Dr. Ganz Allergy and Asthma Center

Latex Allergy

Latex Allergy: an Emerging Healthcare Problem

Allergy to natural rubber latex, commonly referred to as latex, appears to have been an uncommon occurrence before 1980 and the origin of the current proliferation of cases remains unknown. Initial European reports of latex hypersensitivity described an unusual frequency of anaphylactic another significant reactions in individuals, the majority of whom were healthcare workers, and confirmed the presence of latex-specific-IgE in a majority of cases.

In the United States, attention to latex allergy was prompted by reports of several fatalities due to anaphylaxis induced by latex retention balloons used in barium enema procedures and by frequent intra-operative anaphylaxis is among children with spinabifida, a fact later attributed to the high prevalence of latex allergy among these children which was most probably induced by early and repeated exposures.

During the past 15 years allergic reactions to latex have become a significant public health problem, particularly among healthcare workers. Approximately 800,000 American adults and children have become allergic to natural rubber latex, found in gloves and pacifiers. When exposed to latex or latex dust, sensitized persons can develop hives, nasal and eye irritation, asthma, and anaphylaxis, a life-threatening condition in which the breathing passageways swell closed. About 1% of the general public and 4. 5% to 17% of health-care workers and others exposed to latex on their jobs have become sensitized. Some have even been forced to terminate their careers for this reason. Medical and dental procedures on sensitized individuals may be complicated by anaphylactic events, as may the use of latex pacifiers by infants. The FDA has received more than 2000 reports of injury and several reports of death associated with latex allergy.

Latex is a common component of disposable gloves, intravenous tubing, syringes, stethoscopes, catheters, dressings, bandages, and other medical supplies. Among health-care workers, gloves are the most significant source because they are frequently used, and the powder used to line some of them can absorb latex proteins and become airborne. Asthmatic reactions have occurred among people who did not use gloves but merely inhaled latex-containing dust. Thus, sensitive workers can be affected not only by their own gloves but also by those worn by co-workers.

The surge of latex allergy among health-care workers is primarily attributable to greater use of disposable gloves to prevent the spread of AIDS and hepatitis B. Increased demand and cost pressures for gloves has led some manufacturers to shorten the manufacturing time by reducing the number of washing and purifying steps, which increases the amount of sensitizing protein that the gloves will transmit.

Among highly exposed patients, sensitization rates vary more widely, but in the most studied group, children with spinabifida, the prevalence ranges from 10% to 65%. Further, elevated levels of latex specific antibodies are not confined to individuals in high risk groups alone; recent studies in Detroit and in the United Kingdom have demonstrated that more than 6% of blood donors have measurable anti-latex IgE. The clinical significance of such antibody sensitization requires further clarification. However, since latex anaphylaxis has been reported among patients with no recognizable risk factors, this finding mandates a cautious attitude on the part of healthcare givers who direct procedures that expose mucosal and/or serosal surfaces to high concentrations of latex antigen.

The personal and institutional consequences of latex allergy are considerable. Sensitized workers may develop occupational allergies, including urticaria, rhinoconjunctivitis, asthma and anaphylaxis which are probably primarily mediated by elevated workplace levels of latex allergen carried by latex glove donning powders. Medical procedures on sensitized personnel, including routine dental and pelvic examinations, may be complicated by anaphylactic events. Disability issues are undefined in this “new” disease and in some instances, insurance carriers and health industry employers have been reluctant to support legitimate claims by affected workers. Those workers and patients most severely allergic may experience significant acute reactions from unintentional encounters with latex contained in a large number of household products and from cross-reactive food allergens.

At the same time, the lack of information concerning the latex content of medical devices has resulted in severe allergic reactions in inadvertently exposed patients and in enormous duplication of effort by hospital and clinic occupational health units trying to maintain timely lists of “safe” goods for their latex allergic patients and workers. These unnecessary healthcare system costs and excess patient risks should be avoided.

The list of “unknowns” in latex allergy is lengthy. The natural history and progression has yet to be determined; anecdotal observations of some allergic healthcare workers suggest that sensitization may be long standing, perhaps due to continued latex exposure outside the workplace. Other than a history of atopy, risk factors for developing latex allergy are unclear; some studies have suggested that glove associated dermatitis, a very common condition, may increase risk substantially. Epidemiologic studies to date have been confined to single time point prevalence assessments; longitudinal and case-control studies to delineate incidence, prevalence, and risk factors are urgently needed. As indicated, workman's compensation issues remain undefined and some workers who have suffered anaphylactic reactions have been urged to return to their workplace without appropriate safeguards in place. Safety rules regarding latex exposure, especially latex aerosols, must be established.

The gravity of this health care problem requires appropriate changes in patient care practices, occupational health guidelines, and effective leadership by governmental regulatory agencies to ensure that the welfare and safety of patients and of healthcare workers is not jeopardized by potentially harmful medical devices, including latex gloves. At a minimum, updating medical device regulations to require content labeling for natural rubber latex and to discard use of the term “hypoallergenic” as applied to latex and non-latex gloves (as proposed by the Office of Compliance and Surveillance of the Center for Devices and Radiological Health of the United States Food and Drug Administration in a letter issued in March 1993), deserves immediate implementation.

The development of a comprehensive approach to safeguarding patients and healthcare workers should be viewed as an urgent priority. This may require the cooperation and input of other relevant governmental agencies such as the Occupational Safety and Health Administration (OSHA) and the National Institute of Occupational Safety and Health (NIOSH) of the Centers for Disease Control, members of the rubber industry, as well as appropriate medical specialists and patient groups. The American College of Allergy, Asthma and Immunology suggests that following proposals be addressed immediately:

The American College of Allergy, Asthma, and Immunology has published guidelines and recommends that people who have been diagnosed as allergic wear an identification card (or bracelet)and a self-injectable adrenalin device. Sensitive individuals should be sure that their health-care providers are aware of their condition so that they are not exposed to latex during medical procedures or surgery. A few states have introduced bills to ban the use of powdered latex gloves in medical facilities.

All of the proposed measures are justifiable in terms of patient and employee health and welfare alone. The costs of initiating these proposals would appear to be small in comparison to the savings expected from reducing the administrative, medical, disability, and liability costs of latex allergy. BACK TO TOP