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
|
