Presumptive frequency of, and review of reports on, allergies to household gloves

Background  Allergies to latex or 'rubber chemicals' in medical or other occupationally used gloves are not uncommon. In contrast, very few articles have reported on latex allergy (type I) or allergic contact sensitization to additives (type IV) associated with household gloves, in spite of some 44 million pairs sold in Germany in, e.g., 2006.
Objective  We seek to determine the frequency of allergies to household gloves by providing own data and we reviewed the literature.
Methods  The study was based on 105083 consultations of patients with suspected contact allergy (Type IV) in the Information Network of Departments of Dermatology (IVDK) in Germany in the years 1995 to 2006 and on the PubMed databases (last access 7/2008).
Results  1221 patients were identified in whom protective gloves were considered as a possible cause of contact dermatitis and who did not work in occupations associated with above average risk of contact allergy to rubber chemicals. In 178 cases positive reactions to rubber components were reported, while 13 additional cases reacted only to a previously used rubber glove brand, but not to commercial allergens.
In the literature only two publications on type I and two on type IV reactions were found in which allergies to rubber household gloves were explicitly reported.
Conclusions  Allergies to rubber household gloves seem to be rare. Factors presumably counteracting contact sensitization by household gloves, compared to occupational use, comprise short intermediate use, loose fitting and the incorporation of e.g. an inner cotton surface reducing skin contact with rubber chemicals.

Conflict of interest

Ehrhardt Proksch has acted as consultant to Wirtschaftsverband der deutschen Kautschukindustrie e.V. (WDK).     

Comparison of diagnostic methods in latex surgical glove contact urticaria

Surgical rubber gloves contain allergens derived from natural rubber latex which may sensitize, causing contact urticaria and even systemic reactions. We examined 15 hospital employees allergic to latex surgical gloves, using various skin tests and RAST, to determine the most reliable diagnostic method and to investigate coexistent allergy to glove powder and rubber chemicals. Prick testing using a stock solution made from one brand of latex glove yielded positive (2+ to 4+) reactions in all 15 employees: 8 retained positive reactions at a 1/10 dilution, 1 at 1/100 and 4 at 1/1000. A prick test using rubber-tree sap (Hevea brasiliensis) was positive in 12/15 employees and a scratch-chamber test using crushed rubber-tree leaf was positive in 13/15. A latex glove use test was positive in 12/13 employees and a latex RAST detected measurable amounts of specific IgE in 8/15. No positive prick test reactions were obtained using glove powder. On patch testing, 2/15 employees showed delayed allergy to rubber chemicals but no immediate reactions were detected. The present results indicate that in addition to the use test, prick testing with a stock solution prepared from latex surgical gloves is an adequate test method for routine practice when diagnosing latex glove contact urticaria. The correlation between prick tests and whole glove use tests was good, but latex RASTs yielded some negative results.     

Protective gloves in Swedish dentistry: use and side-effects

BACKGROUND: During the 1980s routine wearing of gloves in dentistry was recommended by health authorities in several countries. However, prolonged glove use is associated with side-effects of irritant and allergic origin. OBJECTIVES: To investigate the extent of glove use and self-reported glove intolerance reactions among Swedish dentists, and to examine how far IgE-mediated allergy to natural rubber latex (NRL) occurs in subjects who report rapid itching when in contact with protective gloves. SUBJECTS/METHODS: A postal questionnaire was answered by 3083 of 3500 licensed dentists, a response rate of 88%. Of the dentists who reported rapidly occurring itching of the hands from gloves, 131 of 170 attended a clinical examination including a skin prick test (SPT) and a serological examination (RAST) for IgE-mediated allergy. RESULTS: Seventy-three per cent of the dentists reported daily glove use of more than 2 h, 48% more than 6 h a day, and 6% reported no use. NRL gloves were used most frequently (P < 0.001) and were the main material that elicited symptoms (P < 0.001). Female dentists reported more frequent glove use than males, as did young dentists (P < 0.001) compared with older ones. Females also preferred vinyl gloves. Glove intolerance reactions were reported by 723 (23%) dentists, [females 28%, males 21% (P < 0.001)] and were more common in younger dentists. Of the 417 dentists with reported hand eczema during the previous year, 54% reported glove intolerance, compared with 20% of the dentists without hand eczema (P < 0.001). A logistic regression analysis including hand eczema, age, sex and atopy showed that all these factors contributed significantly to the risk of glove intolerance, and that hand eczema was a stronger factor than atopy. In 15 of 131 (11%) dentists examined for reported glove-related itch, latex allergy was verified by SPT and/or RAST. Glove-related conjunctivitis, rhinitis and asthma, in contrast to skin symptoms, showed a significant association with IgE-mediated allergy to NRL. CONCLUSIONS: Swedish dentists show good compliance with the recommendations for routine glove use. Intolerance reactions are frequently reported, especially by dentists with hand eczema, which emphasizes the need for preventive skin care programmes. Glove-related symptoms from mucous membranes showed a higher association with IgE-mediated allergy to NRL than reported itching of the skin, a fact that should be considered when composing screening questionnaires for NRL sensitization     

Allergenicity of natural rubber latex gloves

The concentrations of proteins, allergens and rubber chemicals are essential parameters of the allergenicity of NRL gloves. To date, a standardized method has been given only for analysis of the protein concentration (DIN EN 455-3), and not for the concentrations of allergens and rubber chemicals. In the present study, we investigated 11 brands of surgical gloves currently available on the German market. Additionally 1 glove, not subjected to final leaching procedures, was added for comparison purposes. Protein concentrations were analysed by different methods in different laboratories. Allergen concentrations were assayed by prick tests in NRL-allergic volunteers and by RAST inhibition methods. Rubber chemicals were analysed by HPTLC and GC. The protein concentrations analysed by the Lowry method in the 2 laboratories gave concordant results, but the correlations between protein and allergen concentrations were low. The protein concentration analysed by HPLC correlated with the allergen concentration, and gave better information on the allergenicity of the gloves. The development of standardized methods for allergen analysis in the assessment routine is necessary, due to significant discrepancy between protein and allergen levels of some gloves. Thiurams were not found in any of the gloves, though carbamates were present in all gloves tested. Our data indicate that washing procedures have little or no effect on the concentration of rubber chemicals.     

Delayed reactions to reusable protective gloves

The materials in plastic protective gloves are thought to cause less contact allergy than rubber gloves. Our aim was to estimate the frequency of delayed reactions to different types of reusable protective gloves among dermatitis patients. 2 × 2 cm pieces of polyvinyl chloride (PVC) gloves, nitrile gloves, and natural rubber latex (NRL) gloves were tested as is in consecutive dermatitis patients tested with the baseline series. Among 658 patients, 6 patients reacted to PVC gloves and 6 patients to the NRL gloves. None reacted to both these types of gloves. Five of six patients with reactions to rubber gloves reacted to thiuram mix in the baseline series. Delayed reactions to reusable PVC gloves may be as common as to reusable NRL gloves. In contrast to most reactions to the NRL glove, the reactions to the PVC glove had no obvious association with reactions to any allergen(s) in the baseline series.     

Rubber contact urticaria

To compare the immediate skin test reactivity of various latex (natural rubber) surgical and cleaning gloves, prick tests were performed on 40 latex-allergic persons, 26 of whom were sensitized by surgical and 14 by cleaning latex gloves. 6/17 surgical gloves tested and 1/2 cleaning gloves caused positive reactions in almost all (over 87%) of the allergic subjects. In contrast, the frequencies of positive reactions to 4 other surgical latex gloves were as low as 8-21%, suggesting that not all surgical gloves are equally allergenic. Control prick tests with 1 synthetic rubber and 1 polyvinyl chloride (PVC) glove were negative in all subjects. 2 surgical latex gloves causing either a high or low number of positive prick tests in allergic subjects were analyzed with high-pressure liquid chromatography (HPLC). Similar allergenic protein fractions were detected, which showed protein peaks at MW 2000, 5000 and 30,000 daltons. Corresponding proteins were detected in 1 latex cleaning glove analyzed and in natural rubber. This result confirms that allergenic proteins persist in various surgical and cleaning latex gloves after manufacture from natural rubber and may cause contact urticaria symptoms in sensitized people.     

Glove-related skin symptoms among operating theatre and dental care unit personnel

Following interviews on glove-related skin symptoms, 202 subjects, 56 hospital workers at an operating theatre and 146 workers at dental care centres, were skin prick tested with different latex extracts. Also, in 193 cases, blood samples were RAST-analysed, using the CAP system. Sensitization to latex diagnosed by positive skin prick test and/or by demonstration of specific antibodies in serum analyses was found in 3.5% of the subjects investigated. 4 cases (2%) showed 1 or more positive skin tests, and 4 cases (2%) had positive RAST to latex antigens. Further work on the diagnostic tools is still needed, as are prognostic studies.     

Occupational skin diseases among dental nurses

Out of 923 female dental nurses in the Helsinki district, 799 were interviewed using a computer-assisted telephone interview. A structured questionnaire was used to inquire about skin, respiratory symptoms, atopy, work history and methods, and exposure at work. The 328 nurses, who reported work-related dermatitis on their hands, forearms or face, were invited to an interview by an occupational physician; 245 nurses participated. 31 nurses had previously been diagnosed with an occupational skin disease (OSD). 133 nurses with a suspected OSD were selected for further clinical examinations with prick and patch testing. Among the 107 nurses examined, 22 new cases of OSD were diagnosed. There were altogether 29 cases of allergic contact dermatitis, 15 of contact urticaria, 12 of irritant contact dermatitis, and 1 case of onychomycosis. Rubber chemicals and natural rubber latex (NRL) in protective gloves, as well as dental-restorative plastic materials [(meth)acrylates], were the most common causes of allergy. 42% of the OSD cases in the studied population had been missing from the statistics (Finnish Register of Occupational Diseases). Plastic gloves or NRL gloves with a low-protein content are recommended for dental work. Skin exposure to (meth)acrylates should be avoided.     

Latex allergy: new insights to explain different sensitization profiles in different risk groups

Background  Differences in latex allergen sensitization profiles have been described between children subjected to repetitive surgical interventions and health care workers (HCW). 'Major' allergens for patients with spina bifida are Hev b 1, 3 and 7, while for HCW, 'major' allergens are Hev b 2, 5, 6.01 and 13. The reason for these differential sensitization profiles is currently unknown.
Objectives  To investigate latex allergen profiles on internal and external surfaces of natural rubber latex gloves.
Methods  Eighty-two samples of commonly used surgical gloves (41 glove brands) were used for analysis. Specific allergen levels of Hev b 1, 3, 5 and 6.02 on both surfaces of the gloves were quantified using an enzyme immunometric assay, a FITkit^® (FIT Biotech, Tampere, Finland).
Results  Differences in allergen levels were observed between internal and external surfaces of all glove types. Concentrations of Hev b 1 and Hev b 3 were significantly higher on external surfaces, while internal surfaces had higher allergen levels of Hev b 5 and Hev b 6.02. Analysis of surgical and examination gloves, powdered and nonpowdered gloves also showed that the content of Hev b 5 and Hev b 6.02 was significantly higher on internal surfaces while that of Hev b 1 and Hev b 3 was higher on external surfaces.
Conclusions  Our study showed different allergen profiles on internal and external surfaces of natural rubber latex gloves. These results may suggest a relationship between latex allergen localization and sensitization routes in different risk groups.     

Latex sensitization in dental students using powder-free gloves low in latex protein:a cross-sectional study

In Germany, employers must provide low-protein, powder-free gloves. This study was carried out to determine the current prevalence of latex sensitization in dental students using these gloves and to compare our results with a study of the same design dating from 1990/1991 at our university. A cross-sectional study was performed by questionnaire, prick testing and determination of specific IgE antibodies. 226 of 403 dental students underwent prick testing with a panel of 8 aero-allergens, 1 commercially available latex extract and 5 high-ammonia accelerator-free latex fluids. 39 of 226 dental students (17.3%) had a positive prick test response to at least 1 of the 6 latex substances tested. The prick test positivity was similar in preclinical education (semester 1-6) and in clinical education (semester 7-10), at 17.1% and 17.4%, respectively. In 9 of 32 persons with positive prick tests, specific IgE antibodies to latex could be detected. Within the past 10 years, prick test positivity increased from 8.7% to 17.3%. 14 students (6.2%) reported a history of glove intolerance, 3 of them (1.3%) showing a positive prick test to latex. By the use of low-protein, powder-free gloves less students with glove intolerance were observed. The observed reactions to between 1 and 3 of 6 latex substances tested may indicate a decrease in intensity and spectrum of sensitization. Additionally non-occupational sensitization may be of importance.     

Wearing test with 2 different types of latex gloves with and without the use of a skin protection cream

72 subjects reporting symptoms indicating Type I hypersensitivity reactions to natural rubber latex (NRL) gloves were included in this study. 44 of them had a positive prick test to NRL. They underwent wearing tests using 2 types of NRL gloves with high (n=63) and low (n=70) allergen contents. Unigloves Malaysia with a high allergen content caused positive skin reactions in 47% of SPT-positive and no IgE-negative subjects. After application of Hand Sense skin protection cream, the frequency of positive skin responses in wearing tests decreased to 30% in prick-test-positive subjects. The Biogel Diagnostic gloves with low allergen caused hypersensitivity with and without Hand Sense in 2 cases (5%) of the prick-test-positive. 60% of all test participants had a positive prick test to NRL. No prick-test-negative subjects showed any urticaria during the glove-wearing test. Our study demonstrates that high allergen contents in latex gloves frequently elicit skin responses in NRL-sensitized subjects. Since other skin protection creams have shown to increase allergic symptoms, it is encouraging to report that Hand Sense skin cream may hamper the uptake of allergens from gloves, thus decreasing allergic reactions.     

A study of natural rubber latex allergens in gloves used by healthcare workers in Singapore

BACKGROUND: Allergy to natural rubber latex (NRL) proteins is a well-recognized health problem among subjects using protective gloves and products made of NRL. There is currently no information on NRL allergen levels in gloves used in Singapore. OBJECTIVES: This study aims to quantify the amount of specific allergens (Hev b 1, Hev b 3, Hev b 5 and Hev b 6.02) found in rubber gloves used in Singapore. It also aims to determine if these levels are above thresholds that may cause NRL allergy. It also compares the levels of these specific allergens in gloves used for different purposes, namely gloves used for examination purposes or for surgical procedures. METHODS: Forty-nine rubber gloves were obtained from major hospitals and healthcare departments in Singapore and were analysed for their NRL allergen levels. FITkit, based on the enzyme immunometric assay technique, was used to determine the specific allergen levels of Hev b 1, Hev b 3, Hev b 5 and Hev b 6.02 in the gloves. RESULTS: Examination gloves had higher NRL allergen content compared with surgical gloves, and powdered gloves had higher allergen content compared with nonpowdered gloves. Among the various allergens, Hev b 5 and Hev b 6.02 were present in larger quantities than Hev b 1 and Hev b 3. Only two of 19 (11%) surgical gloves had the sum of the four allergens (Hev b 1, Hev b 3, Hev b 5, Hev b 6.02) in excess of 1 microg g(-1), which is believed to be a clinically relevant threshold. Among the examination gloves, 25 of 30 (83%) exceeded this level. CONCLUSIONS: This study shows that NRL allergen levels are present in the majority of examination gloves used by healthcare workers in Singapore at levels high enough to cause NRL allergy among sensitized persons. The information can serve as evidence for a possible requirement for manufacturers to produce gloves with low NRL allergen levels and to state the allergen level in gloves in the product information.     

Immediate reactions to fruits and vegetables

Common fruits and vegetables were tested as such with the "scratch-chamber" method in 388 patients with various atopic disorders. Of the patients with hypersensitivity to birch pollen, 36% showed immediate positive responses to these natural, fresh materials. Apple, carrot, parsnip and potato elicited reactions more often than, e.g. swede, tomato, onion and parsley. On the basis of clinical data, the relevancy of the results of the skin tests was 80–90%. Both "false positive" and "false negative" responses were seen.
Itching and tingling with or without oedema of the lips, mouth and tongue were the most common complaints after eating raw fruits and vegetables. In addition, laryngeal and abdominal disturbances, rhinitis and hand dermatitis were recorded.
Among patients without allergy to birch pollen, reactions to fruits and vegetables were rare.
The nature of the allergens could not be determined.     

The use of protective gloves and the prevalence of hand eczema, skin complaints and allergy to natural rubber latex among dental personnel in the county of Uppsala, Sweden

During the past decade, there has been an increasing problem with acrylate allergy and natural rubber latex (NRL) allergy among dental personnel. The aim of the present study was to evaluate the prevalence of these problems among dentists, dental nurses and dental hygienists in Uppsala county, Sweden. The study was based on a self-administered questionnaire sent to 690 persons with 527 responders (76%). The most common skin problem was dry skin, fissures and/or itching on the hands. Of the 72 persons (13.6%) reporting to have suffered from hand eczema during the past 12 months, 41 were patch tested with the TRUE Test standard series and the Swedish dental screening series. In the patch tested group, 9.8% reacted to 1 or more of the acrylates. In addition, 389 persons were tested for NRL allergy with the Pharmacia Upjohn CAP-RAST test, and of these, we found 7.2% to be positive. The prevalence of self-reported hand eczema and the number of positive CAP-RAST tests differed between the 3 occupations, with higher figures for the dentists. There was also a correlation between atopic eczema and hand eczema. Of those reporting skin symptoms, 67.7% connected them to the place of work and 28.8% related them to the use of gloves.     

Natural rubber latex allergy in a health-care population in Wales

BACKGROUND: Type 1 natural rubber latex (NRL) allergy prevalence rates quoted vary due to the different populations studied and methodologies used for assessment and investigation of NRL allergy. OBJECTIVES: To investigate the rate of type 1 allergy to NRL in health-care workers (HCWs) in a single NHS trust in Wales. METHODS: A response rate of 3716 of 5548 (67%) of the employees was obtained with a latex allergy questionnaire administered by the occupational health departments. Type 1 NRL allergy was diagnosed by correlating clinical symptoms, skin prick testing and IgE RAST to latex in the dermatology department. RESULTS: The period prevalence (1998-2001) for type 1 clinical latex allergy in HCWs was 25 of 4439 (0.56%). Of the 25 positive HCWs, 18 (72%) were nurses. CONCLUSIONS: The low prevalence rate of type 1 NRL allergy should not lead to underestimating the importance of clinically significant NRL allergy and the risks that need to be minimized.