Latex Allergy
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Latex products are manufactured from a milky fluid derived from the rubber
tree, Hevea brasiliensis. Several chemicals are added to this fluid
during the processing and manufacture of commercial latex. Some proteins in
latex can cause a range of mild to severe allergic reactions. Currently available
methods of measurement do not provide easy or consistent identification of
allergy-causing proteins (antigens) and their concentrations. Until well accepted
standardized tests are available, total protein serves as a useful indicator
of the exposure of concern. The chemicals added during
processing may also cause skin rashes. Several types of synthetic rubber are
also referred to as "latex," but these do not release the proteins that cause
allergic reactions.
A wide variety of products contain latex: medical supplies, personal protective
equipment, and numerous household objects. Most people who encounter latex
products only through their general use in society have no health problems
from the use of these products. Workers who repeatedly use latex products are
the focus of this Alert. The following are examples of products that may contain
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
Individuals who already have latex allergy should be aware of latex-containing
products that may trigger an allergic reaction. Some of the listed products
are available in latex-free forms.
Workers in the health care industry (physicians, nurses, dentists, technicians,
etc.) are at risk for developing latex allergy because they use latex gloves
frequently. Also at risk are workers with less frequent glove use (hairdressers,
housekeepers, food service workers, etc.) and workers in industries that manufacture
latex products.
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Three types of reactions can occur in persons using latex products:
- Irritant contact dermatitis
- Allergic contact dermatitis (delayed hypersensitivity)
- Latex allergy
The most common reaction to latex products is irritant contact dermatitis --
the development of dry, itchy, irritated areas on the skin, usually the hands.
This reaction is caused by skin irritation from using gloves and possibly by
exposure to other workplace products and chemicals. The reaction can also result
from repeated hand washing and drying, incomplete hand drying, use of cleaners
and sanitizers, and exposure to powders added to the gloves. Irritant contact
dermatitis is not a true allergy.
Allergic contact dermatitis (delayed hypersensitivity, also sometimes
called chemcial sensitivity dermatitis) results from exposure to chemicals
added to latex during harvesting, processing, or manufacturing. These chemicals
can cause skin reactions similar to those caused by poison ivy. As with poison
ivy, the rash usually begins 24 to 48 hours after contact and may progress
to oozing skin blisters or spread away from the area of skin touched by the
latex.
Latex allergy (immediate hypersensitivity) can be a more serious reaction
to latex than irritant contact dermatitis or allergic contact dermatitis. Certain
proteins in latex may cause sensitization (positive blood or skin test, with
or without symptoms). Although the amount of exposure needed to cause sensitization
or symptoms is not known, exposures at even very low levels can trigger allergic
reactions in some sensitized individuals.
Reactions usually begin within minutes of exposure to latex, but they can
occur hours later and can produce various symptoms. Mild reactions to latex
involve skin redness, hives, or itching. More severe reactions may involve
respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat,
and asthma (difficult breathing, coughing spells, and wheezing). Rarely, shock
may occur; but a life-threatening reaction is seldom the first sign of latex
allergy. Such reactions are similar to those seen in some allergic persons
after a bee sting.
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Studies of other allergy-causing substances provide evidence that the higher
the overall exposure in a population, the greater the likelihood that more individuals
will become sensitized . The amount of latex exposure needed to produce sensitization
or an allergic reaction is unknown; however, reductions in exposure to latex
proteins have been reported to be associated with decreased sensitization and
symptoms.
The proteins responsible for latex allergies have been shown to fasten to
powder that is used on some latex gloves. When powdered gloves are worn, more
latex protein reaches the skin. Also, when gloves are changed, latex protein/powder
particles get into the air, where they can be inhaled and contact body membranes.
In contrast, work areas where only powder-free gloves are used show low levels
or undetectable amounts of the allergy-causing proteins.
Wearing latex gloves during episodes of hand dermatitis may increase skin
exposure and the risk of developing latex allergy. The risk of progression
from skin rash to more serious reactions is unknown. However, a skin rash may
be the first sign that a worker has become allergic to latex and that more
serious reactions could occur with continuing exposure.
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Workers with ongoing latex exposure are at risk for developing latex allergy.
Such workers include health care workers (physicians, nurses, aides, dentists,
dental hygienists, operating room employees, laboratory technicians, and hospital
housekeeping personnel) who frequently use latex gloves and other latex-containing
medical supplies. Workers who use latex gloves less frequently (law enforcement
personnel, ambulance attendants, funeral-home workers, fire fighters, painters,
gardeners, food service workers, and housekeeping personnel) may also develop
latex allergy. Workers in factories where latex products are manufactured or
used can also be affected.
Atopic individuals (persons with a tendency to have multiple allergic conditions)
are at increased risk for developing latex allergy. Latex allergy is also associated
with allergies to certain foods especially avocado, potato, banana, tomato,
chestnuts, kiwi fruit, and papaya. People with spina bifida are also at increased
risk for latex allergy.
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Latex allergy should be suspected in anyone who develops certain symptoms
after latex exposure, including nasal, eye, or sinus irritation; hives; shortness
of breath; coughing; wheezing; or unexplained shock. Any exposed worker who
experiences these symptoms should be evaluated by a physician, since further
exposure could result in a serious allergic reaction. A diagnosis is made by
using the results of a medical history, physical examination, and tests.
Taking a complete medical history is the first step in diagnosing latex allergy.
In addition, blood tests approved by the Food and Drug Administration (FDA)
are available to detect latex antibodies. Other diagnostic tools include a
standardized glove-use test or skin tests that involve scratching or pricking
the skin through a drop of liquid containing latex proteins. A positive reaction
is shown by itching, swelling or redness at the test site. However, no FDA-approved
materials are yet available to use in skin testing for latex allergy. Skin
testing and glove-use tests should be performed only at medical centers with
staff who are experienced and equipped to handle severe reactions.
Testing is also available to diagnose allergic contact dermatitis. In this
FDA-approved test, a special patch containing latex additives is applied to
the skin and checked over several days. A positive reaction is shown by itching,
redness, swelling, or blistering where the patch covered the skin.
Occasionally, tests may fail to confirm a worker who has a true allergy to
latex, or tests may suggest latex allergy in a worker with no clinical symptoms.
Therefore, test results must be evaluated by a knowledgeable physician.
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Once a worker becomes allergic to latex, special precautions are needed to
prevent exposuresduring work as well as during medical or dental care. Certain
medications may reduce the allergy symptoms, but complete latex avoidance (though
quite difficult) is the most effective approach. Many facilities maintain latex-safe
areas for affected patients and workers.
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The prevalence of latex allergy has been studied by several methods:
- Questionnaires to assess reactions to latex gloves
- Medical histories of reactions to latex-containing products
- Skin tests
- Tests for latex antibodies in a worker's blood
Reports about the prevalence of latex allergy vary greatly. This variation
is probably due to different levels of exposure and methods for estimating
latex sensitization or allergy. Recent reports in the scientific literature
indicate that from about 1% to 6% of the general population and about 8% to
12% of regularly exposed health care workers are sensitized to latex. Among
sensitized workers, a variable proportion have symptoms or signs of latex allergy.
For example, one study of exposed hospital workers found that 54% of those
sensitized had latex asthma, with an overall prevalence of latex asthma of
2.5% . Prevalence rates up to 11% are reported for non-health care workers
exposed to latex at work .
Several reasons may exist for the large numbers of latex allergies recently
reported in workers :
1. Workers rely increasingly on latex gloves to prevent the transmission of
human immunodeficiency virus (HIV), hepatitis B virus, and other infectious
agentsas
outlined in Recommendations for Prevention of HIV Transmission in Health-Care
Settings and in Guidelines for Prevention of Transmission of Human Immunodeficiency
Virus and Hepatitis B Virus to Health-Care and Public-Safety Workers.
2. Since 1992, the Occupational Safety and Health Administration (OSHA)
has required employers to provide gloves and other protective measures for
their employees.
3. Some manufacturers may have produced more allergenic gloves because of
changes in raw materials, processing, or manufacturing procedures to meet
the increased demand for latex gloves. These production changes may account
partly for the varied concentrations of extractable latex proteins reported
for latex gloves (up to a 3,000-fold difference in gloves from various manufacturers).
Variations may also exist between lots produced by the same manufacturer.
4. Physicians are more familiar with latex allergy and have improved methods
for diagnosing it.
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The following case reports briefly describe the experiences of six workers
who developed latex allergy after occupational exposures. These cases are
not representative of all reactions to latex but are examples of the most
serious types of reactions. They illustrate what has occurred in some individuals.
Case No. 1
A laboratory technician developed asthma symptoms after wearing latex gloves
while performing blood tests. Initially, the symptoms occurred only on contact
with the gloves; but later, symptoms occurred when the technician was exposed
only to latex particles in the air.
Case No. 2
A 33-year-old woman sought medical treatment for occupational asthma after
6 months of periodic cough, shortness of breath, chest tightness, and occasional
wheezing. She had worked for 7 years as an inspector at a medical supply
company, where her job included inflating latex gloves coated with cornstarch.
Her symptoms began within 10 minutes of starting work and worsened later
in the day (90 minutes after leaving work). Symptoms disappeared completely
while she was on a 12-day vacation, but they returned on her first day back
at work.
Case No. 3
A nurse developed hives in 1987, nasal congestion in 1989, and asthma in
1992. Eventually she developed severe respiratory symptoms in the health
care environment even when she had no direct contact with latex. The nurse
was forced to leave her occupation because of these health effects.
Case No. 4
A midwife initially suffered hives, nasal congestion, and conjunctivitis.
Within a year, she developed asthma, and 2 years later she went into shock
after a routine gynecological examination during which latex gloves were
used. The midwife also suffered respiratory distress in latex-containing
environments when she had no direct contact with latex products. She was
unable to continue working.
Case No. 5
A physician with a history of seasonal allergies, runny nose, and eczema
on his hands suffered severe runny nose, shortness of breath, and collapse
minutes after putting on a pair of latex gloves. He was successfully resuscitated
by a cardiac arrest team.
Case No. 6
An intensive care nurse with a history of runny nose, itchy eyes, asthma,
eczema, and contact dermatitis experienced four severe allergic reactions
to latex. The first reaction began with asthma severe enough to require treatment
in an emergency room. The second and third reactions were similar to the
first. The fourth and most severe reaction occurred when she put on latex
gloves at work. She went into severe shock and was successfully treated in
an emergency room.
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Latex allergy in the workplace can result in potentially serious health
problems for workers, who are often unaware of the risk of latex exposure.
Such health problems can be minimized or prevented by following the recommendations
outlined in this Alert.
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The following recommendations for preventing latex allergy in the workplace
are based on current knowledge and a common-sense approach to minimizing
latex-related health problems. Evolving manufacturing technology and improvements
in measurement methods may lead to changes in these recommendations in the
future. For now, adoption of the recommendations wherever feasible will contribute
to the reduction of exposure and risk for the development of latex allergy.
Employers
Latex allergy can be prevented only if employers adopt policies to protect
workers from undue latex exposures. NIOSH recommends that employers take
the following steps to protect workers from latex exposure and allergy in
the workplace:
1. Provide workers with nonlatex gloves to use when there is little potential
for contact with infectious materials (for example, in the food service industry).
2. Appropriate barrier protection is necessary when handling infectious
materials. If latex gloves are chosen, provide reduced protein, powder-free
gloves to protect workers from infectious materials.
3. Ensure that workers use good housekeeping practices to remove latex-containing
dust from the workplace:
- Identify areas contaminated with latex dust for frequent cleaning (upholstery,
carpets, ventilation ducts, and plenums).
- Make sure that workers change ventilation filters and vacuum bags frequently
in latex-contaminated areas.
4. Provide workers with education programs and training materials about
latex allergy.
5. Periodically screen high-risk workers for latex allergy symptoms. Detecting
symptoms early and removing symptomatic workers from latex exposure are
essential for preventing long-term health effects.
6. Evaluate current prevention strategies whenever a worker is diagnosed
with latex allergy.
Workers
Workers should take the following steps to protect themselves from latex
exposure and allergy in the workplace:
1. Use nonlatex gloves for activities that are not likely to involve
contact with infectious materials (food preparation, routine housekeeping,
maintenance, etc.).
2.Appropriate barrier protection is necessary when handling infectious materials.
If you choose latex gloves, use powder-free gloves with reduced protein content:
- Such gloves reduce exposures to latex protein and thus reduce the risk
of latex allergy (though symptoms may still occur in some workers).
- So-called hypoallergenic latex gloves do not reduce the risk of latex
allergy. However, they may reduce reactions to chemical additives in the
latex (allergic contact dermatitis).
3. Use appropriate work practices to reduce the chance of reactions to latex:
- When wearing latex gloves, do not use oil-based hand creams or lotions
(which can cause glove deterioration) unless they have been shown to reduce
latex-related problems and maintain glove barrier protection.
- After removing latex gloves, wash hands with a mild soap and dry thoroughly.
- Use good housekeeping practices to remove latex-containing dust from
the workplace:
- Frequently clean areas contaminated with latex dust (upholstery,
carpets, ventilation ducts, and plenums).
- Frequently change ventilation filters and vacuum bags used in latex-contaminated
areas.
4.Take advantage of all latex allergy education and training provided by
your employer:
- Become familiar with procedures for preventing latex allergy.
- Learn to recognize the symptoms of latex allergy: skin rashes; hives;
flushing; itching; nasal, eye, or sinus symptoms; asthma; and shock.
5. If you develop symptoms of latex allergy, avoid direct contact with latex
gloves and other latex-containing products until you can see a physician
experienced in treating latex allergy.
6. If you have latex allergy, consult your physician regarding the following
precautions:
- Avoid contact with latex gloves and other latex-containing products.
- Avoid areas where you might inhale the powder from latex gloves worn
by other workers.
- Tell your employer and your health care providers (physicians, nurses,
dentists, etc.) that you have latex allergy.
- Wear a medical alert bracelet.
7. Carefully follow your physician's instructions for dealing with allergic
reactions to latex.
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Centers
for Disease Control & Prevention
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