Atopy and other risk factors for UK dentists reporting an adverse reaction to latex gloves

Self report of skin problems among farmworkers in North Carolina

BACKGROUND

This study estimates the prevalence of self-reported skin problems among Latino farmworkers and identifies associated risk factors.

METHODS

The study used a longitudinal surveillance design. Participants were interviewed up to five times and reported skin problems and personal, work, and environment characteristics. Frequencies and counts were calculated for 13 skin problems. Adjusted odds ratios were obtained for six skin problems.

RESULTS

More than one-third of participants reported skin problems, including skin and nail fungus; sunburn; bumps, pimples, or acne; calluses; itching; rash; and insect bite. A variety of work and environment factors were associated with higher rates of skin problems. One of the strongest predictors was working in wet clothes or shoes.

CONCLUSIONS

Programs are needed to educate farmworkers about measures they can take to decrease their risk of skin problems. Changes in work practices and personal protective equipment provided could help decrease the prevalence of skin problems.

Occupational skin diseases among dental nurses

Out of 923 female dental nurses in the Helsinki district, 799 were interviewed using a computer-assisted telephone interview. A structured questionnaire was used to inquire about skin, respiratory symptoms, atopy, work history and methods, and exposure at work. The 328 nurses, who reported work-related dermatitis on their hands, forearms or face, were invited to an interview by an occupational physician; 245 nurses participated. 31 nurses had previously been diagnosed with an occupational skin disease (OSD). 133 nurses with a suspected OSD were selected for further clinical examinations with prick and patch testing. Among the 107 nurses examined, 22 new cases of OSD were diagnosed. There were altogether 29 cases of allergic contact dermatitis, 15 of contact urticaria, 12 of irritant contact dermatitis, and 1 case of onychomycosis. Rubber chemicals and natural rubber latex (NRL) in protective gloves, as well as dental-restorative plastic materials [(meth)acrylates], were the most common causes of allergy. 42% of the OSD cases in the studied population had been missing from the statistics (Finnish Register of Occupational Diseases). Plastic gloves or NRL gloves with a low-protein content are recommended for dental work. Skin exposure to (meth)acrylates should be avoided.

Alergia ao látex e a frutas em profissionais da área da saúde

INTRODUÇÃO: A alergia ao látex tornou-se um risco crescente aos indivíduos expostos, como os profissionais da área da saúde, tendo como agravo a associação com hipersensibilidade a vários alimentos, especialmente frutas. OBJETIVO: Avaliar a freqüência de sensibilização ao látex e a frutas em profissionais da área da saúde. MÉTODOS: Foram avaliados 53 profissionais da saúde, 81,9% do sexo feminino, aplicando-se questionário alergológico e testes cutâneos por puntura para alérgenos inaláveis, do látex e de frutas (mamão papaia, kiwi, abacate, banana, figo, tomate, noz). RESULTADOS: Dos 53 indivíduos estudados, 15 (28,5%) eram alérgicos ao látex. A sensibilidade a frutas foi diagnosticada em 14 (26,4%), dos quais 10 (18,8%) apresentavam teste por puntura positivo para o látex; as frutas alergênicas mais freqüentes foram papaia (80,0%), kiwi (60,0%) e abacate (50,0%). CONCLUSÃO: Estes achados demonstram a existência da alergia látex-fruta, como descrito na literatura, sendo de suma importância uma avaliação in vivo em profissionais da área de saúde, caracterizados como potencial grupo de risco.

Natural rubber latex allergy in a health-care population in Wales

BACKGROUND

Type 1 natural rubber latex (NRL) allergy prevalence rates quoted vary due to the different populations studied and methodologies used for assessment and investigation of NRL allergy.

OBJECTIVES

To investigate the rate of type 1 allergy to NRL in health-care workers (HCWs) in a single NHS trust in Wales.

METHODS

A response rate of 3716 of 5548 (67%) of the employees was obtained with a latex allergy questionnaire administered by the occupational health departments. Type 1 NRL allergy was diagnosed by correlating clinical symptoms, skin prick testing and IgE RAST to latex in the dermatology department.

RESULTS

The period prevalence (1998-2001) for type 1 clinical latex allergy in HCWs was 25 of 4439 (0.56%). Of the 25 positive HCWs, 18 (72%) were nurses.

CONCLUSIONS

The low prevalence rate of type 1 NRL allergy should not lead to underestimating the importance of clinically significant NRL allergy and the risks that need to be minimized.

Alergia látex-fruta

O látex está sendo considerado o alergênico do ano 2000, tendo em vista que inúmeros indivíduos, principalmente profissionais da área de saúde e pacientes submetidos a várias intervenções diagnósticas e terapêuticas, estão freqüentemente expostos aos alérgenos do látex, presentes em produtos de borracha natural. As manifestações clínicas conseqüentes às reações alérgicas de hipersensibilidade imediata vão desde rinite, urticária, conjuntivite, angioedema, asma, até anafilaxia. Estudos recentes estão demonstrando que pacientes alérgicos ao látex desenvolvem concomitantemente sensibilização a certos alimentos de origem vegetal, especialmente frutas como papaia, figo, banana, abacate, kiwi, pêssego, abacaxi, melão e castanha, acreditando-se numa provável ocorrência de reações cruzadas entre os alérgenos do látex e destas frutas. Faz-se, então, uma revisão sobre a alergia ao látex, em particular sobre os grupos de risco, incluindo a presença de reatividade cruzada entre o látex e as frutas.

Comprehensive analysis of 28 patients with latex allergy and prevalence of latex sensitization among hospital personnel

Recently anaphylactic shock caused by latex gloves and medical instruments has been discussed as an important problem in surgical operations. Patients with contact urticaria or anaphylaxis due to natural rubber latex were first reported in Japan in 1993, and the number of cases is gradually increasing. In the present study, we analyzed 28 patients examined in our clinic from 1993 to 1998. The diagnosis of latex allergy was made on the basis of clinical history, latex specific IgE antibody, skin test, and use test. The 3 male and 25 female patients included 20 nurses, 4 doctors, 2 housewives, one animal hospital employee, and one worker in a senile rehabilitation center. The majority were health care workers. Contact urticaria from rubber gloves was the most common clinical symptom. Some of the patients developed severe attacks of anaphylaxis. During the period from 1995 to 1997, we also performed a questionnaire study and a serum examination of latex specific IgE antibody among the personnel of our university hospital. The screening test for the antibody was more reliable than our questionnaire study in detecting latex-sensitive persons. The prevalence of latex allergy was found to be 4.6%. This indicates that not only dermatologists but also all hospital workers should be aware of this type of allergy.

Protective gloves in Swedish dentistry: use and side-effects

BACKGROUND

During the 1980s routine wearing of gloves in dentistry was recommended by health authorities in several countries. However, prolonged glove use is associated with side-effects of irritant and allergic origin.

OBJECTIVES

To investigate the extent of glove use and self-reported glove intolerance reactions among Swedish dentists, and to examine how far IgE-mediated allergy to natural rubber latex (NRL) occurs in subjects who report rapid itching when in contact with protective gloves.

SUBJECTS/METHODS

A postal questionnaire was answered by 3083 of 3500 licensed dentists, a response rate of 88%. Of the dentists who reported rapidly occurring itching of the hands from gloves, 131 of 170 attended a clinical examination including a skin prick test (SPT) and a serological examination (RAST) for IgE-mediated allergy.

RESULTS

Seventy-three per cent of the dentists reported daily glove use of more than 2 h, 48% more than 6 h a day, and 6% reported no use. NRL gloves were used most frequently (P < 0.001) and were the main material that elicited symptoms (P < 0.001). Female dentists reported more frequent glove use than males, as did young dentists (P < 0.001) compared with older ones. Females also preferred vinyl gloves. Glove intolerance reactions were reported by 723 (23%) dentists, [females 28%, males 21% (P < 0.001)] and were more common in younger dentists. Of the 417 dentists with reported hand eczema during the previous year, 54% reported glove intolerance, compared with 20% of the dentists without hand eczema (P < 0.001). A logistic regression analysis including hand eczema, age, sex and atopy showed that all these factors contributed significantly to the risk of glove intolerance, and that hand eczema was a stronger factor than atopy. In 15 of 131 (11%) dentists examined for reported glove-related itch, latex allergy was verified by SPT and/or RAST. Glove-related conjunctivitis, rhinitis and asthma, in contrast to skin symptoms, showed a significant association with IgE-mediated allergy to NRL.

CONCLUSIONS

Swedish dentists show good compliance with the recommendations for routine glove use. Intolerance reactions are frequently reported, especially by dentists with hand eczema, which emphasizes the need for preventive skin care programmes. Glove-related symptoms from mucous membranes showed a higher association with IgE-mediated allergy to NRL than reported itching of the skin, a fact that should be considered when composing screening questionnaires for NRL sensitization

Mutual boosting effects of sensitization with timothy grass pollen and latex glove extract on IgE antibody responses in a mouse model

Type I allergy to natural rubber latex can be an important health problem for latex-exposed individuals (e.g., health care workers, spina bifida children). Also beyond these risk groups, a high sensitization rate of varying and partly unknown clinical relevance has been reported. Atopy represents a risk factor for latex allergy and recent studies indicate that patients suffering from pollen allergies may have pollen allergen-specific IgE antibodies which cross-react with latex allergens. In order to investigate whether sensitization to pollen allergens can have priming effects on the production of IgE antibodies against latex in vivo, a mouse model was established. Groups of 10 BALB/C mice were immunized with Al(OH)3-adsorbed pollen extracts from timothy grass, ragweed, mugwort, or birch. For control purposes, one additional group received adjuvant only and another group was not immunized. Half of the mice of each group were subsequently immunized with Al(OH)3-adsorbed latex glove extract, the other half with adjuvant only. Pollen and latex-specific IgE- and IgG1-antibody responses were analyzed by enzyme-linked immunosorbent assay and statistically evaluated by analysis of variance. Antibody responses to cross-reactive antigens were investigated by immunoblotting. We found significantly increased IgE reactivities to latex after pollen sensitization and vice versa. Moreover, mice immunized with timothy grass pollen extract alone - without subsequent latex immunization - displayed IgE reactivity to latex. Cross-reactive antibodies were directed against pollen antigens of approximately 60 kDa molecular weight. Our results thus demonstrate a mutual boosting effect of pollen and latex sensitization in vivo which may be also operative in polysensitized plant allergic patients.

Prevalence and risk factors for latex allergy: a cross sectional study in a United Kingdom hospital

OBJECTIVES

To determine the prevalence and risk factors for symptoms related to gloves, and the relation between symptoms and immunological evidence of type 1 hypersensitivity to latex in a United Kingdom health care setting.

METHODS

A cross sectional survey was carried out among 773 employees at a British hospital. A self administered questionnaire was used to collect information about symptoms related to gloves and associated risk factors in a sample of hospital staff who were likely to use gloves at work. All of those who reported symptoms suggestive of type 1 hypersensitivity were invited for skin prick testing and measurement of specific IgE to latex (RAST).

RESULTS

Among the 372 responders, symptoms related to gloves were common, 49% reported redness or itching of the hands, 14% reported urticaria, and 6% reported chest tightness. However, the frequency of positive skin prick tests and RASTs was surprisingly low (only two subjects tested positive).

CONCLUSIONS

These findings indicate the need for caution in the interpretation of symptoms related to gloves even when they seem to suggest type 1 hypersensitivity.