Primary prevention of natural rubber latex allergy in the German health care system through education and intervention

BACKGROUND: The development of occupational asthma and allergic skin reactions caused by natural rubber latex (NRL) allergy are risks for health care workers. There are few published studies to suggest that intervention programs to reduce exposure will lead to primary prevention of sensitization. OBJECTIVE: This study assesses the effects of intervention to reduce the incidence of NRL allergy in personnel working in health care facilities insured by the German statutory accident insurance company for health care workers, Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, with approximately 3 million insured employees, by switching to powder-free NRL gloves. METHODS: The timing of introduction of intervention strategies, such as education of both physicians and administrators, together with regulations demanding that health care facilities only purchase low-protein, powder-free NRL gloves are reported. We reviewed the annual numbers of reported suspected cases of NRL-caused occupational allergies and the amount and type of gloves used in German acute-care hospitals since 1986. RESULTS: The purchase of powder-free NRL examination gloves exceeded that of powdered gloves for the first time in 1998. This only became true for powder-free NRL sterile gloves 2 years later in 2000. The incidence of suspected occupational NRL allergy cases rose until 1998 and has declined steadily since. There was a 2-year lag between the beginning of the decline in the purchase of powdered NRL examination gloves and the beginning of a decline in suspected NRL-caused occupational asthma cases. CONCLUSIONS: Despite the effect of increased recognition of NRL allergies, education about NRL allergies in health care facilities combined with the introduction of powder-free gloves with reduced protein levels has been associated with a decline in the number of suspected cases of occupational allergies caused by NRL in Germany on a nationwide scale. These results clearly indicate that primary prevention of occupational NRL allergies can be achieved if these straightforward and practical interventions are properly carried out and maintained.     

Identification and practical management of latex allergy in occupational settings

Allergy to natural rubber latex (NRL) from Hevea brasiliensis is a relevant occupational health hazard. The use of gloves and products manufactured with latex and environmental allergen exposure in the work environment are risks factors for the development of occupational allergy among different job categories. Healthcare workers have been the most commonly affected, but other professions with exposure to latex products such as hairdressers, cleaners, food handlers and those making natural rubber latex (NRL) products are also at risk of developing occupational allergy. Clinical manifestations of IgE-mediated latex allergy can range from troublesome skin disorders to life-threatening systemic reactions. It is very important to identify the occupational allergic diseases in their early stages in order to implement avoidance strategies. For this purpose, the interventions for prevention should emphasize the importance of latex allergy awareness and surveillance among exposed workforces.     

Latex hypersensitivity in Department of Veterans Affairs health care workers: glove use, symptoms, and sensitization.

BACKGROUND: This report of the prevalence of latex glove allergy in 3 Department of Veterans Affairs (VA) medical centers was a collaboration of the VA, the Centers for Disease Control and Prevention, and the National Institute for Occupational Safety and Health. OBJECTIVE: To enroll and evaluate personnel from across the entire hospital workforce for latex hypersensitivity and to determine the type and extent of latex glove use. METHODS: A questionnaire was administered that covered demographics, job category, latex glove use, and current latex glove allergic symptoms. Skin testing to aeroallergens was performed to evaluate the presence of atopy. Blood was drawn for analyses of serum antilatex IgE antibody by CAP assay. RESULTS: Of 1,959 subjects, 158 (8.1%) had latex glove-allergic symptoms, a positive latex CAP assay result, or both. In 1,003 subjects who reported latex glove use, 915 (91.4%) used nonpowdered gloves. A total of 133 subjects reported latex glove allergic symptoms, and 36 subjects had positive CAP assay results. Latex sensitization was correlated with atopy, race, and latex glove exposure. Latex symptoms were correlated with atopy, a positive CAP assay result, and latex glove exposure. Of the 133 subjects with latex glove allergic symptoms, only 11 had positive CAP assay results, giving a prevalence of confirmed latex glove allergy of 0.6%. CONCLUSIONS: Symptoms attributed to latex gloves and/or latex sensitization occurred in 8.1% of the employee population, with exposure, race, and atopy being the major risk factors. Few symptomatic individuals were sensitized to latex (0.6%). This low rate of confirmed latex glove allergy may have been related to nonpowdered glove use.     

IgE-mediated natural rubber latex allergy: practical considerations for health care workers.

OBJECTIVE: To focus on some specific topics of major significance for health care workers confronted with natural rubber latex (NRL) allergy: 1) sensitization and routes of exposure; 2) threshold allergen exposure levels; 3) evaluation of occupational NRL allergy; 4) prevention of sensitization and allergic reactions to NRL-containing devices; 5) selecting the right alternative; and 6) regulatory responses to NRL allergy issues. DATA SOURCES: English and French language papers identified through a MEDLINE search and bibliographies of the identified papers and the National Institute for Occupational Safety and Health and Food and Drug Administration web sites. RESULTS: 1) The threshold levels of NRL exposure needed for sensitization and the precise way in which it comes about remain to be elucidated, but cutaneous, percutaneous, mucosal, and parenteral exposure can all give rise to symptoms. 2) Strengths and weaknesses of the questionnaire and currently available diagnostic techniques for NRL allergy are emphasized. 3) Prevention strategies should focus on dipped materials and stress upon the possibility of passive and active transmission of NRL aeroallergen. 4) Generally, vinyl gloves are an appropriate alternative for NRL gloves; however, when barrier integrity is a concern, nitrile gloves provide protection that is comparable with NRL. 5) Several government bodies, standards organizations, and regulatory agencies have issued regulations concerning the control and labeling of protein and allergen levels in NRL products. CONCLUSION: Accurate diagnosis and management of NRL allergy is essential because of the potential for severe hypersensitivity reactions. Major developments have been made in characterizing and cloning NRL allergens, and future development in this area may lead to better diagnostic tools and possible therapeutic agents for immunotherapy. However, at present, avoidance remains the only effective approach. We hope that additional well performed prospective incidence studies will bring more accurate data concerning sensitization doses and provide the valuable information to improve prevention strategies.     

Passive dispersion of latex aeroallergen in a healthcare facility.

BACKGROUND: Prompted by worsening asthma in a dental assistant with latex allergy and occupational asthma while under personal latex precautions, we confirmed continuing latex aeroallergen exposure. OBJECTIVES: To determine the source of latex aeroallergen and ascertain the effects of site-wide substitution of nonpowdered low allergen latex glove in a health care site. METHODS: Using a volumetric sampler, baseline latex aeroallergen levels were measured in rooms where she worked and nearby rooms, as well as shared X-ray, laboratory, and waiting rooms. Allergen levels were measured in upholstery fabric samples, ventilation duct dust, and latex gloves. Alterations in aeroallergen levels following change of glove types were prospectively determined. RESULTS: Baseline latex aeroallergen levels ranged from 6 to 25 ng/m3 in the patient's work areas and in other rooms from 29 to 90 ng/m3 during work hours. Latex antigen was found in three brands of powdered latex gloves (chi = 1,156 microg/g) used in the nearby opertories and the hygiene room, and in upholstery fabric, carpet dust, but not ventilation duct dust. In the absence of any other control measures, airborne latex became undetectable (<5 ng/m3) with exclusive use of nonpowdered latex gloves. DISCUSSION: Latex aeroallergen is primarily generated by active glove use; carpeting and fabric upholstery can serve as important aeroallergen repositories. Site-wide substitution of nonpowdered latex gloves eliminates detectable latex aeroallergen.     

Nasal provocation test in the diagnosis of natural rubber latex allergy

BACKGROUND: Natural rubber latex (NRL) allergy in workers using rubber gloves has been an occupational health problem for the last 10 years. In the case of the occupational agents, clinical history may be far from conclusive; hence, appropriate provocation should be carried out. The objective was to evaluate the usefulness of the nasal challenge test in the diagnosis of allergic rhinitis in subjects occupationally exposed to NRL. METHODS: A single-blind, placebo-controlled study was conducted in 16 nurses with respiratory symptoms (bronchial asthma and/or rhinitis) related to NRL exposure as well as positive skin prick test (SPT) response to NRL. The controls were nine nurses with asthma and/or perennial rhinitis unrelated to NRL exposure; six atopic patients not occupationally exposed to NRL, with asthma and/or perennial rhinitis; and six healthy subjects. All the controls had negative results of SPT with NRL. Patients with a history of anaphylaxis or positive results of RAST to NRL were not considered in the study. The "nasal pool" technique was used to evaluate the cellular response and changes in protein level and ECP concentration in nasal washings after topical provocation with allergen or placebo. RESULTS: A significant increase was noted in eosinophil and basophil number, albumin/total protein ratio, and ECP level only in NRL SPT-positive patients subjected to nasal challenge with NRL. Neither bronchial nor systemic reactions were found after the nasal provocation with NRL. CONCLUSIONS: The nasal challenge test appears to be useful for diagnosing occupational rhinitis in NRL-sensitized patients.     

Different latex aeroallergen size distributions between powdered surgical and examination gloves: significance for environmental avoidance

BACKGROUND: Proactive medical institutions implement latex allergen avoidance to protect workers and patients with latex allergy and to prevent latex sensitization in these groups by creating latex-safe environments that include replacement of natural rubber latex examination and surgical gloves, especially those that are powdered, with synthetic alternatives. We have hypothesized that an apparent decreasing trend in new latex allergy cases in hospitals using only synthetic examination gloves but the occasional powdered latex surgical glove might result from constitutive differences in allergen content (particle size distribution and quantity) between powdered surgical gloves and examination gloves. OBJECTIVE: Because aerodynamic particle size determines where inhaled airborne allergen deposits in the airway, the aim of this study was to investigate the differential particle size distribution of latex allergen released from powdered latex examination and surgical gloves. METHODS: Powdered and nonpowdered latex examination and surgical gloves were processed to create an aerosol in a glove box equipped with air sampling equipment capable of total particle number and mass measurements. Air particulate generated in the glove box was collected on impactors with less than 2.5-microm, 2.5- to 10-microm, and greater than 10-microm particle size limits (4 L/min for 4 hours). All filters were extracted, and latex allergen was quantified by using a latex-CAP inhibition assay with a human IgE anti-latex serum pool. RESULTS: Latex aeroallergen on powdered sterile surgical gloves resided primarily on particles greater than 10 microm in size (P <.006). In contrast, powdered examination gloves released the highest total latex aeroallergen content, with 68% of the particles sized in the respirable 2.5- to 10-microm range and carrying 56% of the airborne latex allergen. CONCLUSIONS: Significantly lower quantities and larger sizes of latex allergen-containing particles released from surgical gloves provides one potential explanation as to why an apparent decrease in new cases of latex allergy can occur in hospitals that successfully replace latex examination gloves with synthetic gloves but continue occasional use of powdered surgical gloves.     

Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers

BACKGROUND: The development of allergy to natural rubber latex (NRL) is a risk for health care workers. A regulation banning powdered NRL gloves was implemented in Germany in 1998. OBJECTIVE: This study assesses the effects of this regulation on the development of occupational skin disease caused by NRL in health care personnel working in facilities insured by the German statutory accident insurance company, covering some 1.8 million insured health care workers. METHODS: We reviewed the annual numbers of reported suspected cases of NRL-induced occupational allergies (mainly contact urticaria) from 1996 through 2002, as well as the number and type of gloves purchased in acute-care hospitals from 1986 through 2002. RESULTS: The number of purchased nonsterile examination gloves increased by 1387% between 1986 and 2002. The purchase of powder-free NRL examination gloves exceeded that of powdered gloves in 1998. The incidence of suspected cases increased until 1998 and has since decreased by 79.9%. Most suspected cases (67.9%) were identified as occupationally caused. CONCLUSIONS: Reducing the purchase of powdered NRL gloves is associated with a decrease in suspected and proved cases of occupational contact urticaria caused by NRL. Development of occupationally caused contact urticaria by NRL can be reduced by banning the use of powdered NRL gloves.     

Outcomes of a natural rubber latex control program in an Ontario teaching hospital

BACKGROUND: Allergy to natural rubber latex (NRL) has been frequently reported in health care workers. However, there is little published evidence of the outcome of hospital intervention programs to reduce exposure and detect cases of sensitization early. OBJECTIVE: This study assesses the effects of intervention to reduce NRL allergy in an Ontario teaching hospital with approximately 8000 employees. METHODS: A retrospective review assessed annual numbers of employees visiting the occupational health clinic, allergy clinic, or both for manifestations of NRL allergy compared with the timing of introduction of intervention strategies, such as worker education, voluntary medical surveillance, and hospital conversion to low-protein, powder-free NRL gloves. RESULTS: The number of workers identified with NRL allergy rose annually, from 1 in 1988 to 6 in 1993. When worker education and voluntary medical surveillance were introduced in 1994, a further 25 workers were identified. Nonsterile gloves were changed to low-protein, powder-free NRL gloves in 1995: Diagnoses fell to 8 workers that year, and 2 of the 3 nurses who had been off work because of asthma-anaphylaxis were able to return to work with personal avoidance of NRL products. With a change to lower protein, powder-free NRL sterile gloves in 1997, allergy diagnoses fell to 3, and only 1 new case was identified subsequently up to May 1999. No increased glove costs were incurred as a result of consolidated glove purchases. CONCLUSIONS: This program to reduce NRL allergy in employees was effectively achieved without additional glove costs while reducing expenses from time off work and workers' compensation claims.     

Latex allergy in children

Natural rubber is a component of the latex of the tropical Hevea brasiliensis tree which is widely used in the manufacturing of medical devices and a large variety of articles for everyday use. Over a dozen allergens have been identified in the latex of H. brasiliensis. The allergens Hev b 1, Hev b 3, Hev b 6, and Hev b 7 are proteins that are involved in the biosynthesis of rubber or the coagulation of latex. Allergens that are part of the plant's defense system are represented by Hev b 2 and class I endochitinases. The allergens Hev b 4, Hev b 5, and Hev b 8-10 were classified as either structural or housekeeping proteins. Immediate-type hypersensitivity reactions to proteins present in Hevea latex were first described in 1927. Since then, natural rubber latex (NRL) allergy has become an important medical problem for an increasing number of individuals. Sensitization mainly occurs by wound or mucosal contact with NRL devices during surgery or by inhalation of airborne allergens released from powdered latex gloves. The number of surgical interventions and an atopic disposition are the most important risk factors for developing latex allergy, especially in children with spina bifida. Exposure to NRL products should be carefully avoided for individuals who belong to high-risk groups. Initial studies on establishing a latex-free environment for surgery in all spina bifida patients have reported on a decrease in sensitization and allergy to NRL.     

Latex allergy and skin

PURPOSE OF REVIEW: In this review we address the prevalence and outcome of latex allergy in health care workers (HCWs). Recent findings in natural rubber latex (NRL) allergens and trials of specific immunotherapy (SIT) are also of interest. RECENT FINDINGS: A study involving skin prick test (SPT) screening in HCWs in Russia and adjacent countries found a prevalence of latex allergy of 1.9%. Questionnaire studies performed in Wales and in the USA identified prevalence rates of about 0.6%. An intervention undertaken at the Mayo Clinic, in which only gloves with low or undetectable allergen levels were allowed, reduced markedly the incidence of NRL allergy. Two studies, one from Finland and another from Ohio, showed that outcomes in latex-allergic HCWs are generally good. A study involving SPT screening showed that 6% of construction workers had latex allergy. A questionnaire study among allergists practicing in the USA showed that 62% performed latex SPT and 6% reported anaphylaxis, which mostly occurred while using a homemade SPT solution. Hev b 2, Hev b 5, Hev b 6.01 and Hev b 13 produced positive SPT reactions in over 60% of latex-allergic individuals. Topical application of NRL in a murine model of protein contact dermatitis caused a striking increase in prohevein-specific (Hev b 6.01) immunoglobulin E levels, together with a T-helper-2 type dermatitis. A placebo-controlled SIT trial with NRL extract alleviated cutaneous symptoms but caused some systemic reactions in latex-allergic patients. SUMMARY: Low prevalence rates suggest that the peak of the latex allergy epidemic has already passed in HCWs. Hospital-wide interventions requiring use of low-allergen gloves reduce sensitization and changing gloves to nonlatex ones, or even using low-allergen latex gloves, in the affected individuals appears to confer adequate secondary prevention. In the USA there is an urgent need for standardized latex SPT reagent. Hev b 5 and Hev b 6.01 are major in vivo NRL allergens. Findings in mice suggest that NRL proteins eluting from latex gloves may also cause hand eczema in humans. SIT with NRL extract must still be considered an experimental treatment.     

Occupational allergies caused by latex

Allergy to natural rubber latex is an important cause of occupational allergy in healthcare workers. Disposable medical gloves are the major reservoir of latex allergens, particularly powdered gloves, in healthcare delivery settings. Diagnosis of latex allergy requires a history of exacerbation of cutaneous, respiratory, ocular, or systemic signs and symptoms after exposure to natural rubber latex products; and evidence of sensitization by patch testing, skin testing, measurement of latex-specific IgE antibodies, or challenge testing. Optimal management of latex allergy involves education concerning cross-reacting allergens, reduction of cutaneous or mucosal contact with dipped rubber products, and minimization of exposure to latex aeroallergens in work environments.     

Latex aeroallergen quantification in hospitals of Moscow, Russia.

BACKGROUND: Health care workers (HCWs) who use latex gloves regularly are at a significant risk for developing allergic sensitization to natural rubber latex (NRL) proteins. The airborne route of exposure presents a hazard for sensitization and subsequent allergic symptoms. OBJECTIVE: The purpose of this study was to measure the content of the NRL proteins in the air of work areas (laboratories, treatment rooms, operating rooms, examination rooms, and dentist's treatment rooms) in eight Moscow hospitals where the employees used powdered latex gloves. METHODS: The air samples were collected by a volumetric filtration method using a static air sampler at a flow rate of 3 L/second. Airborne particles were collected onto polytetrafluoroethylene filters rated 99.9% efficient at 0.3 microm. The NRL allergens were extracted from the air filter samples in phosphate-buffered saline and quantified by an inhibition immunoassay using a five-person pool of sera containing latex-specific human immunoglobulin E. RESULTS: The airborne latex allergen concentrations in 11 areas (including positive control) where latex gloves were used varied from 5 to 26 ng/m3. Conversely, in 12 areas where latex gloves were seldom used or where powdered-free latex gloves were used allergen levels were not detectable (including two negative controls). The highest concentration of latex allergen (26 ng/m3) was found in an examination room of a gynecology department. Low and moderate concentrations were detected in most operating rooms, and low concentrations in the laboratories and treatment rooms. CONCLUSIONS: This study indicates that, in general, the airborne NRL concentrations in the work areas of Moscow hospitals are rather low compared with NRL concentrations reported from American hospitals and are dependent on the intensity of latex glove usage.     

A high-molecular-weight mite antigen (HM1) fraction aggravates airway hyperresponsiveness of allergic mice to house dusts and whole mite cultures

BACKGROUND: Using non-powdered, low-protein natural rubber latex (NRL) gloves has been shown to reduce the elicitation of respiratory symptoms in latex-allergic individuals; however, the role of dermal exposure in the induction of sensitization is not completely understood. OBJECTIVE: These studies were conducted to (1) determine levels of NRL protein in gloves currently in use and (2) evaluate, using a murine model, the potential for dermal exposure to induce NRL sensitization and subsequent airway hyperreactivity upon respiratory challenge. METHODS: Total extractable protein and NRL allergen levels were evaluated from 38 glove samples using the Lowry and CAP inhibition assays, respectively. BALB/c mice were dermally exposed to non-ammoniated latex (NAL, 6.25-25 microg) 5 days/week for 13 weeks and monitored weekly/biweekly for IgE levels. Airway hyperreactivity was determined following respiratory challenge with methacholine (MCH) or NAL proteins on days 60 and 93, respectively. RESULTS: Glove total protein and NRL allergen levels ranged from below the limit of detection to 946 microg/g and from 0.002 to 112 microg/g, respectively. Mice demonstrated dose-dependent increases in total serum IgE levels by day 58 with increased airway hyperreactivity observed upon respiratory challenge with MCH (day 60) or NAL proteins (day 93). CONCLUSONS: These studies investigated the continued use of gloves with high levels of total extractable protein and NRL allergen. The potential for dermal exposure to induce NRL-specific IgE and airway hyperreactivity upon respiratory challenge suggests there should be continued concern regarding the induction of sensitization in individuals using non-powdered latex gloves.     

Latex allergy--Part I

Natural rubber latex (NRL), is a resin sap produced in the cells of caoutchouc plants. It is a water dispersion of cis-1,4-polisopren (caoutchouc)--35%, stabilized with little amounts of proteins, sugar, alcohol, fatty acids and salts. The concentration of all solid substances is about 40%, the rest is water. Immunogenicity of latex depends on the proteins it contains. For many years we read in medical papers about the cases of contact urticaria, asthma, rhinitis, and anaphylaxis after contacting with latex products. It turns out that medical staff is the group of high occupational risk, because of exposure to gloves and other latex products. It is connected with the fact of high gloves usage caused by the danger of virus infections: HIV, HBV, HCV. Latex allergy is one of the reasons of dramatic complications after surgical operations. People who are allergic to latex may have cross reactions to allergens not connected with occupational environment. These are: food and houseplants (Ficus benjamina). The frequency of latex allergy is about 0.1% of the population. In the groups of high risk the frequency rises sharply. It is 17% among medical staff and it reaches 60% among children with spina bifida.     

Prevalence and risk factors for latex-related diseases among healthcare workers in an Italian general hospital

Latex allergy has become an occupational hazard among healthcare workers. Atopy and degree of exposure have been recognized as predisposing factors for latex sensitization. We investigated the prevalence of latex allergy and the potential risk factors for latex sensitization, by distributing a questionnaire to 284 employees of a general hospital in central Italy. We collected information about occupational history, including specific tasks performed; time of first exposure to latex gloves; number of pairs of gloves; and duration of daily exposure. We also investigated the interval between first exposure and onset of symptoms, as well as the exact circumstances of their appearance. We evaluated pre-existing rhinoconjunctivitis, asthma, atopic and contact dermatitis, and allergies to drugs and foods using prick and patch tests. Latex allergy was established by means of skin-prick test, specific IgE, patch-test, and latex-glove-wearing test. This survey documented a high prevalence of symptoms related to the use of latex (47%) among the hospital staff, demonstrable sensitization to latex was considerably lower (12%), though strongly associated to atopy and duration of occupational exposure. Despite non-specificity, validated questionnaires constitute the most useful means to implement health surveillance and prevention of latex-related diseases among healthcare workers.     

Particulate masks and non-powdered gloves reduce latex allergen inhaled by healthcare workers

BACKGROUND: Although allergy to latex is a well-characterized phenomenon, some hospitals continue to provide staff with powdered latex gloves as an option to low- or non-powdered gloves. OBJECTIVE: We aimed to measure the extent to which inhalation of latex particles could be reduced by the use of protective masks or by replacing powdered latex gloves with non-powdered latex gloves. METHODS: Twenty healthcare workers in a hospital setting wore nasal air samplers (NAS) and Institute of Occupational Medicine (IOM) samplers for four 20-min periods. Subjects wore powdered gloves, non-powdered gloves and no gloves during three sampling periods, and in the fourth, subjects applied an aerosol barrier face-mask or a particulate face-mask (N95) while wearing powdered gloves. All samples were stained for particles bearing Hev b 5 allergen by the Halogen assay. RESULTS: All subjects inhaled Hev b 5 bearing particles in all sampling periods. IOM samplers collected particles at 70% of the rate of NAS. The number of particles inhaled while wearing powdered gloves was 23.8-fold higher than when not wearing gloves and 9.7-fold higher than when wearing non-powdered latex gloves (P < 0.0001). Wearing an aerosol barrier mask did not significantly reduce the number of particles inhaled (P = 0.108), while use of particulate masks significantly reduced the number of particles inhaled by 17.4-fold (P = 0.003). CONCLUSIONS: Use of non-powdered gloves is the most effective method of reducing occupational aeroallergen exposure to latex arising from gloves. However, secondary protection using particulate masks is a valid alternative, and may be helpful for preventing respiratory sensitization.     

Changes in rates of natural rubber latex sensitivity among dental school students and staff members after changes in latex gloves.

BACKGROUND: A high rate of sensitization and clinical allergy to natural rubber latex (NRL) gloves has been reported in dental students and staff members. OBJECTIVE: The purpose of this study was to determine whether a change in glove use from high-protein/powdered to low-protein/powder-free latex gloves at a previously surveyed dental school reduced the prevalence of NRL sensitivity among students and staff members. METHODS: A cross-sectional study was performed through use of a questionnaire and skin prick testing to low ammoniated NRL extract; the method was similar to that used in a study conducted in 1995. Analyses were performed on the entire groups as well as on a subset of senior students. RESULTS: A total of 97 subjects (61 students and 36 staff members) completed the questionnaire and underwent skin prick testing; this compared with 131 subjects in 1995. Percentages of subjects reporting asthma symptoms, rhinitis or conjunctivitis, urticaria, or pruritis within minutes of NRL exposure were 4%, 7%, 6%, and 8%, respectively; the corresponding percentages in the 1995 survey were 7% (P = not significant), 13% (P = not significant), 20% (P =.004), and 22% (P =.005). Results were similar for the subset of senior students, but in addition there were also significantly fewer complaints of rhinoconjunctivitis in 2000 than in 1995 (0% and 12%, respectively; P =.007). Of 97 subjects who underwent skin prick testing, 3 (3%) had positive skin prick test responses of 2+ or greater to NRL; this compared with 13 (10%) of 131 subjects in 1995 (P =.03). There were 3 positive skin test responses among staff members in 2000; there were none among students. CONCLUSIONS: Our results suggest a preventive effect on NRL allergy in dental students from the change to low-protein/powder-free NRL gloves in the dental school.     

Neonatal sensitization to latex

Babies born in delivery rooms of hospitals are exposed to latex through skin and mucous membrane contact with prepowdered latex gloves worn by midwives and doctors, and through the inhalation of latex-bound starch powder in the air of the delivery room. This paper examines the hypothesis that they are at risk for latex sensitization, and that part of the sharp increase of childhood asthma, eczema and anaphylaxis in the past 30-40 years may be linked. These possibilities seem hitherto unsuspected. In over 700 papers on latex allergy no mention of neonatal exposure to latex has been found. Even obstetric papers discussing the risks for an atopic mother (atopy - a tendency to develop allergies) do not seem to anticipate any risk for the baby, who might also be atopic. Latex allergy is primarily regarded as an occupational hazard. This paper suggests that it is a hazard for every baby handled by latex gloves at birth.     

Latex medical gloves: time for a reappraisal

Many hospitals have implemented policies to restrict or ban the use of devices made of natural rubber latex (NRL) in healthcare as precautionary measures against the perceived risk of NRL allergy. Changes in glove technology, progress in measuring the specific allergenic potential of gloves and a dramatic decrease in the prevalence of NRL allergies after interventions and education prompted us to revisit the basis for justifiable glove selection policies. The published Anglophone literature from 1990 to 2010 was reviewed for original articles and reviews dealing with the barrier and performance properties of NRL and synthetic gloves and the role of glove powder. The review shows that NRL medical gloves, when compared with synthetic gloves, tend to be stronger, more flexible and better accepted by clinicians. The introduction of powder-free gloves has been associated with reductions in protein content and associated allergies. Recently, new methods to quantify clinically relevant NRL allergens have enabled the identification of gloves with low allergenic potential. The use of low-protein, low-allergenic, powder-free gloves is associated with a significant decrease in the prevalence of type I allergic reactions to NRL among healthcare workers. Given the excellent barrier properties and operating characteristics, dramatically reduced incidences of allergic reactions, availability of specific tests for selection of low-allergen gloves, competitive costs and low environmental impact, the use of NRL gloves within the hospital environment warrants reappraisal.