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 Table of Contents  
REVIEW ARTICLE
Year : 2013  |  Volume : 3  |  Issue : 3  |  Page : 201-204

Latex glove allergy: The story behind the "invention" of the surgical glove and the emergence of latex allergy


1 Department of Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
2 Department of Anaesthesia, Withybush General Hospital, Haverfordwest, Pembrokeshire, United Kingdom

Date of Web Publication28-Mar-2014

Correspondence Address:
Anokha Oomman
8, Maple Avenue, Haverfordwest SA61 1EF, Pembrokeshire
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.129563

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  Abstract 

Latex rubber gloves have become increasingly common over the last 30 years. This has led to an increase in allergy to natural rubber latex (NRL) proteins in health care professionals using protective gloves and/or in those exposed to products made of NRL. This has led to a growing need to monitor the allergenicity of gloves and other latex goods to prevent sensitization and clinical allergy. There is still considerable amount of misinformation regarding latex allergy. In this article, we examine the history behind the "invention" of the surgical glove, the emergence of latex allergy and the diagnostic tests available and possible remedies. We searched PubMed and MedLine using key words such as Latex allergy, surgical gloves, rubber, immunoglobulin E proteins, radioallergosorbent test. Recent and old papers on the subject were reviewed and analyzed. Surgical gloves were a huge milestone in the field of surgery as it allowed the development in the field of asepsis. It was instrumental in reducing the rates of infection and making health care professionals think about aseptic techniques. However, the emergence of latex allergy over the last few decades has proved a challenge in the perioperative setting. Surgical gloves are important tools in performing safe surgery. However, the increasing incidence of latex allergy and its effects on theatre personnel is of great concern.

Keywords: Latex allergy, radioallorgosorbent test, surgical gloves


How to cite this article:
Oomman A, Oomman S. Latex glove allergy: The story behind the "invention" of the surgical glove and the emergence of latex allergy. Arch Int Surg 2013;3:201-4

How to cite this URL:
Oomman A, Oomman S. Latex glove allergy: The story behind the "invention" of the surgical glove and the emergence of latex allergy. Arch Int Surg [serial online] 2013 [cited 2019 Oct 18];3:201-4. Available from: http://www.archintsurg.org/text.asp?2013/3/3/201/129563


  Introduction Top


Latex products have been in use since 1600 BC in Mesoamerica. [1] However, surgical latex gloves were "invented" only in the late 1890's. Several individuals have helped in the "invention" of the rubber surgical gloves. [2] In 1813, Adam Elias von Siebold first suggested that physicians should protect themselves from infections by wearing horse or swine bladder as gloves whilst delivering babies. [2] In 1843, the process of vulcanization was discovered almost at the same time by Charles Goodyear and Nathaniel Hayward in the United States and Thomas Hancock in England, which allowed the possibility of making rubber gloves that were stable. [3] In 1889, William Halstead ordered a pair of rubber gloves from the Goodyear tyre company as the carbolic acid he was using to sterilize his instruments were damaging the hands of his scrub nurse (who later on became his wife) and causing her severe dermatitis. [4]

Allergy to latex rubber gloves has become increasingly common today. Looking back 30 years ago, chances are that most health care professionals didn't know what latex allergy was. However, over the last decade the incidence of natural latex glove allergy has increased in prevalence and attained world-wide importance. [5],[6] This is thought to be due to the huge rise of the use of the latex gloves following the recommendations in 1987 by the US Center for Disease Control, which suggested that latex gloves should be used for "touching blood and bodily fluids and handling items or surfaces soiled with blood or bodily fluids and for performing vascular access procedures". [7] This surge in the use of latex gloves led to an increase in concomitant exposure. [6] The increase in demand in latex gloves meant that during importation products were not subjected to rigorous quality assurance procedures appropriate for medical devices. [6] It remains unclear whether the increase in allergic reactions to natural rubber latex (NRL) is a direct result of increased glove use or abnormally high levels of residual latex antigen in those gloves as a result of manufacturing issues. [7]

The first published case of immediate hypersensitivity to natural latex was in 1979, which documented case of a woman with a history of dermatitis who presented with pruritis after 5 min of wearing latex gloves. A skin prick test with natural rubber glove extract demonstrated a wheal on testing. [8]


  Epidemiology Top


Latex sensitization prevalence rate ranges from 2.9% to 22% in health care workers and from 0.12% to about 20% in occupationally unexposed populations. [9] It can present with glove hypersensitivity, contact urticaria, rhinitis, conjunctivitis, asthma and anaphylaxis. [10] It has been suggested that there is an association between long-term work in health care institutions and latex sensitization. [11] Studies have shown that sensitization is related to the degree of exposure. [11],[12] Health care workers at the beginning of their training have the same likelihood of latex allergy as the general population. [12]


  What is Latex? Top


Latex is the milky fluid derived from the lactiferous cells of the rubber tree, Hevea brasiliensi. [13] It contains a large variety of sugars, lipids, nucleic acids and highly allergenic proteins. The milky fluid is made to undergo a complex process when ingredients such as sulfur and organic chemicals are added. The allergic protein components cannot be fully removed during the manufacturing process. [14] These latex proteins present in the gloves mediate latex allergy and have been shown to adhere to glove powder, which acts as a vehicle for the allergens. [15] Cornstarch powder is the donning agent used in making latex gloves in order to make them easier to put on and take off, it can remain in the air for as long as 5 h. [16] Powdered gloves have higher latex allergen content than powder-free gloves. [17] There is evidence that the use of powdered gloves is associated with a substantially higher prevalence and rate of latex sensitization. [6]


  Latex Sensitization versus Latex Allergy? Top


The presence of immunoglobulin E (IgE) antibodies specific to latex without symptoms is defined as latex sensitization. [11] Whilst latex allergy is described as an immunologically mediated reaction to latex that are either type IV or type I mediated hypersensitivity. It is believed that latex sensitization can occur through skin contact or through inhalation of the aerosol glove powder coming into contact with the mucous membranes of the nose and lungs. [18] In sensitized individuals, re-exposure to latex antigens may result in anaphylaxis, urticaria, angioedema, asthma and allergic rhinitis. [11] There seems to be a greater risk of sensitization associated with spina bifida, multiple surgeries, history of atopy and some food allergies (e.g. banana, Avocado, Kiwi and Chestnut). [5] Essentially patients with medical problems that cause frequent NRL exposure during surgery or catheterization are at a high risk for NRL protein allergy.

Latex gloves are associated with 3 types of adverse reactions: Irritant contact dermatitis, immediate-type (type I) allergic reactions and allergic contact dermatitis (type IV or delayed type hypersensitivity reactions). [5] Immediate reaction appears within 30 min of contact with latex and is due to proteins present in the NRL. The main symptoms are urticaria and edema. However asthma, nasal congestion and conjunctivitis may be noted if the mucous membranes are breached. [19] If the latex protein comes into contact with broken skin then very rarely anaphylactic reactions may occur. The delayed hypersensitivity reaction occurs after contact with latex and usually occurs by 24-48 h. It is caused by accelerating agents that have been added to latex in the manufacturing process. This leads to allergic contact dermatitis of the skin and is characterized particularly by an erythematous or itching rash on the back of the hands. [14]


  Diagnosing Latex Allergy Top


The clinical diagnosis of latex-induced contact urticaria is based on a compatible history and evidence of sensitization to NRL. The diagnosis of latex allergy should not be made on the basis of either of these criteria alone. [20]

Methods available to measure NRL allergen activity

  1. Skin prick testing: A microscopic amount of an allergen is introduced into patient's skin by pricking the skin with a needle. The immune response in terms of an urticarial rash or more worrying anaphylaxis is noted. [13],[21] The size of the reaction is dependent on and is directly proportional to the quantity of allergens to which the patient has IgE class antibodies. A patch test can also be done. This involves a 2-day occlusion of the test material to intact skin and the response is noted after 48-72 h. Patch testing however, could lead to sensitivity in previously non-sensitized individuals. [14]
  2. Human IgE-based immunologic inhibition assays: There are two different types of immunoassays available. Radioallegosorbent test inhibition and enzyme-linked immunosorbent assay inhibition test. They both help in measuring "total" allergen content. It involves the reaction of the patients serum with an antigen polymer complex in the presence of a labeled IgE antibody. [22]
  3. Methods based on immunoelectrophoresis and imunoblotting: Studies have described a large variety of NRL proteins binding IgE from sera of NRL allergenic patients. [23] However if a patient's history is strongly suggestive of latex allergy; then even if his tests are negative, he should still be managed as a latex allergy. [13]



  Hospital Staff Allergic to Late Top


There is evidence to suggest that latex containing gloves are the primary source of allergen in the health care environment. Avoiding contact with latex-containing gloves is the most effective method of preventing sensitization of high-risk groups. Measures to create a "latex-safe" environment should be undertaken for healthcare workers who are sensitized to latex. In an attempt to create a latex safe environment it has been suggested that latex gloves should only be used under universal precautions. Therefore, it should not be used by domestic staff, food handlers and transportation personnel. Low-allergen, non-powdered latex gloves should be used as they reduce sensitization. Lastly hospital staff that are allergic to latex should be provided with latex free gloves. [5]

It has been suggested that questionnaires relating to latex allergy should be included as part of pre-employment assessment, with examinations in the hospital Occupational Health Department, especially when dealing with individuals who might be working in an environment such as operating theater where frequent glove use is anticipated. [24],[25] This will help identify individuals who are at risk of developing latex allergy. If a patient or a health care professional is allergic to latex allergy, then avoidance and substitution of latex gloves is essential. By avoiding exposure to the allergens, most adverse responses to latex gloves can be controlled. Latex-free alternatives include nitrile, vinyl, neoprene and styrene butadiene. [23]


  Why Don't We Switch to Non-latex Gloves? Top


The use of NRL alternative gloves has met with some resistance. There are clinical advantages of using latex gloves which outweigh non-latex gloves. These include lower rates of glove tear, better tactile sensitivity, better strength, elasticity and a better fit. The rates of viral leakage are also noted to be higher in non-latex gloves. Non-latex gloves have a higher rate of failure to protect against herpes simplex virus type I. [5]

Even though, synthetic or non-latex gloves may be free of protein, they can also cause an allergic reaction. Cases of type 1 and type 4 hypersensitivity have been noted with the non-latex gloves too. [21] Furthermore, disposing off latex gloves is easier as they are biodegradable and unlike the synthetic gloves do not produce harmful emissions when incinerated. [21]


  Conclusion Top


NRL is a widely-used and cost-effective material, which for the majority of the population is not a clinical risk. It has many benefits which are yet to be equaled. However, it remains to be seen whether an increased use of non-latex gloves will lead to an increase in "non-latex glove" allergies in the future.

 
  References Top

1.Hosler D, Burkett SL, Tarkanian MJ. Prehistoric polymers: Rubber processing in ancient Mesoamerica Science 1999;284:1988-91.  Back to cited text no. 1
    
2.Ownby DR. A history of latex allergy. J Allergy Clin Immunol 2002;110:S27-32.  Back to cited text no. 2
[PUBMED]    
3.Randers-Pehrson J. The Surgeon's Glove. Springfield (IL): Charles C. Thomas; 1960.  Back to cited text no. 3
    
4.Lathan SR. Caroline Hampton Halsted: The first to use rubber gloves in the operating room. Proc (Bayl Univ Med Cent) 2010;23:389-92.  Back to cited text no. 4
[PUBMED]    
5.Ranta PM, Ownby DR. A review of natural-rubber latex allergy in health care workers. Healthc Epidemiol 2004;38:253.  Back to cited text no. 5
    
6.Power S, Gallagher J, Meaney S. Quality of life in health care workers with latex allergy. Occup Med (Lond) 2010;60:62-5.  Back to cited text no. 6
    
7.Hunt LW, Fransway AF, Reed CE, Miller LK, Jones RT, Swanson MC, et al. An epidemic of occupational allergy to latex involving health care workers. J Occup Environ Med 1995;37:1204-9.  Back to cited text no. 7
    
8.Nutter AF. Contact urticaria to rubber. Br J Dermatol 1979;101:597-8.  Back to cited text no. 8
[PUBMED]    
9.Page EH, Esswein EJ, Petersen MR, Lewis DM, Bledsoe TA. Natural rubber latex: Glove use, sensitization, and airborne and latent dust concentrations at a Denver hospital. J Occup Environ Med 2000;42:613-20.  Back to cited text no. 9
    
10.Monduzzi G, Franco G. Practising evidence-based occupational health in individual workers: How to deal with a latex allergy problem in a health care setting. Occup Med (Lond) 2005;55:3-6.  Back to cited text no. 10
    
11.Garabrant DH, Roth HD, Parsad R, Ying GS, Weiss J. Latex sensitization in health care workers and in the US general population. Am J Epidemiol 2001;153:515-22.  Back to cited text no. 11
    
12.Poley GE, Slater JE. Current reviews of allergy and clinical immunology. Part 1. J Allergy Clin Immunol 2000; 105:3-6.  Back to cited text no. 12
    
13.Farley CA, Jones HM. Latex allergy. Br J Anaesth 2002;2:20-3.  Back to cited text no. 13
    
14.Sinha A, Harrison PV. Latex glove allergy among hospital employees: A study in the north-west of England. Occup Med (Lond) 1998;48:405-10.  Back to cited text no. 14
    
15.Newsom SW, Shaw M. A survey of starch particle counts in the hospital environment in relation to the use of powdered latex gloves. Occup Med (Lond) 1997;47:155-8.  Back to cited text no. 15
    
16.Woods JA, Morgan RF, Watkins FH, Edlich RF. Surgical glove lubricants: From toxicity to opportunity. J Emerg Med 1997;15:209-20.  Back to cited text no. 16
    
17.Koh D, Ng V, Leow YH, Goh CL. A study of natural rubber latex allergens in gloves used by healthcare workers in Singapore. Br J Dermatol 2005;153:954-9.  Back to cited text no. 17
    
18.Jaeger D, Kleinhans D, Czuppon AB, Baur X. Latex-specific proteins causing immediate-type cutaneous, nasal, bronchial, and systemic reactions. J Allergy Clin Immunol 1992;89:759-68.  Back to cited text no. 18
    
19.Kujala V. A review of current literature on epidemiology of immediate glove irritation and latex allergy. Occup Med (Lond) 1999;49:3-9.  Back to cited text no. 19
[PUBMED]    
20.Bernstein DI. Management of natural rubber latex allergy. J Allergy Clin Immunol 2002;110:S111-6.  Back to cited text no. 20
[PUBMED]    
21.Sugiura K, Sugiura M, Hayakawa R, Sasaki K. Di (2-ethylhexyl) phthalate (DOP) in the dotted polyvinyl-chloride grip of cotton gloves as a cause of contact urticaria syndrome. Contact Dermatitis 2000;43:237-8.  Back to cited text no. 21
    
22.Palosuo T, Alenius H, Turjanmaa K. Quantitation of latex allergens. Methods 2002;27:52-8.  Back to cited text no. 22
    
23.Evangelisto M. Latex allergy: The downside of standard precautions. Todays Surg Nurse 1997;19:28-33.  Back to cited text no. 23
[PUBMED]    
24.Elliott BA. Latex allergy: The perspective from the surgical suite. J Allergy Clin Immunol 2002;110:S117-20.  Back to cited text no. 24
[PUBMED]    
25.American Latex Allergy Association. Dermatitis: Is it irritation or allergy. 2006.  Back to cited text no. 25
    




 

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  In this article
Abstract
Introduction
Epidemiology
What is Latex?
Latex Sensitizat...
Diagnosing Latex...
Hospital Staff A...
Why Don't We Swi...
Conclusion
References

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