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Accommodating latex allergy concerns in surgical settings

AORN Journal, Oct, 2003 by Esah S. Yip

Since the nineteenth century, nurses and physicians have used natural rubber latex gloves to protect themselves and their patients from the transmission of viruses and harmful infectious diseases. These gloves provide effective barrier performance, as well as durability, comfort, fit, and tactility. In the late 1980s, the use of latex gloves in health care facilities increased significantly due to concerns about transmission of the AIDS virus. This sudden upsurge in glove demand led to the production of many inadequately manufactured latex gloves that were high in residual proteins and excessively powdered--the type of gloves now known to cause serious allergic reactions in individuals who are latex sensitive. This problem has raised concern among both health care professionals and latex glove manufacturers. This article examines latex allergy issues, discusses research findings pertaining to the use of unproved gloves that can help alleviate allergy problems, and highlights the need for proper glove selection for effective barrier protection in the OR.

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TYPES OF REACTION

Three types of reactions have been associated with the use of disposable medical gloves--irritant contact dermatitis, type IV reaction of delayed hypersensitivity, and type I reaction of immediate hypersensitivity. Only one of the three reactions--type I--is a reaction to latex proteins in natural rubber latex gloves. Type 1 reaction affects about 1% of the general population, (1) although its prevalence is 3% to 16% among health care workers. (2) Irritant dermatitis, which is a reaction to non-proteinaceous irritants, and type IV allergy, which is a reaction to certain residual chemicals employed during manufacture of medical gloves, are more likely to occur and potentially less serious. These reactions can occur with use of either natural rubber latex or synthetic gloves and should not be mistaken for latex protein allergy.

IRRITANT CONTACT DERMATITIS. Irritant contact dermatitis is a nonallergic reaction resulting from sensitivity to soap, hand cream, powder, disinfectants, and temperature and pH extremes. Symptoms include itching, skin rashes or flakiness, burning sensations, inflammation, or blister formation.

TYPE IV REACTION. Type IV reaction causes symptoms that are very similar to those of irritant contact dermatitis. The allergic reactions are caused by the presence of residual chemicals, such as accelerators belonging to types of thiuram, thiazoles, and carbonates, which often are used in the manufacture of both latex and synthetic gloves. The allergic reaction is cell-mediated, and it occurs within hours after contact with the allergens.

TYPE I REACTION. Type I reaction results from exposure to certain allergenic proteins. In contrast with type IV, type I is immunoglobulin E (IgE) mediated (ie, involving the Ige anti-bodies of the immune system). Type I reaction commonly is caused by proteins found in foods, such as peanuts, watermelons, bananas, avocados, potatoes, tomatoes, and some seafood. Type 1 reactions also can be elicited by insect bites, penicillin, and certain other medications. Latex proteins are a recent addition to this list. Studies also have shown that there can be cross-reactivity among allergens from foods and latex proteins; that is, individuals can become sensitized by exposure to proteins from one source and react when later exposed to another source.

Type I reactions usually occur within minutes of contact with allergens. Symptoms can vary from mild reactions, such as urticaria, hay fever, and allergic conjunctivitis, to asthma and, in rare cases, anaphylaxis.

If another type of medical glove could provide the barrier protection, tactile properties, and reasonable cost of natural rubber latex gloves, it is possible that the health care community might deal with latex allergy by simply replacing natural rubber latex gloves with synthetic substitutes. The superior performance of natural rubber latex gloves over many synthetics, however, has prompted researchers and manufacturers to investigate and work toward alleviating allergic reactions to provide the best possible protection for health care workers and their patients.

LATEX PROTEINS

Natural rubber latex gloves are made from latex, a milky sap that comes from the Hevea brasiliensis tree. It comprises about 30% rubber particles dispersed in a liquid medium that also contains small amounts of nonrubber substances, such as carbohydrates and minerals. The bulk of latex is water, and total proteins comprise about 1% of latex. Fewer than 5% of the proteins in latex have been identified and characterized to show IgE-binding activity. (3)

When latex is processed into gloves, many of the soluble proteins are lost, leaving only a small fraction in the product. It is this residual fraction of extractable proteins that is implicated in allergic reactions. Not all residual extractable proteins demonstrate allergenic activity. Furthermore, this residual fraction is water soluble and can be removed from the gloves by proper processing, particularly adequate leaching.

Health Care Industry

Accommodating latex allergy concerns in surgical settings

AORN Journal, Oct, 2003 by Esah S. Yip

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