In addition to many professionals using various protective gloves in their work, OR personnel frequently have been found to be affected by the immediate allergy to proteins present in surgical latex gloves. The
exact frequency and incidence of natural rubber latex (NRL) allergy are not known but there are some publications telling about the occurrence. At Tampere University Hospital in Finland,512 employees were tested and 7.4% of surgeons and 5.6% of OR nurses were found to be NRL
allergic. At Helsinki University Central Hospital,77 of 78 nurses and surgeons working at the Fourth Department of Surgery were skin prick tested with several latex glove eluates and 5.2% were NRL allergic. In France, 197 OR nurses were skin prick tested with latex allergen from Stallergenes, which gives reliable results when compared to glove eluates, and 11 % were found to be NRL allergic. The reason for this large
number seems to be that all personnel at the French hospital used latex gloves known to be highly allergenic. There also are some studies on occurrence of NRL allergy based on questionnaires, which give much
higher numbers. On the other hand, questionnaires have been found to be rather unreliable, because clinical history of irritant and immediate or delayed allergic reactions from gloves are often indistinguishable.
The difficulty with diagnosis of NRL allergy is the lack of a commercially available, standardized skin prick test allergen. In Finland I have used glove eluates made from different latex glove brands modified
according to the method first described by Nutter (1979). The allergenicity of glove brands has been found to vary greatly, but some highly allergenic brands consistently have retained their allergenicity
over the years. The glove eluates also have been compared with skin prick testing to diluted non-ammoniated latex, leaves of rubber trees and to three different commercial, non-standardized latex allergens,
showing reproducible results. Ten years of testing has caused no systemic reactions in sensitive patients.
Because frequency of NRL allergy among surgeons is unknown, Ansell offered me the opportunity to test surgeons at their stand at the 1993 EuroSurgery Congress in London. Altogether,1,500 surgeons
attended the meeting and 162 of them elected to be tested. The distribution of nations of the tested persons was: UK,42; Italy, 16; Turkey, 10; Netherlands,10; Spain, 8; Poland,7; Germany,5; Ireland,5;
Portugal,5; Sweden,5; Belgium,4; Denmark,4; Slovakia,4; France,4; and 1-3 representatives from 22 other nationalities. Eighty-seven percent were males with an average age of 39 and 15 years in
surgery. The surgeons completed a form asking for anamnestic data concerning personal history of atopic diseases and hand dermatitis. Previous or present atopic eczema was indicated in 16%, rhinitis in 27%,
asthma in 11 %, previous hand dermatitis in 25% and present hand dermatitis in 8%.
The diagnosis was made by skin prick testing using the lancet of ALK (Allergologisk Laboratorium, Denmark) with a one-mm long peak and shoulders preventing deeper penetration. Histamine dihydrochloride 10mg/ml was used as the positive control and physiological saline as negative control. Eluates made from three different glove brands were used as test material: two high allergenic (Triflex, Baxter, USA; and Exona, Semperit, Austria) and one low allergenic brand (Nutex, Ansell Melaka, Malaysia). The glove eluates were made by cutting gloves in small pieces. One gram of each was added to 5 ml of saline taken from a bag
with no previous rubber contact. After 15 minutes, the glove pieces were removed and the solution was used "as is" for skin prick testing. No preservatives were used. When used over longer periods, new solutions are made every month. The test was made on the person's forearm. First one drop of each allergen and control was put on skin and then every drop pierced or punctured by a lancet (a new one for
every drop). The tests were read after 15 minutes. The size of the histamine wheal was taken as reference. Reactions in size of half of the area of histamine were weakly positive, and clearly positive if equal to the
size of histamine. As I used two high allergenic glove eluates, even weak reactions refer to allergy when both react concordantly. Reaction to only one of them was not considered positive. It must be emphasized
that when testing at congresses, use tests and other confirming tests cannot be done.
Among 162 surgeons, only one (0.6%) NRL-allergic person could be diagnosed. That surgeon came from the Netherlands, was aware of his allergy and had found gloves he could use without problems. There
were several other surgeons having problems with glove usage: 14% experienced contact urticaria, 25% hand dermatitis,5% rhinitis and 9% eye symptoms. Some of them already had been patch tested and diagnosed as having delayed allergy to rubber chemicals. Most of the surgeons must have irritant reactions behind their symptoms, as found in earlier studies among hospital workers.
The possible reasons why so few positive cases were found are many: in some countries only low allergenic gloves were used; in poor countries gloves were reused many times whereby repeated washing and
sterilizing are known to diminish the amount of allergens; and, finally, the participating number from many countries was too low to take any conclusion on the occurrence of NRL allergy. The diversity between
findings and symptoms given from glove usage confirms the earlier experiences on the unreliability of questionnaires in diagnosis of NRL allergy. All surgeons (whose knowledge of NRL allergy seemed limited) received information about NRL allergy. No adverse reactions appeared during the three testing days.
In conclusion, it appears that offering such a test at a conference is a convenient method to distribute information about NRL allergy and also offers participants an opportunity for professional and safe
diagnosis of NRL allergy.
