the vegetables immunologically related to latex (potato, tomato, chestnut, banana, kiwi fruit). Associations between potential risk factors for latex allergy were assessed. Results: Glove-related symptoms were noticed on 17.2% of the nurses (200) the majority of symptoms being mild dermatitis with itching and erythema (120 subjects, 11.1%). Symptoms suggestive of IgE-mediated latex allergy were found in 51 subjects: 35 (3%) complained of contact urticaria and 16 (2.2%) complained of asthma and/or rhinitis. The resulting symptoms were significantly related to skin prick tests that were positive to latex (odds ratio (OR)=11.89; 6.40–22.2), to personal atopy (OR=2.15; 1.47–3.12), to familiar atopy (OR=2.12; 1.48–3.03), to skin prick test positivity to related fruit (OR=2.01; 1.16–3.46) but not to prick test positivity to common inhalant allergens (OR=1.00; 0.71–1.39). Symptoms increased as a direct function of the time-usage of latex gloves and were more prevalent in operating room staff. Conclusion: In this large cross-sectional study, glove-related symptoms and latex skin sensitisation appear to be substantial among health care workers, and are related to common signs of atopy. We stress the need of preventive measures to avoid latex exposure when health care workers are at risk of developing allergy symptoms. Received: 18 May 2000 / Accepted: 1 November 2000     

Latex gloves fingered in allergic reactions

As more hospital workers don disposable latex examination gloves, reports of serious reactions and at least 16 deaths from latex allergies are being noted. Symptoms of latex allergy range from mild eczema to hives, welts and anaphylaxis. A rise in such incidents is of great concern for hospitals, which are expected to spend more than $500 million on latex examination gloves this year.     

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.     

Confronting and dealing with problems of latex-based products

The use of powdered latex gloves and other latex-based products and allergy problems related to them have become a major safety and environmental health concern of hospitals. In this report, we'll present the findings and viewpoints of allergists and anti-latex activists as well as those of manufacturers of latex products. We'll also give details on steps two major medical centers are taking to protect their employees and patients.     

Prevalence and risk factors for latex allergy: a cross sectional study in a United Kingdom hospital

OBJECTIVES: To determine the prevalence and risk factors for symptoms related to gloves, and the relation between symptoms and immunological evidence of type 1 hypersensitivity to latex in a United Kingdom health care setting. METHODS: A cross sectional survey was carried out among 773 employees at a British hospital. A self administered questionnaire was used to collect information about symptoms related to gloves and associated risk factors in a sample of hospital staff who were likely to use gloves at work. All of those who reported symptoms suggestive of type 1 hypersensitivity were invited for skin prick testing and measurement of specific IgE to latex (RAST). RESULTS: Among the 372 responders, symptoms related to gloves were common, 49% reported redness or itching of the hands, 14% reported urticaria, and 6% reported chest tightness. However, the frequency of positive skin prick tests and RASTs was surprisingly low (only two subjects tested positive). CONCLUSIONS: These findings indicate the need for caution in the interpretation of symptoms related to gloves even when they seem to suggest type 1 hypersensitivity.

 

     

A survey of starch particle counts in the hospital environment in relation to the use of powdered latex gloves

As latex proteins, which cause latex hypersensitivity, can befound on starch particles and inhalation may be a route forsensitization, the presence of starch particles in hospitalair was examined. The starch particles were demonstrated byimmobilization onto cellulose acetate filters and staining withiodine. Rooms in which powdered latex gloves were used gavecounts of up to >3667 particles per cubic meter of air. Starchparticles were not found in the air in rooms where latex gloveswere not used, and were highest in rooms with a high glove usagebut no ventilation. A change to powder-free gloves significantlyreduced the count of starch particles in the unventilated Accident/EmergencyDepartment air. Use of powder-free gloves should be consideredespecially in unventilated areas in healthcare premises.     

Glove selection as personal protective equipment and occupational dermatitis among Japanese midwives

This study was conducted to 1) evaluate the personal selection and use of protective gloves against bloodborne pathogens and management of glove selection in the workplace, 2) survey the experience with occupational dermatitis and other allergic symptoms, 3) explore the relationships between occupational dermatitis experience and glove use, and 4) determine the impact of glove selection upon occupational dermatitis among midwives. Subjects were 1,150 midwives working in Japan. Participants were selected from the members of Japanese Nursing Association and 835 responded to the survey. More than 30% of respondents wore gloves only when clients had an infectious disease, 41% reported experience of occupational dermatitis, 26% associated the dermatitis with medical glove use, and 2% had a diagnosis of latex allergy. Demographic variables that were significantly associated with occupational dermatitis included history of allergic symptoms other than due to occupational exposure, age, tenure and type of working institution. Using latex gloves during administering enema, shaving, changing pads, washing perineum, receiving newborns, suctioning, and handling waste significantly increased the risk of occupational dermatitis experience compared to not using gloves. Logistic regression analysis with backward stepwise elimination revealed glove selection management, such as availability of alternative glove types, using latex gloves for washing perineum, and using latex gloves for handling waste were significant predictors of occupational dermatitis. Occupational dermatitis is a significant issue and glove use as personal protective equipment is not standardized. Some occupational dermatitis may be preventable by managing appropriate glove selection.     

Do symptomatic radiographers provide evidence for 'darkroom disease'?

Non-controlled studies performed in New Zealand and the UK reported a high incidence of a large number of symptoms within radiographers. The authors of these investigations proposed that these symptoms resulted from exposure to X-ray processing chemicals and the associated fumes, and collectively labelled the condition 'darkroom disease'. The absence of control groups in these investigations weakens the 'darkroom disease' hypothesis. The current work set out to address this deficiency. Forty percent of radiographers (n = 295) and 40% of physiotherapists (n = 250) working in 34% of Irish hospitals (n = 31) were asked if they experienced any of the 15 symptoms described in 'darkroom disease'. The results demonstrated that radiographers had a significantly higher incidence than physiotherapists for only two of the symptoms--bad taste (P < 0.0001) and sore eyes (P < 0.001). These higher incidences were confined to three of the 31 hospitals surveyed. Physiotherapists expressed a higher incidence for sore throats (P < 0.01) and nasal discharge (P < 0.01). These results clearly demonstrate that radiographers are no more symptomatic than a group of hospital staff not exposed to processing chemicals. The current findings offer no support for the 'darkroom disease' hypothesis.