To date, few allergic reactions to polyvinyl chloride (PVC) gloves have been reported. However, with the increasing number of latex allergic individuals seeking alternative gloving options, and continued increased glove usage due to the Universal Precautions mandate, it is expected that the incidence of vinyl glove
allergies will increase.
PVC gloves are being offered as an alternative to natural rubber latex (NRL). However it is important to know the risk related to PVC. Reports of contact dermatitis and contact urticaria syndrome due to PVC have been published previously, and respiratory tract illness was induced from unheated PVC. In animal examinations, PVC-induced lung tumors have been developed. In this paper, we introduce the advantages and disadvantages of PVC.
Additives and contaminants of PVC
Polyvinyl chloride (PVC) is made through the polymerization of vinyl chloride monomer. It is a plastic material softened by heating. The addition of a small amount (<5%) of plasticizer makes a hard PVC, whereas the addition of 30%~50% plasticizer results in a soft PVC for use in making film, sheets, chemical shoes, plastic gloves, etc. Plasticizers, such as di(2-ethylhexyl)phthalate (DOP), butyl benzyl phthalate (BBP), din-butyl maleate (DBM), are used in making a soft PVC. Other ingredients and contaminants such as organic pigment,1 pigment,2 BHT,3 oleylamide,3 mercury4 are also used in the manufacturing process. Even protein contaminates in plastic gloves.
PVC Manufacturing process
PVC is produced by the free radical polymerization of vinyl chloride monomer. Vinyl resins are classified into four grades that reflect particle size. Dispersion grade vinyl resin, with fine particles ranging from 0.1 to 2µm, is used to produce vinyl gloves.6 The high-molecular-weight polymer is mixed with low-molecular-weight plasticizer to form a liquid plastisol. Either oil-soluble or water-soluble initiators start the polymerization reaction. Common initiators are 2-ethylhexyl per-oxidicarbonate or peroxyester such as tertiary butylperoxyneodecanoate. At the end of polymerization, the residual monomer must be removed because of its toxicity.
Depending on the type of resin and plasticizer, gelatin occurs between 160°F and 200°F. PVC gloves are dip molded like natural rubber latex (NRL) gloves.
Contact dermatitis due to PVC
While reports of allergic reactions to PVC gloves are few, PVC allergies are not rare. Kanerva1 reported a case of contact dermatitis caused from an organic pigment in PVC gloves and Estlander7
reported five cases of allergic eczema from PVC gloves. However, the real causes of the allergic reactions were not detected except in one case of sensitization from orange pigment. Koch4 reported a case of contact dermatitis on both feet due to mercury chloride from a new pair of PVC boots. Within a few days, this case developed mercury exanthema involving legs, groin and lateral parts of the trunk. Patch tests showed a strong positive reaction to mercuric chloride 0.01%pet. Mercuric chloride was identified by atomic absorption spectrometry and polarography in the boots worn. Tung8 reported a case of allergic contact dermatitis caused by PVC. Patch tests in this case were positive for three of four bands tested, resorcinol monobenzoate and benzoyl peroxide. However, manufacturers could not confirm the presence of resorcinol monobenzoate and benzoyl peroxide in their respective bands. It was concluded that the patient's reaction was allergic and due to unknown chemicals in the bands. In Japan, Monma9 reported two cases of contact dermatitis due to PVC gloves. In one case, rubber gloves were substituted and the dermatitis improved.
Contact urticaria due to PVC
Contact urticaria due to natural rubber latex has been well documented. Contact urticaria due to PVC has also been reported. Mitchell10 reported a case of contact urticaria from plastic curtains. The patient showed immediate reactions to the curtains but as the source of manufacture could not be identified, no further investigations were attempted. Sugiura11 reported a case of contact urticaria due to di(2-eth-ylhexyl) phthalate (DOP) in a vinylchloride slip-guard of a pair of cotton gloves. The patient, a 49-year-old male automobile tire wholesaler, exhibited clinical symptoms of Stage III contact urticaria.12 His doctor diagnosed his condition as chronic urticaria and treated him with oral antihistamines. However his condition did not improve. He was hospitalized because of generalized urticaria and severe gastrointestinal symptoms (severe diarrhea), and was injected with corticosteroid intravenously. Simultaneously, he was treated with an oral antihistamine and an oral antiallergenic. His condition improved temporarily, but after three weeks of treatment in the hospital, his urticaria developed at work while wearing cotton gloves. The doctor suspected he had contact urticaria syndrome due to the cotton gloves. IgE RAST of latex, tomato, banana, apple, grapefruit, chestnut, apteryx, avocado and peach were all negative. The usage test of the cotton glove on his hand resulted in a negative reaction. However, after 20 minutes of rubbing his forearm with the PVC slip-guard wheal and flare developed. The extracted solution of the PVC by acetone and methanol was separated by column chromatography. Di(2-ethylhexyl) phthalate (DOP), butyl benzyl phtalate (BBP) and oil were detected in the extract and separated solutions. The positive reactions to di(2-ethyl-hexyl) phthalate (DOP) were confirmed by the scratch testing.
Other disorders due to PVC
It is well known that the thermal decomposition fumes of PVC can cause respiratory tract illness. Lee13 reported that unheated PVC resin dust caused asthma in a patient exposed to the dust during the mixing of chemicals used to make plastic seals for bottle caps. Maltoni14 reported PVC-produced lung tumors in mice and an epidemiological evidence of lung tumors among exposed workers.
Conclusion
The soft PVC is easily processed and can be fashioned to any shape. PVC is water, acid and alkali resistant. It is transparent and easily stained by any color. Therefore, we use this soft PVC to make film, bath curtains, chemical shoes, protective gloves, vinyl housing, etc. When PVC is processed, many kinds of plasticizers are added according to the required end use. Phtalic esters such as di(2-eth-ylhexyl) phthalate (DOP) , butyl benzyl phtalate (BBP) , dimethyl phtalate (DMP), and maleic esters such as di-butyl-maleate (DBM) are usually used as plasticizers in making protective gloves.
The efficacy of PVC gloves as an alternative for natural rubber latex (NRL) gloves for individuals sensitized to NRL is claimed in previous reports. However, PVC itself can also cause sensitization in some individuals. Before promoting PVC as a safe alternative for all individuals, further research must be undertaken to identify possible allergenic reactions.
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