Research into life-threatening allergy to natural rubber latex began in
1983 in the Department of Dermatology at Tampere University Hospital, Tampere, Finland. At that time, Timo Reunala, M.D., Associate
Professor of Dermatology, ~cognized that latex allergy was the cause
of anaphylactic shock during surgical procedures in two nurses. Both
nurses had previously noticed immediate hive-like reactions with the
use of latex gloves which disappeared when the gloves were not used.
Despite the clinical histories presented by these patients, in those early
days it was difficult for other physicians to recognize that latex could
cause such acute reactions.
Based on these cases, our group suspected that other nurses and doctors
at the hospital had experienced symptoms with the use of latex gloves
and had switched to vinyl gloves or glove liners to avoid symptoms.
This idea was tested by using small pieces of wettened gloves on a 5 mm
scratch on the forearm of 512 health care workers at our hospital. The
test revealed that 23 had positive skin test reactions. All 23 were later
investigated at our skin clinic with several glove extracts by skin prick
and a use test with gloves; only 15 of the 512 (3%) were positive and
had relevant clinical histories. We concluded that the test methods can
influence the results and sometimes give false positive reactions. Only
one of the 15 had previously been evaluated by a dermatologist, while
the others had found surgical gloves which did not cause symptoms.
Most were convinced that glove powder caused their symptoms.
During that period of time, two brands of surgical gloves were used at
our hospital. One was tolerated by the 15 sensitized persons, the other
was considered to be a "bad" glove for all. The sensitization was high in
operating room nurses (5.6%) and in physicians (6.5%), because they also
frequently use gloves outside the operating room.
Our study further revealed that up to 25% of the health care workers studied complained of skin irritation under the gloves.
It is known that persons with dry skin may develop toxic, non-allergic
dermatitis as a result of repeated washing of hands and sweating under
occlusion of the gloves. Furthermore, glove powder can also add to the
symptoms. It is important to recognize that the symptoms are similar
whether the worker has immediate allergic sensitization to latex, delayed
type allergy to rubber chemicals used in natural rubber latex glove manufacture, or irritant dermatitis from repeated use of the gloves. The only way
to differentiate these conditions is to carry out specific diagnostic tests.
The hospital screening study was well received because the personnel,
especially the nurses, were gratified when someone was interested in the
symptoms induced by using gloves. They were standing in line to be tested,
as results were available in 15 minutes. To be honest, the surgeons were not
as easily persuaded to participate in testing as one might expect.
With the rising incidence of latex allergy, larger screening studies need to
be performed in the future.
