Accommodating latex allergy concerns in surgical settings

AORN Journal,  Oct, 2003  by Esah S. Yip

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The production of high-protein, high-powdered gloves in the late 1980s is believed to be a result of improper leaching during some manufacturing processes. This resulted in a residual extractable protein content as high as 1,000 [micro]g per g to 2,000 [micro]g per g of gloves, as determined by the modified Lowry method, a test that is widely used for protein estimation of gloves. Positive clinical skin test reactions elicited by such high protein levels have been demonstrated in individuals who are latex sensitive. (4,5)

With advancements in manufacturing technologies, it is possible to reduce the residual extractable protein content in natural rubber latex gloves to less than 50 [micro]g per g of gloves. (6) Technologies now available include

* the use of low protein latex,

* the application of proper leaching protocols during processing,

* chlorination and/or polymer coating, and

* enzymatic or chemical treatment.

Powder-free natural rubber latex gloves, especially those treated by chlorination, have markedly reduced residual extractable protein fraction, due in part to the extensive washing adopted during the process of chlorination. Powdered or powder-free latex gloves with very low protein content often are associated with low allergen content. (7,8)

LOW-PROTEIN NATURAL RUBBER LATEX GLOVES

A number of recent independent hospital studies have shown that changing from high-protein, high-powder gloves to low-powder or powder-free natural rubber latex gloves that are low in protein and allergens resulted in dramatic decreases in the incidence of latex allergy. More importantly, the use of these improved gloves enabled workers who are latex sensitive to work alongside colleagues wearing natural rubber latex gloves. Other observations and conclusions from studies include the following.

* A reduction of aeroallergen levels in a work place to an undetectable level within 24 hours was reported by one study. Six of seven allergic individuals tested showed significant decreases in their latex-specific IgE antibodies. (9)

* Two of three nurses from an Ontario hospital who had stopped working because of latex allergy were able to return to work, and no extra costs were incurred from the change to low-protein natural rubber latex gloves during a three-year period. (10)

* Concentration of the latex allergen also was greatly reduced in a work site at the Mayo Clinic, Rochester, Minn. The number of latex allergy cases was reduced, and the change has allowed individuals with latex allergies to continue to work at their usual jobs. The change resulted in a cost savings of $200,000 per year at the clinic. (11)

* One study reported that providing a completely latex-free environment in most surgical suites may be unrealistic; however, a significant reduction in aeroallergen can be achieved by switching to low-allergen gloves. (12)

* The replacement of high-allergen latex gloves with very low-allergen latex gloves enabled all latex-allergic health care workers in one study to continue in their work assignments in a hospital. The prevalence of hand eczema also diminished significantly. Only a few clinicians who were latex allergic needed to use latex-free gloves during procedures, but none of them had symptoms from the low allergen latex gloves used by their coworkers, even though the gloves were powdered. (13)