SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
2/19/04
Latex allergy in occupational settings
Summary
There has been increasing interest in the occurrence of latex allergy
(LA) as an occupational disorder. This subject has been reviewed recently
in several reports. Ranta and Ownby of the Medical College of Georgia
in Augusta, GA discussed LA in healthcare workers (1). They concluded
that individuals with either IgE-mediated or cell-mediated hypersensitivity
to latex should be able to continue working in a health care environment
by suitable exposure reduction. Therefore, complete removal of the individual
from the health care setting is often not necessary. The use of low
allergen, non-powdered latex gloves substantially reduces exposure to
latex in most health care settings.
Ahmed et al of the Indiana Univ. Dermatology Clinic in Indianapolis,
IN (2) pointed out that disposable latex medical gloves, particularly
when powdered, are the major source of latex allergens in health care
settings. The diagnosis of LA requires a history of ocular, respiratory,
cutaneous, or systemic symptoms following appropriate exposure to dipped
latex rubber products. LA must be confirmed by appropriate in vitro
IgE assays patch and/or prick skin tests or blinded challenge testing.
Avoidance of exposure to dipped latex products (particularly inhalation
and mucosal exposures) is key to appropriate treatment. The patient
with LA must also be educated about the potential for cross-sensitization
to certain foods.
Reference
1. Clin Infect Dis 2004;38:252-6
2. Immunol Allergy Clin North Am 2003;23:205-19
Editor's Comments
These reviews give balanced discussions of what has become a contentious
issue in some quarters. It seems that there has developed a litigation
industry in which claimants try to obtain disability payments and even
liability damages based on their reported 'systemic' (often subjective)
symptomatology that occurs by just working anywhere in a hospital or
other health care facility. Several careful studies have concluded:
1) the major source of exposures inducing LA in health care environments
are dipped latex products, mainly powdered latex gloves. There have
been occasional reactions attributed to soft rubber connectors in IV
infusion sets but this seems to be rare. There is still debate whether
the rubber dam closures in medication vials for parenteral injection
are a significant source of latex exposure. Hard rubber products (e.g.
stoppers) do not appears to be a source; 2) airborne levels of latex
allergen which can induce respiratory or systemic reactions are confined
to areas where powdered latex gloves are often used. There is little
airborne exposure to latex in other areas of the hospital, particularly
in administrative areas.
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