SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

11/16/04

Do preventive measures help health care workers with existent latex sensitivity?

Summary
Background - With the increasing use of latex gloves in medical facilities, latex sensitivity (LS) has become a major occupational hazard in health care workers (HCW). It is now recognized that the incidence of LS is lower in institutions that use powder-free, low allergen content latex gloves instead of the traditional latex gloves. Will this approach help individuals already sensitized to latex?

Findings - Rueff et al of the Univ of Munich in Germany studied 33 HCW with clinically manifest latex allergy and 55 HCW with positive latex skin tests but no latex -related clinical manifestations. All patients were instructed in latex avoidance. At the same time, powder free latex gloves were substituted for traditional latex gloves in that institution. After 38 months follow-up, a loss of latex skin test reactivity was seen in 16 of 35 individuals with LS but no prior clinical symptoms. In contrast, latex skin test reactivity was lost in only one of 29 individuals with prior clinical as well as skin test reactivity to latex. However, most individuals in this latter group no longer had clinical symptoms related to exposure to the powder-free latex gloves.

Conclusion - LS can be reversed following reduced exposure to latex allergens.

Reference
Ann Allergy Asthma Immunol 2004;92:530-37

Editor's Comments
As reviewed by me, a recent report has described an overall reduction in LS in many institutions in Germany since switching to a powder- free low allergen latex gloves (J Allergy Clin Immunol 2004;114:347-51). It is thought that the lubricating powder formerly used in all latex gloves helped to disseminate latex allergens into the airborne environment during donning and removal of the gloves. The study described above suggests that existent LS can also be reversed with this program of latex avoidance. A more definitive conclusion could have been reached if they carried out similar sequential studies in another institution that had not switched from traditional to powder-free latex gloves.

If the findings described above are valid, why was there a much greater frequency of reversal of LS in those with pre-existent LS without symptoms than in those LS individuals with clinical manifestations? The most likely explanation is that the latter group had higher levels of anti-latex IgE antibodies. However, one has to also check whether the latex allergens involved differed in the patients from the 2 groups.

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