As discussed in previous articles, it is a fact that certain brands of
latex exam and surgical gloves are among the primary source of latex
protein sensitization of patients and health care workers.
Skin irritation and allergy may produce similar symptoms. It is
important for people with skin irritation who frequently contact natural
rubber latex products, especially latex gloves, to determine whether
skin reactions signify irritation or allergy and take proper steps to
diagnose and remedy the condition.
Non-allergic Dermatitis
Possible Symptoms: Dry, crusty, hard bumps and horizontal cracks
on skin which may manifest itself a itchy dermatitis on the back of the
hands under the gloves. This is the most common form of perceived
allergy; but, in fact, it is not an allergy. This condition may affect
up to 35% of the gloving population at some time during glove usage.
Cause: Frequent hand washing, strong surgical scrubbing agents,
soaps, detergents, glove powder and occlusion caused by gloves.
Diagnosis: Symptoms may mimic chemical allergy and, therefore,
require a dermatologist to make a definitive diagnosis.
Solution: Identify irritability factor and reduce or eliminate
contact.
Allergic Contact Dermatitis Type IV
Hypersensitivity: Chemical Allergy
Contact dermatitis has been described in literature since 1930. It is
most commonly produced by latex gloves, shoes and medical devices and
occurs one to two days after contact with the offending product. This
allergy is a Type IV delayed-type cell mediated hypersensitivity
reaction typically due to excess residual chemicals utilized as
accelerators and antioxidants in the manufacturing process. When not
removed from the product by washing or leaching process, these
chemicals, usually thirurams, carabamates or benzothiazoles, are
responsible for most cases of allergic contact dermatitis.
Possible Symptoms: Eczema - red rash, palpable areas with bumps,
sores and horizontal cracks under the glove contact area and may extend
up the forearm. Appears several hours to several days after contact with
offending chemicals.
Cause: Low molecular weight chemicals not removed during
manufacturing process from the final product.
Diagnosis: Based on clinical history, morphology of the lesions
and their distribution. Specific diagnosis is established by
epicutaneous patch testing with rubber chemicals by a dermatologist.
Solution: Utilize gloves which have been proven not to contain
these excess chemicals (currently called hypoallergenic) or change to
non-latex gloves. Caution: some non-latex gloves may also contain
chemicals other than those listed which in some instances may also evoke
reactions.
Allergy To Natural Rubber Latex Proteins Type I Hypersensitivity:
Contact Urticaria, Protein Contact Dermatitis
Type I reactions to natural rubber latex were first reported in Germany
in 1927. The next published cases appeared 52 years later. It was only
in the mid-1980s that a more thorough study of latex protein allergy was
conducted and published by Dr. Turjanmaa in Finland. The earliest North
American reports were I published in 1989. Over the next | four years,
the US Food and Drug | Administration (FDA) received | reports of over
1,100 injuries and 16 l deaths associated with latex protein I allergy.
Possible Symptoms: These may vary from mild urticaria (wheat and
flare reaction, hives) and eczema to rhinitis, conjunctivitis, facial
swelling, respiratory distress, asthma or anaphylaxis.
Diagnosis: In a separate section of this edition, diagnostic
techniques are discussed in detail Diagnosis of Latex Allergy. However, many of
the techniques still lack either sensitivity or specificity. The lack of
standardized allergen for testing is a major impediment to current
diagnosis techniques. However, today the most accurate technique is the
Skin Prick Test Tests Available for Diagnostics of Individuals With NRL Allergy developed by Dr.
Turjanmaa.
Possible Solutions: Change to lesser allergenic gloves or avoid
all contact with latex in both hospital and home environments.
Summary
Latex glove allergens, both chemical and protein, can be managed and
controlled by selection of gloves which have been properly manufactured.
It is obligatory for hospitals to increase their diligence in selection
of appropriate gloves.
*Case studies prodded by K Turjanmaa, MD, University of
Tampers, Finland.
