Stop the Sensitization

"Reproduced from The Journal of Allergy and Clinical Immunology, Kevin J. Kelly, MD, Gordon Sussman, MD, and Jordan N. Fink, MD, STOP THE SENSITIZATION, 1996, Volume 98, page 857, with permission from Mosby-Year Book, Inc."

Latex hypersensitivity has been implicated in occupationally-induced urticaria, rhinitis, asthma, and anaphylaxis.1-4 The disorder occurs in 8% to 12% of the healthcare worker population and is due to sensitization to a variety of latex proteins.5,6 Before the Occupational Safety and Health Administration mandate concerning protection of workers who have contact with body fluids, contact dermatitis, primarily caused by latex glove chemicals, was the most common form of adverse immune reaction to gloves in the healthcare worker population.7

In recent years it has become clear that latex protein, largely carried on the cornstarch used as donning powder in gloves, is inhaled and causes allergic sensitization.8 Alternatively, the sensitizing antigens of latex may penetrate the skin after being solubilized by sweat or may enter through the skin inflamed by the contact dermatitis reaction. In fact, it appears that contact dermatitis often precedes other skin or respiratory symptoms in the healthcare worker.9 Further, in recent years, exposure to latex protein antigens has been magnified by the marked increase in the use of examination gloves over surgical gloves, pointing to the increased exposure to latex from examination gloves as the major source of the rising rate of allergic sensitization. It would thus seem reasonable and immunologically sound to decrease glove allergenicity and worker exposure. This could be accomplished by elimination of glove powder or by use of alternative protective materials.

Recent studies measuring latex allergens in natural rubber latex gloves have demonstrated wide differences in allergen content among different brands.10,11 Air sampling of environments in which powdered gloves with high protein content were used detected greater amounts of airborne, and thus inhalable, allergen than in environments in which low-allergen, especially low-allergen non-powdered latex gloves were used.12,13

Individuals working in environments where they use high-allergen gloves have more symptoms than those in environments where measurable latex protein antigen levels have been reduced by the use of non-powdered or latex-free gloves.12,13 Furthermore, when patients allergic to latex practice strict latex protein avoidance, symptoms decrease, and evidence of immune sensitization, as manifested by skin reactivity to latex, diminishes.13-15 Most important; however, when sensitized healthcare workers continue to be exposed to latex, asthma may develop, which may progress and persist even after strict avoidance of the workplace and all nonhospital sources of latex. Once established, the asthma may be triggered by nonspecific stimuli, and pulmonary function may remain permanently impaired even after leaving the healthcare profession, as in other cases of occupational asthma.16 Thus healthcare workers have latex sensitivity that may result in progressive asthma, ending their career.

To control this serious and potentially disabling occupational disease, the process of sensitization, as well as treatment, of those healthcare workers already sensitized needs to be addressed. Low-antigen, nonpowdered latex gloves reduce inhalation of latex allergen and thus should significantly reduce the rate of sensitization of exposed healthcare workers and the progression of allergic disease in those already sensitized. All healthcare and especially hospital facilities should use only synthetic nonlatex or low-antigen, powder-free latex examination and surgical gloves. Reducing inhalation or contact with latex antigen should reduce sensitization and preserve functional capacity in health care workers who are at risk of sensitization. Because sensitized workers react to nonpowdered latex gloves,17 they should be given nonlatex gloves with the same barrier properties as latex. A number of manufacturers market such gloves (Table 1). However, recent powder-free latex glove storage difficulties with generation of heat may have compromised the barrier properties of such gloves, perhaps related to chlorination.18 Thus care should be taken in the choice of gloves. In spite of this problem, the universal use of nonlatex examination gloves with adequate barrier protection may be desirable because the majority of gloves used in healthcare are currently latex. If we are to reduce the problem of latex sensitivity in the nation's healthcare workers, measurers shown to be effective need to be instituted as soon as possible.

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References

  1. Eghari-Sabet S, Slater JE. Latex allergy: a potentially serious respiratory disorder. J Respir Dis 1993:14:473-82.
  2. Bubak ME, Reed CE, Fransway AF, Yunginger JW, Jones RT, Carlson CA, et aL Allergic reactions to latex among health care workers. May clinic Proc. 1992:67: 1075-9.
  3. Sussman G, Tarlo S, Kolonch J The spectrum of IgE-mediated responses to latex. JAMA 1991:265:2844-7.
  4. Ownby D, Tomlavich M., Sammons N, et aL Anaphylaxis associated with latex allergy during barium enema examinations. JAMA 1991:156:903-8.
  5. Alenius H, Turjanmaa K, Palosuo T, et aL Surgical latex glove allergy: characterization of rubber protein allergens by immunoblotting. Int Arch Allergy Appl Immunol 1991:96:376-82.
  6. Kurup VP, Murali PS, Kelly KJ, Latex antigens. In: Fink JN, editor. Latex allergy, Philadelphia: WB Saunders, 1995:45-59.
  7. Fisher AA, Allergic contact reactions in health personnel. J Allergy Clin Immnunol 1992:90:729-38.
  8. Beezhold DH, Beck WC. Surgical glove powders bind latex antigens. Arch. Surg 1992:127:1354-7.
  9. Charous BL, Hamilton RG, Yunginger JW. Occupational latex exposure characteristics with contact and systemic reactions in 47 workers. J Allergy Clin Immunol 1994:94:12-8.
  10. Turjanmaa K, Renula T, Alenius H, et al. Allergens in latex surgical gloves and glove powder. Lancet 1990:336:1588-90.
  11. Yunginger JW, Jones RT, Fransway AF, et al. Extractable latex allergen and proteins in disposable medical gloves and other rubber products. J Allergy Clin Immunol 1994:93:836-42.
  12. Swanson MC, Bubak ME, Hunt LW, et al. Quantification of occupational latex aeroallergens in a medical center. J Allergy Clin Immunol 1994:94:445-551.
  13. Tarlo SM, Sussman G, Contala A, Swanson MC. Control of airborne latex protein exposure by use of low protein powder free gloves [abstract]. J Allergy Clin Immunol 1996:97:429.
  14. Siu SR, Smith GJ, Sussman GL, et al. Reduction in airborne latex protein exposure by use of low protein powder free gloves [abstract]. J Allergy Clin Immunol 1996:97:325.
  15. Zeldin RK, Hamilton RG, Adkinson NF Jr. The effect of avoidance on the natural history of latex rubber allergy [abstract]. J Allergy Clin Immunol 1996;97:429.
  16. Chan-Yeung M, Malo Jr. Current concepts: Occupational asthma. N Engl J Med 1995:333:107-12.
  17. Gehring LL, Fink JN, Kelly KJ. Evaluation of low allergenic gloves in latex sensitive patients [abstract]. J Allergy Clin Immunol 1996:97:186.
  18. FDA Public Health Advisory. Potential risk of spontaneous combustion in large quantities of patient examination gloves [letter]. Med Watch June 27, 1996.

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