Reactions to latex gloves lead to NIOSH alert
October 1, 1997 6 minutes read
Reactions to latex gloves lead to NIOSH alert
Gloves required, but nonlatex alternatives sought
Latex gloves are posing an increasing health care threat to the very workers they were designed to protect from infectious agents, warns the National Institute of Safety and Health (NIOSH). Issuing an alert about the issue, NIOSH reports that "workers exposed to latex gloves and other products containing natural rubber latex may develop allergic reactions such as skin rashes; hives; nasal, eye, or sinus symptoms; asthma; and (rarely) shock."1
The document also presents recommendations for both workers and employers for reducing exposures, using appropriate work practices, training and education, monitoring symptoms, and substituting nonlatex products when appropriate. (See related story, p. 157.)
Reports of allergic reactions among health care workers have increased in recent years. DeLon Hull, PhD, deputy director of NIOSH’s division of surveillance, hazard evaluations, and field studies in Cincinnati and a lead author of the alert, says the agency became aware of the "magnitude of the problem" a year and a half ago while holding open meetings to develop a national occupational research agenda.
"We heard from concerned individuals and groups about this problem, and that’s when we became aware we needed to do something to address it. We put together a working group to look deeper into the problem, and the group felt that the NIOSH alert was the appropriate response, that more information needed to be in the hands of the workers," Hull says.
Latex sensitization of health care workers, mainly as a result of exposure to latex gloves in the workplace, is a serious problem affecting significant numbers of workers. "It certainly has consequences outside of the workplace too, because, once sensitized, people have to be careful of other latex exposures as well," he says.
NIOSH’s main recommendation reads as follows: "If you choose to use latex [gloves], use powder-free low-protein," Hull states.
The proteins responsible for latex allergies fasten to powder used on some latex gloves, allowing more latex proteins to reach the skin and to be released into the air, where they can be inhaled. Work areas where only powder-free gloves are used show undetectable amounts or low levels of allergy-producing proteins.2,3
Hospital workers at risk for developing allergy are those with ongoing latex exposure, such as physicians, nurses, aides, operating room employees, lab technicians, housekeeping personnel, ambulance attendants, and food service workers.
Calling in the cardiac arrest team
Reports about latex allergy prevalence vary greatly, the recommendations point out. Recent reports indicate that about 8% to 12% of health care workers are sensitized to latex, compared with about 1% to 6% of the general population.4-6 Case reports cited by NIOSH included that of a physician with a history of seasonal allergies, runny nose, and eczema on his hands who suffered severe runny nose, shortness of breath, and collapsed minutes after putting on a pair of latex gloves. He was successfully resuscitated by a cardiac arrest team.7 Another case cited in the same study involved an intensive care nurse with a history of runny nose, itchy eyes, asthma, eczema, and contact dermatitis who experienced four severe allergic reactions to latex. The first reaction began with asthma severe enough to require treatment in an emergency room. The second and third reactions were similar to the first. The fourth and most severe reaction occurred when she put on latex gloves at work. She went into severe shock and was successfully treated in an emergency room.
Latex allergy problems extend to certain groups of patients, as well. Another study found that 28% to 67% of children with spina bifida demonstrate an allergic reaction to latex proteins. About two-thirds of those have latex allergy symptoms. Life-threatening anaphylactic shock can occur intraoperatively in highly sensitive patients because of mucosal absorption of latex protein allergens, the authors warn.8
According to NIOSH, reasons for the large numbers of latex allergies reported among health care workers include increasing reliance on latex gloves to prevent transmission of bloodborne pathogens; the U.S. Occupational Safety and Health Administration’s (OSHA) bloodborne pathogens standard requirement that employers provide gloves and other protective measures for employees; production changes in latex glove manufacturing to meet increased demand; and increased physician familiarity with latex allergy and improved methods for diagnosing it.
The NIOSH recommendations represent "a step," but an "incomplete" one, says B. Lauren Charous, MD, director of the allergy and respiratory care center at Milwaukee Medical Clinic and a national advocate for latex-disabled health care workers, which are many of his patients.
"It hedges on the question of powdered gloves," Charous maintains. He notes that on one hand, the recommendations call for use of powder-free gloves when latex gloves are used. On the other hand, the guidelines instruct workers to remove latex-containing dust from the workplace and to avoid areas where they might inhale latex glove powder.
"I don’t think this is very clear," he says, "and I don’t think the onus should be on the employee. This is a question of workplace safety. I’m opposed to the notion that it is up to the employee to defend his own inhaled-air safety. His atmosphere has to be made safe."
Charous says continuing to use powdered latex gloves is a matter of preference rather than necessity. "There are hospitals that have gone completely to nonpowdered and nonlatex gloves, so it can be done. If it can’t be done, [employers] have to very carefully monitor and restrict their use in particular areas, and then get anyone who is allergic to latex out of that area. Powdered gloves are the cause of respiratory allergy and occupational asthma. There is no question about that. We’ve got to do away with powdered gloves," he says. "That’s the direction we have to take."
Sue Lockwood of Grafton, WI, was one of Charous’ first patients. A former surgical tech, her occupationally acquired extreme latex allergy left her unable to work in health care or any other setting. After being diagnosed in 1991, Lockwood went on to establish and become executive director of Allergy to Latex Education and Resource Team (ALERT), which provides education and support to nearly 2,000 health care workers and others nationwide.
"I’m glad to see something come out of the government, but it’s just a beginning," Lockwood says. "There needs to be more effort and more action in the workplace to implement this. I want hospitals to see that this is coming from the government, that it provides a place to start, and to jump on it."
The directors of ELASTIC (Education for Latex Allergy Support Team and Information Coalition), a national activist education and support group with chapters in 46 states, also regard the NIOSH document as a first step toward preventing latex allergies. Debra Adkins, RN, of Torrington, CT, a nurse for more than 20 years until she was felled by a series of anaphylactic reactions to latex, says the recommendations "go a long way to protect health care workers. Nobody ever goes far enough for us, but it gives employers the opportunity to make changes."
Adkins notes that nurses’ aides in some facilities still wear latex gloves for tasks such as taking blood pressures and charting. "That’s ridiculous," she says. "People have to start examining what universal precautions really mean."
[Editor’s note: For a copy of the NIOSH alert, call (800) 35-NIOSH and ask for publication no.97-135. It also is available on the World Wide Web at http:// www.cdc.gov/niosh/latexalt.html. For a copy of ALERT’s latex-safer hospital facility packet, which includes guidelines, protocols, and product lists, call (888) 97ALERT. The cost is $25 postpaid.]
References
1. National Institute of Occupational Safety and Health. NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Workplace. DHHS (NIOSH) Pub. No. 97-135. Washington, DC: NIOSH; 1997.
2. Swanson MC, Bubak ME, Hunt LW, et al. Quantification of occupational latex aeroallergens in a medical center. J Allergy Clin Immunol 1994; 94:445-451.
3. Tarlo SM, Sussman G, Contala A, et al. Control of air-borne latex by use of powder-free latex gloves. J Allergy Clin Immunol 1994; 93:985-989.
4. Kelly KJ, Sussman G, Fink J. Stop the sensitization. J Allergy Clin Immunol 1996; 98:857-858.
5. Liss GM, Sussman GL, Deal K, et al. Latex allergy: Epidemiological study of hospital workers. Occup Environment Med 1997; 54:335-342.
6. Ownby DR, Ownby HE, McCullough J, et al. The prevalence of anti-latex IgE antibodies in 1000 volunteer blood donors. J Allergy Clin Immunol 1996; 97:1188-1192.
7. Rosen A, Isaacson D, Brady M, et al. Hypersensitivity to latex in health care workers: Report of five cases. Otolaryngol Head Neck Surg 1993; 109:731-734.
8. Sussman GL, Beehold DH. Allergy to latex rubber. Ann Intern Med 1995; 122:43-46.
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