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Source To Surgery - February 1995, Vol. 3 Issue I
Stop the Sensitization
Kevin J. Kelly, M.D., Director of Pediatric Allergy/lmmunology
Medical College of Wisconsin and Children's Hospital of Wisconsin,
Milwaukee, USA
Latex Allergy has become a central problem for health care and latex
manufacturers. Certain groups at high risk for the development of latex
allergy have been identified in the past seven years allowing specific
understanding about the mode of sensitization. Health care workers,
patients with spina bifida, individuals who have undergone multiple
surgeries, atopic persons (individuals with a tendency to produce
allergic antibody) and others frequently exposed to latex all may be
sensitized from latex contact in high enough exposure. The exact level
of latex protein exposure required to induce sensitization is not known
and will require large, complicated, and prolonged epidemiology study of
high risk individuals coupled with exposure time and allergen
quantification. In the interim, it is clear that significant exposure to
latex medical gloves is the most common source of sensitizing allergen.
Although the abrupt increase in sensitization may be associated with
universal precautions, changes in manufacturing, latex processing or
sources of latex may have contributed significantly to the problem.
Analysis of the medical literature suggests that in the mid 1980s the
overall sensitization data for health care workers was 2.9%. In 1992,
reports increased the number to 10% and in the U.S. are now as high as
17% in one hospital. This suggests that close to one million health care
workers are developing IgE antibody directed against latex protein.
Alarmingly, the propensity of these individuals to experience
life-threatening anaphylaxis and persistent respiratory symptoms is
unprecedented.
It is now clear that the health care industry cannot wait for the FDA to
come up with guidelines. The sensitization of individuals must be
curbed. Analysis of data from three sources suggests a means of
accomplishing this. Health care administrators must work with department
personnel to establish protocols for establishing latex-free OR and
recovery suites and for obtaining a complete medical history from high
risk patients prior to surgeries. In addition, the human resources
department must be made aware of the existence of latex allergies so
that suitable alternative employment can be found for latex sensitive
health care workers who are unable to continue working in their normal
departments. Seminars and information should be provided for all groups
so that latex sensitive and non-latex sensitive individuals are aware of
the causes and potential solutions. Certainly this approach may have
limits but clearly has advantages. It also is clear that this approach
is merely to avoid sensitization and has no application for the patient
who is already sensitized to latex. Those individuals should not be
exposed to latex.
Utilizing four different methodologies, three groups independently
analyzed the allergen content of gloves. The premise used by all is that
the exposed individual contacts extractable latex allergen. Two groups
utilized in vitro testing of latex glove extracts. At the Mayo Clinic,
RAST (radioallergosorbent test) inhibition using pooled sera from latex
allergic patients has convincingly shown that glove allergen values have
reproducible variations from manufacturer to manufacturer. The Guthrie
Research Institute also has confirmed these results by using rabbit
polyclonal sera to analyze extractable allergen. A third group from
Finland has utilized standardized extraction of gloves followed by in
vivo skin testing. The skin tests are graded by size of skin wheat
response and the number of people (known to be sensitive to latex) who
respond to a particular extract from gloves.
Certain general conclusions can be made. Many gloves are reproducible
highly allergenic while other latex gloves are not. This allergenicity
varies from lot to lot, glove type (ambidextrous vs. surgical glove) and
among companies. A hospital clinic or other medical facility has a
choice. They can ignore this important data or it can be utilized to
make an important buying decision. By utilizing gloves that clearly have
low allergen content, there is intuitively less chance of sensitizing a
patient. It is no longer acceptable to buy a glove only because it costs
less or an individual believes it feels better on his/her hand. The
price eventually will be paid in the form of workers compensation,
disability and litigation for not taking measures to limit a worker's
exposure to a sensitizing agent.
The data is available and all health care facilities need to act to stop
the sensitization to latex gloves.
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