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NEWS & INFORMATION
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Source To Surgery - February 1998, Vol. 6 Issue I
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Are Latex Gloves the Cause of Allergy?
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Gordon L. Sussman, M.D., F.R C.P. (C), Associate Professor, University of Toronto, Head Section of Allergy, Division of Immunology, The Wellesley Central Hospital, Toronto, Ont., Canada
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In my opinion there is no doubt that natural rubber latex (NRL) disposable gloves are a primary cause of latex sensitization in healthcare workers1,2. The data substantiating this claim comes from several sources. Firstly, measurable levels of allergenic proteins are found on nearly all NRL gloves 3,4. Healthcare workers have significant exposure to these allergens. Susceptible individuals produce specific IgE antibody to these NRL proteins5,6. Individuals may
then develop a spectrum of clinical manifestations including contact (dermatitis and urticaria), inhalant (rhinitis, conjunctivitis and asthma), and anaphylactic reactions7. Removing the glove powder or lowering the protein content of the NRL gloves significantly lowers the measurable latex allergen levels and enables clinically allergic
patients to return to their vocation of choice8,9.
Exposure to NRL proteins occurs by direct contact and inhalation 10. NRL proteins are bound to starch granules which are responsible for aerosolization of allergens11,12,13. A reduction in respiratory latex allergen not only would result in a decrease in sensitization but also a reduction in the incidence of occupational asthma14,15.
Gloves have higher levels of latex protein than most other products made from NRL9. Exposure to other NRL devices (catheters, rubber stoppers, syringe plungers) have been shown to have reduced
allergenic potential16,17. These devices would be unlikely to cause allergic sensitization.
In summary, I believe NRL gloves are a primary cause of latex sensitization. Restricting the use of NRL gloves to areas where blood borne pathogen protection is required, and reducing the protein and powder in available NRL gloves, are probably the most significant interventions which would result in a decline in sensitization and clinical manifestations of latex allergy.
REFERENCES
- Kelly KJ, Sussman GL, Fink JN: Stop the sensitization. J Allergy Clin Immunol 98(5):857-858, 1996.
- Sussman GL, Beezhold DH: Allergy to latex rubber. Ann Intern Med 122:43-46, 1995.
- Beezhold DH, Swanson M, Zehr BD, Kostyal D: Measurement of Natural Rubber proteins in latex glove extracts: Comparison of the methods. Ann Allergy 76:520-526, 1996.
- Yunginger JW, Jones RT, Frassway AF, Kelso JM, Warner MA, Hunt LW: Extractable latex allergens and proteins in disposable medical gloves and other rubber products. J Allergy Clin Immunol 93(5):836-842, 1994.
- Beezhold DH, Pugh B, Liss GM, Sussman GL: Correlation of protein levels with skin prick test reactions in patients allergic to latex. J Allergy Clin lmmunol 98(6): 1097-1102, 1996.
- Beezhold DH, Chang N-S, Kostyal DA, Sussman GL: Identification of a 46 kilodalton latex allergen in healthccare workers. Clin Exp. Immun. 98:408-413, 1994.
- Sussman GL, Tarlo SM, Dolovich J: The Spectrum of IgE-mediated Responses to Latex. JAMA 265:2844-2847, 1991.
- Swanson MC, Bubak ME, Hunt LW, Yunginger JW, Warner MA, Reed CE: Quantification of occupational latex aeroallergens in a medical center. J Allergy Clin Immunol 94(3):445-551, 1994.
- Heilman DK, Jones RT, Swanson MC, Yunginger JW: A prospective, controlled study showing that rubber gloves are the major contributor to latex aeroallergen levels in the operating room. J Allergy Clin Immunol 98(20:325-330, 1996.
- Tarlo SM, Sussman GL, Contala A, Swanson MC: Control of airborne latex by use of powder-free gloves. J Allergy Clin Immunol 93;985-989, 1994.
- Beezhold DH, Beck WC: Surgical glove powders bind latex antigens. Arch of Surg 127:1354-1357, 1992.
- Tomazic et al: Cornstarch Powder on Latex Products is an Allergen Carrier. J Allergy Clin Immunol 93:4 751-758, 1994.
- Bauer X, Ammon J, Chen Z, Beckman U, Czuppon AB: Health risk in hospitals through airborne allergens for patients presensitized to latex. Lancet342:1148-1149, 1993.
- Venables K, Chan-Yeung M: Occupational asthma. The Lancet 349:1465-1469, 1997.
- Vandenplas O, Delwiches JP, Evrared G, Aimont P, Van Der Brempt S, Jamart J, Delaunois L: Prevalence of occupational asthma due to latex among hospital personnel. Am J Respir Crit Care Med 151:54-60, 1995.
- Sussman GL, Beezhold DH, Perrella FW, Jones JM: IgE-dependent reactions to urologic catheter extracts by skin testing in latex-allergic patients. Ann Allergy, Asthma & Immunol 74(8):133-137, 1995.
- Jones JM, Sussman GL, Beezhold DH: Latex allergen levels of injectable collagen stored in syringes with rubber plungers. Adult Urology 47(6): 898-902, 1996.
- Sussman GL, Gold M: Guidelines for the Management of Latex Allergies and Safe Latex Use in Healthcare Facilities, Canadian Healthcare Association, 1996.
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