Zinc may be allergy link, but hand washing the rub
Topical gel promising against latex reaction
A new topical hand cream was effective in preventing allergic reactions in health care workers with a history of known sensitivity to latex gloves, a researcher reported recently in Toronto at the Interscience Conference on Antimicrobial Agents and Chemotherapy.
The product a topical gel containing zinc gluconate could help stem the tide of health care workers who have to leave medical employment after developing allergic reactions to latex in an era of ubiquitous glove use for infection control measures, notes Shanta Modak, PhD, associate research scientist in the department of surgery and one of the developers of the product at Columbia-Presbyterian Medical Center in New York City.
"This cream can prevent latex glove allergies for up to four hours when applied before putting on the gloves," says Modak. "Use of the cream may reduce health care workers’ risk of becoming sensitized to latex after continued exposure and may help the tens of thousands of health care workers who suffer daily with chronic irritant dermatitis."
The National Institute of Occupational Safety and Health (NIOSH) recently issued an alert about the issue, reporting 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 (See story in Hospital Infection Control, October 1997, pp. 155-157.) 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.2
Modak and colleagues investigated topical creams containing a new gel composition for their efficacy in preventing irritant dermatitis when used before wearing latex gloves. They discovered that when the zinc gel composition was formulated in a special base, a gel matrix or a protective coating structure was formed on the skin’s surface. The "matrix" appears to react with and bind soluble latex proteins and other irritants that are known to produce allergies, and may actually prevent the allergic response altogether, she reported. Prevention of the initial onset of irritant dermatitis is critical, because the symptoms may precede more severe allergic reactions.
Cream provides double action’
"It forms a barrier, and we believe that the zinc has some action on the allergens, [which] are not allowed to penetrate," Modak tells Hospital Infection Control. "It’s a double action."
Still, the cream could have limited utility for direct patient caregivers, because as currently designed it would have to be reapplied after hand washing, she notes. As a result, testing is now under way to develop a waterproof version that would not have to be reapplied after handwashing.
In the study, 10 volunteers with a history of latex allergy washed their hands with soap and water, and applied the gel on one hand and a placebo cream on the other hand prior to donning gloves. They performed their routine activity for two to four hours. Volunteers were instructed to remove the gloves if they experienced discomfort. The hands were washed after removal of the gloves and the skin reactions were graded. The following week, volunteers repeated the experiment after switching the gel to the other hand.
The results show that gel-treated hands experienced no discomfort or local allergic reactions during or after the use of gloves for two to four hours. In contrast, the placebo-treated hand of the 10 volunteers had mild to moderate skin reactions such as welts, redness, and itchiness within five to 15 minutes. Also, the application of gel on the affected areas of the placebo hands alleviated the skin reactions within 15 minutes. In addition, 15 volunteers with no known latex sensitivity repeatedly used the cream for five days, reapplying it four to six times a day. All the volunteers reported good comfort and absence of skin dryness associated with the glove use, Modak reported. Columbia University has licensed the gel to Virasept Pharmaceuticals Inc. in Elmsfort, NY.
[Editor’s note: For more information about the cost and availability of the product, ICPs can contact Virasept Inc. at (914) 592-2700.]
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. Liss GM, Sussman GL, Deal K, et al. Latex allergy: Epidemiological study of hospital workers. Occup Environmental Med 1997; 54:335-342.
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