December 26 , 2001
Need-to-Know Facts about Health Risks Associated with Latex
Peter P. Greaney , MD
Board-Certified Occupational Physician
President, WorkCare
In 1987, the Centers for Disease Control and Prevention recommended that blood and certain bodily fluids from all individuals should be approached as if potentially infectious. This universal precaution lead to the Occupational Safety and Health Administration's (OSHA) standard for bloodborne pathogens, requiring employers to provide gloves and other barrier protective measures for employees who may come in contact with blood or other potentially infectious material. The subsequent increased use of latex gloves as a barrier protection method has been linked to a significant rise in latex allergies among workers. In one study among health care workers 1 , the prevalence of sensitization to latex ranged from 5 to 12 percent. Employers who use or manufacture latex products in their workplace should be aware of the potential health hazards posed to workers and adopt appropriate policies and procedures to protect workers from undue latex exposures.
Natural Rubber Latex Allergies
Natural Rubber Latex (NRL) is produced from a milky fluid derived from the rubber tree, Hevea brasiliensis . The proteins within NRL are the primary cause of latex allergies. Latex allergies ranges from mild to severe, and rarely can be fatal. There are three types of allergic reactions: (1) Irritant contact dermatitis, (2) Allergic contact dermatitis, (3) Latex allergy.
The most common reaction to latex is irritant contact dermatitis, which is caused by skin irritation from using the gloves or from contact with glove powder. Irritant contact dermatitis can also be caused from soaps, detergents, chemicals or incomplete hand drying. This reaction results in the development of dry, itchy, irritated areas, usually on the hands. Although this reaction is not considered a true allergy, it can lead to the development of latex sensitization if NRL proteins enter a person's system through broken, irritated skin.
Allergic contact dermatitis (also known as type IV delayed hypersensitivity) is a reaction to the chemicals used in latex during the harvesting, processing or manufacturing of the product. Exposures to these chemicals (usually from gloves) can cause reactions similar to poison ivy—blistering and oozing lesions. Similar to poison ivy, the rash usually begins 24-48 hours after contact with gloves or exposure from other chemical sources.
Latex allergy is the most serious form of reaction associated with NRL. This type of reaction is a true IgE /histamine-mediated allergy caused by sensitivity to glove protein or NRL. The symptoms may be localized, and include hives, skin redness or itching. Generalized respiratory symptoms may also occur, such as runny nose, sneezing, itchy eyes, scratchy throat and asthma. In some cases, anaphylaxis may occur, a reaction similar to someone who is allergic to bees and stung by the insect.
Routes of Exposure
Dermal and inhalation are the primary routes of exposure. Powder that is used in gloves has shown to be a vehicle for latex protein; thus more latex reaches the skin using coated gloves, as compared to powder-free types. In addition, when powdered gloves are used, there is a greater chance for respiratory exposure because the powder acts as an airborne vehicle of the latex protein. 2 ,3 The use of powder-free gloves has proven to decrease the potential for allergic reactions because of the reduction of NRL proteins released in the environment.
Latex Protein Sensitization and Risk Factors
The amount of latex protein needed to produce sensitization or allergic reaction is unknown. Current methods of testing do not provide a sound approach to identify allergy-causing proteins and their concentration in latex products. Though, it has been determined that continued exposure to latex protein, once sensitized, increases the likelihood of symptom exacerbation. This evidence supports OSHA's recommendation to select low-protein content gloves, if an employer chooses to use NRL gloves.
Laboratory evidence indicates that an association exists between allergies to natural rubber proteins and allergy to certain foods and plants (e.g., avocado, banana, kiwi, chestnut), and some aeroallergens (e.g., pollens and grasses). Atopic individuals (persons with a tendency to have multiple allergic conditions) are also at increased risk for developing latex allergy, as well as people with spina bifida because of the increased exposure.
Employees with continuing exposure to latex are also at risk of developing latex allergy. These groups include healthcare (physicians, nurses, aides, dentists, dental hygienists, operating room employees, laboratory technicians), as well as employees in food service, day-care settings, housekeeping and workers in latex manufacturing environments.
There are a variety of products that contain latex—from hospital emergency equipment, personal protective equipment, office and hospital supplies and household items. These products generally do not cause health problems when used in normal situations. However, workers who repeatedly use latex products and are sensitized may have reactions to these objects.
Prevention, Diagnosis and Treatment of Latex Allergy
In all types of latex allergies, health officials stress the importance of prevention—reducing the unnecessary exposure to latex and detecting symptoms early. Periodically screening high-risk workers through questionnaires can prevent long-term health effects associated with NRL.
If an employee is suspected of latex allergy, medical advice should be sought. A physician should evaluate individuals with exposure to latex who develop symptoms, since further exposure could lead to severe allergic reaction. A physician will use medical history information, physical examination and tests to determine a worker's sensitization to NRL. If a worker becomes sensitized to NRL, certain medications may reduce allergy symptoms, but avoidance of latex products is the most effective treatment—although not an easy one.
Recommended Strategies - Risk Reduction
According to OSHA, primary prevention is key to reducing potential development of latex allergy. OSHA has provided the following guidelines that employers can use to reduce worker exposure to NRL proteins and their associated health risks:
(1) If selecting NRL gloves for worker use, designating NRL as a choice only in those situations requiring protection from infectious agents;
(2) When selecting NRL gloves, choosing those that have lower protein content. Selecting powder free gloves offers the additional benefit of reducing systemic allergic responses; and
(3) Providing alternative suitable non-NRL gloves as choices for worker use (and as required by OSHA's bloodborne pathogens standard [29 CFR 1910.1030, paragraph (d )( 3)(iii)] for workers who are allergic to NRL gloves).
(4) Implementing appropriate work policies/practices for employees wearing hand protective equipment, including NRL gloves. Practices should include avoidance of contact with other body areas such as the eyes or face and hand washing after glove is removed. Thorough clean-up of any residual powder in the workplace with appropriate vacuum filters will decrease employee exposure as well.
(5) Educate workers about the signs, symptoms and hazards of latex allergies.
Other Useful Prevention Measures
In addition to these measures, the American College of Occupational and Environmental Medicine encourages employers to “provide pre-placement evaluations (i.e., questionnaire should be adequate in most cases) to identify pre-existing latex allergy or risk factors associated with the development of latex allergy for all workers whose job requires routine exposure to NRL.”
The American College of Allergy, Asthma and Immunology has suggested that safe zones (areas in which non-NRL products are used and NRL proteins removed from the environment) be established to protect those workers who are already sensitive to NRL.
Click here for the complete OSHA Technical Information Bulletin on: Potential for Allergy to Natural Rubber Latex Gloves and other Natural Rubber Products.
1 Liss GM. Sussman GL. Latex sensitization: occupational versus general population prevalence rates. American Journal of Industrial Medicine. 35(2):196-200, 1999.
2 Allmers H, Brehler R, Chen Z, et al. "Reduction of latex aeroallergens and latex-specific IgE antibodies in sensitized workers after removal of powdered natural rubber latex gloves in a hospital." J Allergy Clin Immunol . 1998 Nov; 102(5): 841-6
3 McCormack B, Cameron M, Biel L. "Latex sensitivity: an occupational health strategic plan." AAOHN J. 1995 Apr; 43(4): 190-6
Products Containing Latex
Emergency Equipment
Blood pressure cuffs
Stethoscopes
Disposable gloves
Oral and nasal airways
Endotracheal tubes
Tourniquets
Intravenous tubing
Syringes
Electrode pads
Personal Protective Equipment
Gloves
Surgical masks
Goggles
Respirators
Rubber aprons
Office Supplies
Rubber bands
Erasers
Hospital Supplies
Anesthesia masks
Catheters
Wound drains
Injection ports
Rubber tops of multidose vials
Dental dams
Household Objects
Automobile tires
Motorcycle and bicycle handgrips
Carpeting
Swimming goggles
Racquet handles
Shoe soles
Expandable fabric (waistbands)
Dishwashing gloves
Hot water bottles
Condoms
Diaphragms
Balloons
Pacifiers
Baby bottle nipples
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