Latex Allergy Increasing in Health Care Workers

Latex gloves designed to protect health care workers from blood-borne diseases may actually be harmful to those workers by increasing their risk of latex allergy. A recent study from the University of Maryland School of Medicine, published in Annals of Allergy, Asthma & Immunology (the scientific journal of the American College of Allergy, Asthma and Immunology) found that 8 percent of health care workers at the medical center who were screened were latex sensitive. That statistic is much higher than the national average -- an estimated 3 percent of the general public is allergic to latex.

The University of Maryland Medical Center is believed to be the only institution that has instituted a latex allergy screening program for new employees.

"Allergy to natural rubber latex (drawn from the Hevea brasiliensis tree) has become an important occupational health problem for health care workers," said co-author Mary Beth Bollinger, D.O., University of Maryland School of Medicine, Baltimore, Md. "Our study shows how the University of Maryland Medical Center devised a latex allergy screening system to identify sensitized workers and developed a glove conversion plan to remove all natural rubber latex gloves from the institution."

Natural rubber latex causes allergic sensitization in 5 percent to 17 percent of exposed health care workers. An allergic reaction can occur from direct contact with latex gloves and by inhaling latex allergens from powdered gloves.

In 1998, the hospital adopted a mandatory natural rubber latex allergy screening policy for all new employees and any employee transferring to patient care services. Screening was also made available to existing employees. Of the 1,795 employees tested, 8 percent had latex-specific immunoglobulin E antibodies, or latex sensitization. Of those sensitized persons, 57 percent reported skin, eye or respiratory problems when exposed to powdered latex gloves. Among this group, 12 percent had severe symptoms. In addition, 21 percent of those workers who tested negative to latex with a blood test reported some symptoms with latex exposure.

"The authors conclude that workplace changes to accommodate natural rubber latex-sensitized employees are less expensive than worker's compensation payments resulting from latex-allergic symptoms or lost work days in an unmodified work environment," said editorial author John W. Yunginger, M.D., Mayo Clinic and Foundation, Rochester, Minn.

The latex allergy screening has an annual cost of $60,000, but researchers found this to be very cost-effective when comparing it to projected costs of worker's compensation, which could be greater than a million dollars each year. Also, they found that ordering just one type of latex-free gloves is more economical than ordering several different kinds of gloves.

"Various degrees of intervention have been used by institutions. A personal avoidance strategy is not effective because it places health care workers at continued risk for exposure to aerosolized latex allergen when their coworkers are using powdered natural rubber latex gloves. Complete removal of natural rubber latex is the only option that ensures allergic employees a reduced risk of symptoms and further sensitization," Dr. Bollinger said.

"An essential component of any institutional intervention program for natural rubber latex allergy is early detection. While the medical center is converting to a non-latex environment, we thought it was crucial to screen employees at risk so that a safe work environment could be provided for them," she said.

A multidisciplinary task force at the University of Maryland Medical Center took on the task of establishing a four-phase, 5-year natural rubber latex glove conversion plan and an on-going educational program for all staff on basic issues related to latex allergy and the proper use of gloves. At the same time, the screening program will continue until the hospital is a latex-free environment.

"Although the phased approach to replacement of natural rubber latex may be optimal for some clinics and hospitals, our clinic opted to eliminate brands with moderate or high allergen contents throughout the whole medical center at one time. This simultaneous institution-wide changeover to synthetic or low-allergen natural rubber latex gloves addresses not only the occupational latex allergies of employees, but also provides for the safety of latex-sensitive patients," said Dr. Yunginger.

According to another report in Annals of Allergy, Asthma & Immunology based on data from English and French language papers, natural rubber latex avoidance strategies should focus on the type of manufacturing process, which vary depending on the characteristics sought for the finished product.

"Natural rubber-latex products are made either by pouring solid rubber into molds or by forming a coating in a dipped process," said lead author Didier G. Ebo, M.D., University of Antwerp, Antwerp, Belgium. "Solid natural rubber latex goods contain considerably less proteins, or allergens, than dipped materials. Prevention strategies should thus focus use of dipped materials rather than banning all natural rubber latex products.

"Utilization of powdered natural rubber latex gloves is unequivocally the major source of natural rubber latex allergen exposure in medical settings, and a substantial reduction in exposure may be achieved by eliminating them," Dr. Ebo said.

The authors recommend use of alternative materials whenever natural rubber latex avoidance is required, but unfortunately, such alternatives are not always available or acceptable. Glove alternatives might not possess the unique mix of excellent mechanic characteristics, such as elasticity, strength, barrier protection, permeability, resistance and acceptable cost.

"For individuals suffering from natural rubber latex allergy, its avoidance is a compromise between disease prevention, life-style choices and livelihood," Ebo said.

For a free copy of the brochure Advice from Your Allergist About Latex Allergy, call the ACAAI toll free number at (800) 842-7777 or visit its Web site at http://allergy.mcg.edu.

The American College of Allergy, Asthma and Immunology is a professional medical organization comprised of 4,200 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.

The ACAAI issued a 1995 position statement, "Latex Allergy -- An Emerging Healthcare Problem," and participated in the development of the 1997 statement with the American Academy of Allergy, Asthma and Immunology, "AAAAI and ACAAI Joint Statement Concerning the Use of powdered and Non-powdered Natural Rubber Latex Gloves."