Literature Review

Allmers H, Brehler R, Chen Z, et al. Reduction of latex aeroallergens and latex-specific IgE antibodies in sensitized workers after removal of powdered natural rubber latex gloves in a hospital. J Allergy Clin Immunol 1998; 102:841-846.

The study was undertaken to determine the success of eliminating powdered latex gloves in protecting health care workers and patients from latex sensitization and allergic reactions. Results showed that eliminating powdered gloves reduced aerogen natural rubber latex (NRL) allergen loads below detection limits and permitted sensitized/allergic HCWs to remain on the job.

From September 1996 to September 1997, German researchers studied 90 HCWs from four hospital areas (pediatric and adult intensive care and the departments of anesthesiology and surgery). Subjects responded to questionnaires to determine atopic symptoms history and NRL allergy. Follow-up examinations included history, determination of NRL-specific IgE, and skin-prick tests.

A surgical ward floor was used as the control area, in which powdered NRL gloves were used. The pediatrics ICU was switched to non-latex gloves. The pediatrics ward, general surgery, orthopedics operating room, surgical clinic, and adult ICU were changed to powder-free NRL gloves. A changing room used by staff working with powdered NRL gloves also was studied.

Air sampling was performed for 24-hour measurement periods in seven different areas. Samplers were placed to measure areas of greatest contamination, such as near glove storage areas and garbage bins. NRL allergen content in air samples was measured by an immune inhibition assay. Results were expressed as NRL allergenic protein mass per cubic meter of air.

Of the 90 HCWs participating in baseline examinations, 10 (11%) had NRL-specific IgE antibodies during the initial September 1996 exam. Seven of those 10 had a positive skin-prick test response to latex allergens and reported symptoms ranging from urticaria to asthma. The other three subjects had a negative skin-prick test response and reported no allergic symptoms.

The researchers re-examined 49 HCWs (54%) in April 1997 and 62 (69%) in September 1997. Two HCWs reported respiratory symptoms requiring the use of antihistamines or metered-dose inhalers during work. After switching gloves, symptoms disappeared and medication use could be terminated. In September 1996, six HCWs had latex-specific IgE antibody concentrations greater than 1 kU/L. Concentrations were halved in five of those within one year.

"The decrease of NRL-specific IgE antibodies in all seven subjects during 12 months without NRL exposure is highly significant," the authors state. "No new cases of sensitization could be detected in the other participants."

Air sampling showed that within 24 hours after use of powdered gloves ceased, allergen loads fell below the detection limit. Measurements repeated in March and September 1997 showed no detect able allergen load in rooms where only powder-free latex gloves were used.

The researchers’ finding that respiratory symptoms and NRL-specific IgE antibodies were present only in employees who worked in rooms with a detectable NRL allergen load confirmed their hypothesis that "direct allergen contact to the mucosa of the upper and lower respiratory tract is an important cause for the development of sensitization against NRL allergens."

They cite other studies that confirm their hypo thesis, such as research showing significantly lower sensitization prevalence in operating room staff in the United Kingdom, where only powder-free gloves have been used for decades,1 as well as a recent U.S. study finding similar results for measuring aerogen latex allergen concentrations and decline of allergen content in powdered gloves.2

Their hypothesis also seems to be supported by the fact that conversion from negative to positive skin-prick test responses occurred both in the group using powdered gloves and the group using powder-free gloves, but that clinical symptoms were reported only by powdered group participants.

Eliminating powdered NRL gloves and substituting powder-free or non-latex gloves is useful for preventing detectable atmospheric contamination with NRL aeroallergens, the researchers conclude.

"HCWs sensitized and even allergic to NRL can remain on the job if exposure to NRL can be avoided. Banning of powdered NRL gloves in the workplace and a supply of NRL-free material for sensitized individuals seems to be a sufficient prevention strategy," they state.

References

1. Brehler R, Kolling R, Webb M, et al. Glove powder — A risk factor for the development of latex allergy? Eur J Surg Suppl 1997; 579:23-25.

2. Sussman GL, Liss GM, Deal K, et al. Incidence of latex sensitization among glove users. J Allergy Clin Immunol 1998; 101:171-178.