Management of occupational allergy to natural rubber latex in a medical center: The importance of quantitative latex allergen measurement and objective follow-up

Allergic Diseases Research Laboratory and the Departments of Pediatrics and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Journal of Allergy and Clinical Immunology (Impact Factor: 11.48). 09/2002; 110(2 Suppl):S96-106. DOI: 10.1067/mai.2002.125442
Source: PubMed


When our employees began coming to the Occupational Health Service, Dermatology, and Allergy Clinics with symptoms of allergy to rubber gloves 12 years ago, the Mayo Clinic initiated 3 responses. (1) The Allergic Disease Research Laboratory adapted well-established technology to measure both the IgE antibody specific to natural rubber allergens, and by use of this IgE antibody, the allergens in rubber products and in the air of the workplace. (2) The Division of Allergic Diseases and Internal Medicine reviewed the prevalence and severity of the problem. (3) The Clinical Practice Committee appointed a multidisciplinary task force to implement measures to reduce exposure. The 3 sections of this article describe the Mayo Clinic's experience of successful control of this occupational health problem. Use of only gloves with low or undetectable allergen content greatly reduced the concentration of allergen in the work site, reduced the number of new cases of occupational allergy to rubber, and allowed individuals with latex allergy to work at their usual jobs.

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    • "Many hospitals and laboratories are now replacing latex with nitrile gloves, and several studies have documented a reduction in the incidence of latex allergy when implementing this policy (Allmers et al., 2002; Hunt et al., 2002). It is envisaged that more institutions will switch from using latex to nitrile gloves in the future. "
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    ABSTRACT: An increase in the occurrence of latex allergy has been concurrent with the increasing use of latex gloves by laboratory and healthcare workers. In recent years nitrile gloves have been used to replace latex gloves to prevent latex allergy. Nitrile gloves offer a comparable level of protection against chemical and biological agents and are more puncture resistant. However, if manual dexterity is compromised by nitrile gloves to a greater degree than latex then this may increase the risk of sharps injuries. The Purdue pegboard test, which measures both gross and fine finger dexterity, was used to test the dexterity levels of two glove types used at HPA CEPR; Kimberly-Clark SafeSkin nitrile and latex laboratory gloves. There was a statistically significant 8.6% increase in fine finger dexterity provided by latex compared with nitrile SafeSkin laboratory gloves but no difference in gross dexterity between the glove types. There was no significant relationship between glove dexterity and age or gender. The selection of glove size was influenced by the digit length of participants. Moreover, those with longer, thinner fingers appeared to have an advantage when using nitrile SafeSkin gloves. The level of dexterity provided by latex and nitrile SafeSkin gloves for tasks on a gross dexterity level are comparable and health workers will benefit from the non-allergenic properties of nitrile. For tasks requiring fine finger dexterity nitrile SafeSkin gloves may impede dexterity. Despite this, the degree of restriction appears to have a negligible impact on safety in this study when compared with the risk of latex sensitization and subsequent allergy. In addition to glove material, working practices must also take into account glove size, fit, grip and thickness, as these factors can all influence dexterity.
    Annals of Occupational Hygiene 05/2006; 50(3):289-96. DOI:10.1093/annhyg/mei066 · 2.10 Impact Factor
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    • "Latex aeroallergen levels are significantly reduced when medical centers eliminate powdered NRL gloves from the work environment, replacing them with nonpowdered synthetic rubber gloves (Swanson et al. 1994). This workplace modification has been found to be most effective and is associated with an improvement in respiratory and dermatologic symptoms in health care workers and with a reduction in the number of new cases of latex sensitization and allergy (Bernstein et al. 2003; Hunt et al. 2002; Saary et al. 2002; Swanson et al. 1994). It has also been shown to be cost-effective, considering the cost incurred by disability from latex allergy and asthma (Allmers et al. 2002; Phillips et al. 1999). "
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    ABSTRACT: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice. A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time. The patient's presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work. The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.
    Environmental Health Perspectives 08/2005; 113(7):888-93. DOI:10.1289/ehp.7830 · 7.98 Impact Factor
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    ABSTRACT: A exposição profissional a látex em meio hospitalar é pra- ticamente ubiquitária já que diversos materiais de uso hospitalar o contêm, ainda que a sua referência seja essencialmente associada às luvas. A elevada frequência e gravidade de doenças respiratórias, dermatológicas, e até reacções anafilácticas, em indivíduos sensibilizados expos- tos a látex justifica que as áreas científicas da Medicina do Trabalho e da Alergologia desenvolvam programas de prevenção dos eventuais efeitos adversos associados ao seu uso. Por outro lado, a criação de serviços de saúde ocupa- cional nos estabelecimentos de saúde poderá contribuir para a redução da incidência desta patologia através do desenvolvimento de actividades de gestão desse risco pro- fissional.
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