Latex Reactions in Health Care Personnel

Definition

Natural rubber latex allergy (see also Chapter 194 ) is an issue of clinical importance for health care workers in terms of both patient management and occupational health. Use of rubber gloves dates to the late 1800s, when Halsted apparently produced them to protect the hands of his scrub nurse from the disinfectant solution she used to wash her hands. Skin lesions on the hands caused by the wearing of rubber gloves were first described in the medical literature in the 1930s. The increasing prevalence of latex-induced reactions is due to a confluence in the late 1980s of a number of factors: the increasing prevalence of hepatitis and acquired immunodeficiency syndrome (AIDS) led to the need for universal precautions; this led to increased demand for and use of barrier devices, including gloves made from natural rubber latex.

The rubber industry responded to meet this demand, but final product quality may have been compromised by new entrants into the field, new geographic locations for rubber production, political turmoil in rubber-producing countries, and changes in the manufacturing process to increase output while complying with environmental and occupational health concerns. This increase in demand was associated with a greater number of medical gloves imported into the United States.

As the use of latex gloves increased, allergic reactions in patients and health care providers were reported, leading to greater awareness of the problem, which in turn led to efforts to recognize and report it. This growing medical awareness was reflected by an increase in MEDLINE citations of journal articles published with latex as a key word, as shown in Table 153.1 . There was an increase in both the absolute number of these citations and the number of these citations relative to the entire database. By mid-2004, the number of latex citations had increased to 0.1% of the MEDLINE database.

Natural latex contains several polypeptides that bind immunoglobulin E (IgE) and that may be altered during denaturation, polymerization, or breakdown during the manufacturing process. Most latex gloves have a cornstarch powder to facilitate donning. This powder binds various latex antigens and can be dispersed in the atmosphere, readily facilitating exposure through the respiratory system.