Introduction 

Latex, or natural rubber latex, is a product made from the milky fluid of the rubber tree Hevea brasiliensis. Latex has various chemicals and proteins in it. The chemicals can cause skin irritation, but it is the proteins that are the source of the more serious allergic reactions in people using latex products.

Many workers, especially in health care, use latex gloves frequently. Increased exposure to latex proteins increases the risk of developing allergic symptoms. Reports of allergic reactions to latex have increased greatly over the past several years. An estimated 5-10% of health care workers have become sensitized to latex. Since there are many products that contain latex, people who are allergic must be informed about those products and about non-latex products that can be used so they can avoid serious health problems.

Who’s at Risk? 

Latex allergy occurs most often in health care workers, because of the frequent use of latex gloves. Other workers with less latex glove use, such as housekeepers, custodians, cleaners, food service workers, teacher aides helping disabled students and hairdressers are also at risk.

Other risk groups are people who have spina bifida, have had multiple surgeries (especially at an early age), or a history of allergies, such as hay fever, asthma and eczema. Certain food allergies may also indicate a coexisting latex allergy (including banana, avocado, papaya, kiwi, chestnuts, potato, and tomato).

What are the Symptoms?

Irritant contact dermatitis is the development of dry, itchy, irritated areas on the skin, usually the hands. This type of reaction is not an actual allergy to latex, but is the irritation from wearing gloves and possibly from the soaps and detergents that are used to wash hands after glove use. It could also be a reaction to the powders or lubricants used to make gloves easier to put on.

Allergic contact dermatitis is also called chemical sensitivity contact dermatitis. It causes a skin rash like poison ivy that may not appear until several days after the exposure to latex materials. The rash can appear on skin that did not have direct contact with latex. Chemicals added to latex products cause the sensitivity. Like irritant contact dermatitis, allergic dermatitis is not a direct allergy to latex proteins.

Latex allergy, or immediate allergic reaction is caused by reaction to latex proteins. It is less common than the other two reactions but it can result in more severe symptoms. Workers who have contact dermatitis may be at greater risk of developing latex allergy because their damaged and broken skin reduces the skin’s natural protective barrier against latex proteins entering the bloodstream.

Symptoms of latex allergy can be mild (skin redness, rash, hives or itching) to severe. Severe reaction can include respiratory symptoms like runny nose, sneezing, itchy eyes, scratchy throat, and asthma (difficulty breathing, coughing spells and wheezing). In rare cases, a worker with severe latex allergy could go into shock, which could be life threatening.

Latex Containing Products

Many medical and household products contain latex. Disposable gloves are the most commonly used and the one most associated with latex allergy. However, awareness of other products is needed to effectively control latex exposure. Health care products containing latex include catheters, syringes, airways, intravenous tubing, oxygen mask strips, endotracheal tube cuffs and dressings and bandages.

Household products containing latex include erasers, condoms, rubber bands and balloons (latex paints do not contain natural rubber latex and do not cause allergies). There are as many as 40,000 products containing latex. There is no requirement to label these products with their latex protein content. Until legislation or regulation is in place, it will be difficult for people with latex allergies to avoid contact with latex containing items outside of work. There are good workplace guidelines to help reduce the risk of allergic reactions.

The Spina Bifida Association of America (SBAA) is an excellent resource for lists of products that frequently contain latex and examples of latex safe substitutes. The list covers items in the hospital environment and in the home and community. To get a copy of the list, contact the SBAA at:

4590 MacArthur Blvd NW, Suite 250, Washington, DC 20007-4226 , 800-621-3141 - or visit their website at www.sbaa.org.

Prevention

The National Institute for Occupational Safety and Health (NIOSH) has recommended the following steps to protect yourself from latex exposure and allergy at work:

1. Use non-latex gloves for tasks not likely to involve contact with infectious materials (food preparation, routine housekeeping, general maintenance, etc.). Non-latex materials include nitrile and other petroleum based rubbers, PVC, polyethylene, cotton, and kevlar.

2. You need proper barrier protection when handling infectious materials. If you choose latex gloves, use powder-free gloves with reduced protein content.

3. Use proper work practices to reduce your chance of latex reactions:
   • When wearing latex gloves, don’t use oil-based hand creams or lotions. These can cause glove breakdown.

   • After removing latex gloves, wash hands with a mild soap and dry thoroughly.

   • Practice good housekeeping: frequently clean areas and equipment

   • contaminated with latex-containing dust.

4. If you have symptoms of latex allergy, avoid contact with latex gloves and other latex-containing products until you see a doctor experienced in treating latex allergy. If you have latex allergy, consult your doctor about the following precautions:
   • Avoid contact with latex gloves and products

   • Avoid areas where you might breathe in the powder from latex gloves worn by other workers
   • Tell your employer and health care providers (doctors, nurses, dentists, etc.) that you have latex allergy.

   • Wear a medical alert bracelet.

Guidelines for Health Care Facilities

The most effective way of dealing with latex allergy problems in a health care facility is to have a comprehensive program. The following program was written by physicians and organizations with expertise in allergy and immunology and is found on the website of the American College of Allergy, Asthma, and Immunology at www.allergy.mcg.edu/physicians/ltxhome.html. Other helpful websites are those of the National Institute of Occupational Safety and Health at www.cdc.gov/niosh and the federal Occupational Safety and Health Administration at www.osha.gov.

Latex Allergy Task Force: This should be a regular part of the health care facility employee and patient care committee. The task force should include representatives from the medical staff (medicine, surgery, allergy, anesthesia and radiology), nursing (operating room, ambulatory care, intensive care and general ward care), hospital administration, pharmacy, housekeeping, central supply and occupational health.

Policies: Policies about workplace latex allergies should cover issues of (1) measures to be taken for latex-related illness, (2) procedures for reassignment of severely allergic employees, (3) use of sick leave and workers compensation benefits, including relocation, short-term leave and long-term leave.

A mechanism for the complete and timely evaluation of all suspected latex reactions should be in place. Education on potential health risks of latex sensitivity should be first targeted to areas of high glove use.

Consultation Services: Future hospital employees and presurgical patients should routinely be asked questions about latex allergy. A consultation service would conduct investigations on possible latex reactions and advise follow-up testing and consultation as needed.

Review of Glove Use: A facility-wide review of glove use should be done to determine if the use is appropriate (degree of risk, level of protection, compliance with universal precautions). This would prevent the unnecessary use of latex gloves. Substitute gloves, like vinyl, need evaluation of barrier effectiveness because some studies suggest they have a higher viral leakage rate than latex gloves. Workers with irritant or allergic contact dermatitis should use cotton liners under latex gloves for protection or use non-latex gloves.

Product Inventory: The hospital should develop a list all of latex products. Ideally, this would include information on the amount of latex protein. Lists of non-latex substitutes for medical supplies should also be available. Regular review and updating of the list is needed because of the constant development of non-latex alternatives.

Identification of High Risk Patients: High risk patients should be identified and encouraged to have latex allergy testing. Patients with hand dermatitis and exposure to latex need to be referred to an allergy specialist to determine if they are sensitive to latex. Latex sensitive patients should not use barrier cream used to treat contact dermatitis. The creams can draw out latex protein from latex gloves and increase skin penetration of allergens.

  Latex-Safe Environment

A latex-safe environment should be the goal of a health care facility. Latex-safe carts carrying non-latex substitutes should be available in all patient care areas, especially where there is high latex usage, especially in the emergency suites. A latex allergy quality assurance program should be in place that covers:

• Supervising latex use in the hospital areas

• Developing databases of all latex products

• Developing databases of all latex substitutes

• Assessment and reporting of all latex-related reactions

• Supervising and maintaining latex-safe environments

• Changing to low-protein, low-powder latex gloves.