ALERT FOR MEDICAL WORKERS

Allergic Reactions Latex in the Workplace

The National Institute for Occupational Safety and Health (NIOSH) Reports of outbreaks of allergic reactions to latex have increased in recent years --especially among health care workers.

This Alert shows the data and describes case reports of workers who have latex allergy symptoms. The report also shows NIOSH recommendations for reducing latex-related problems in workers. These recommendations include reducing exposures, using correct work practices, training workers, tracking symptoms, and replacing non-latex products when appropriate.

NIOSH asks that employers, owners, editors of trade journals, safety and health officials, and labor unions bring the recommendations in this Alert to the attention of all workers who may be exposed to latex.

*In this report, the term "latex" refers to natural rubber latex. Natural rubber latex is the product manufactured from a milky fluid derived mainly from the rubber tree, Hevea brasiliensis

BACKGROUND

Background of Latex

Some proteins in latex can cause a range of mild to severe allergic reactions. Currently available methods of measurement do not provide easy or consistent identification of allergy-causing proteins (antigens) and their concentrations. The chemicals added during processing may also cause skin rashes. Several types of synthetic rubber are also referred to as "latex," but these do not release the proteins that cause allergic reactions.

Products with Latex

A wide variety of products contain latex: medical supplies, personal protective equipment, and numerous household objects. Most people who encounter latex products only through their general use in society have no health problems from the use of these products. Workers who repeatedly use latex products are the focus of this Alert. The following are examples of products that may contain latex:

Emergency Equipment Containing Latex
Blood pressure cuffs
Stethoscopes
Disposable gloves
Endotracheal tubes
Tourniquets
Intravenous tubing
Syringes
Electrode pads

Personal Protective Equipment that contain Latex
Gloves
Surgical masks
Goggles
Respirators

Hospital Supplies that contain latex
Anesthesia masks
Catheters
Wound drains
Injection ports
Rubber tops of multidose vials
Dental dams

People who already have latex allergy should be aware of latex-containing products that may cause an allergic reaction.

Latex Allergies in the Workplace

Persons in the health care industry (physicians, nurses, dentists, technicians, etc.) are at risk for developing latex allergy because they use latex gloves frequently. Also at risk are workers with less frequent glove use (hairdressers, housekeepers, food service workers, etc.) and workers in industries that manufacture latex products.

SKIN REACTIONS TO LATEX

Three types of skin reactions that occur in individuals using latex products:

Contact Dermatitis

The most common reaction to latex products is contact dermatitis -- dry, itchy, irritated areas on the hands. This reaction is caused by skin irritation from using gloves and chemicals. The irritation can also result from repeated hand washing and drying, incomplete hand drying, use of cleaners and sanitizers, and exposure to powders added to the gloves. Irritant contact dermatitis is not a true allergy.

Chemical Sensitivity Dermatitis

Allergic contact dermatitis results from exposure to chemicals added to latex during harvesting, processing, or manufacturing. These chemicals can cause skin reactions similar to those caused by poison ivy.

Latex Allergy

Latex allergy (immediate hypersensitivity) can be a more serious reaction to latex than irritant contact dermatitis or allergic contact dermatitis. Certain proteins in latex may cause sensitization (positive blood or skin test, with or without symptoms). Reactions usually begin within minutes of exposure to latex, but they can occur hours later and can produce various symptoms. Mild reactions to latex involve skin redness, hives, or itching.

LEVELS OF EXPOSURE

Studies of other allergy-causing substances provide evidence that the higher the overall exposure in a population, the greater the likelihood that more individuals will become sensitized [Venables and Chan-Yeung 1997].

Figure 1. Dust produced by removing a latex glove containing powder.

The proteins responsible for latex allergies have been shown to fasten to powder that is used on some latex gloves. When powdered gloves are worn, more latex protein reaches the skin. Also, when gloves are changed, latex protein/powder particles get into the air, where they can be inhaled and contact body membranes (see Figure 1) [Heilman et al. 1996]. In contrast, work areas where only powder-free gloves are used show low levels or undetectable amounts of the allergy-causing proteins [Tarlo 1994; Swanson et al. 1994].

Wearing latex gloves during outbreaks of hand dermatitis may increase the risk of developing latex allergy. Kkin rash may be the first sign that a worker has become allergic to latex.

WORKERS AT RISK?

Workers such as health care workers (physicians, nurses, aides, dentists, dental hygienists, operating room employees, laboratory technicians, and hospital housekeeping personnel) Workers in factories where latex products are manufactured or used can also be affected.

Atopic individuals (persons with a tendency to have multiple allergic conditions) are at increased risk for developing latex allergy.

DIAGNOSING LATEX ALLERGY

Latex allergy including nasal, eye, or sinus irritation; hives; shortness of breath; coughing; wheezing; or unexplained shock. Any exposed worker who experiences these symptoms should be brought to the attention to a physician.

A positive reaction is shown by itching, swelling or redness at the test site. However, no FDA-approved materials are yet available to use in skin testing for latex allergy. Testing is also available to diagnose allergic contact dermatitis. In this FDA-approved test, a special patch containing latex additives is applied to the skin and checked over several days. A positive reaction is shown by itching, redness, or blistering where the patch covered the skin.

Occasionally, tests may fail to confirm a worker who has a true allergy to latex, or tests may suggest latex allergy in a worker with no clinical symptoms. Therefore, test results must be evaluated by a knowledgeable physician.

TREATING LATEX ALLERGY

Certain medications may reduce the allergy symptoms, but complete latex avoidance is the most effective approach. Many facilities maintain latex-safe areas for affected patients and workers.

CONCLUSIONS

Latex allergy in the workplace can result in potentially serious health problems for workers, who are often unaware of the risk of latex exposure. Such health problems can be minimized or prevented by following the recommendations outlined in this Alert.

RECOMMENDATIONS

Employers

Latex allergy can be prevented only if employers adopt policies to protect workers from undue latex exposures. NIOSH recommends that employers take the following steps to protect workers from latex exposure and allergy in the workplace:

1. Appropriate barrier protection lotion is necessary when handling infectious materials [CDC 1987]. If latex gloves are chosen, provide reduced protein, powder-free gloves to protect workers from infectious materials.
2. Ensure that workers use good housekeeping practices to remove latex-containing dust from the workplace:
• Identify frequent cleaning (upholstery, carpets, ventilation ducts, and plenums) areas.
• Make sure that workers change ventilation filters and vacuum bags frequently in latex-contaminated areas.
3. Provide workers with education programs about latex allergy.
4. Periodically screen high-risk workers for latex allergy symptoms.
5. Evaluate current prevention strategies whenever a worker is diagnosed with latex allergy.

Workers

Workers should take the following steps to protect themselves from latex exposure and allergy in the workplace:

1. Use nonlatex gloves for activities that are not likely to involve contact with infectious materials (food preparation, routine housekeeping, maintenance, etc.).
2. Appropriate barrier protection Lotion is necessary when handling infectious materials [CDC 1987]. If you choose latex gloves, use powder-free gloves with reduced protein content:
• Such gloves reduce exposures to latex protein and thus reduce the risk of latex allergy
• So-called hypoallergenic latex gloves do not reduce the risk of latex allergy. However, they may reduce reactions to chemical additives in the latex (allergic contact dermatitis).
3. Use appropriate work practices to reduce the chance of reactions to latex:
• When wearing latex gloves, do not use oil-based hand creams or lotions (which can cause glove deterioration) unless they have been shown to reduce latex-related problems and maintain glove barrier protection.
After removing latex gloves, wash hands with a mild soap and dry thoroughly.
Use good housekeeping practices to remove latex-containing dust from the workplace:
• Frequently clean areas contaminated with latex dust.
• Frequently change ventilation filters and vacuum bags used in latex-contaminated are.
4. Take advantage of all latex allergy education and training provided by your employer:
• Be familiar with procedures for preventing latex allergy.
• Recognize the symptoms: skin rashes; hives; flushing; itching; nasal, eye, or sinus symptoms; asthma; and shock.
5. If you develop symptoms of latex allergy, avoid direct contact with latex gloves and other latex-containing products until you can see a physician experienced in treating latex allergy.
6. If you have latex allergy, consult your physician regarding the following precautions:
• Avoid contact with latex gloves and other latex-containing products.
• Avoid where you inhale the powder from latex gloves worn by other workers.
• Tell your employer that you have latex allergy.
• Wear a medical alert bracelet.
7. Carefully follow your physician's instructions for dealing with allergic reactions to latex.

ADDITIONAL INFORMATION

For additional information about latex allergy, call 1-800-35-NIOSH (1-800-356-4674); or visit the NIOSH Home Page on the World Wide Web at http://www.cdc.gov/niosh/homepage.html

You may access the following latex allergy website directly or by selecting Latex Allergy through the NIOSH Home Page:

• Workers with ongoing exposure to natural rubber latex* should take the following steps to protect themselves:

1. Use nonlatex gloves for activities that are not likely to involve contact with infectious materials (food preparation, routine housekeeping, maintenance, etc.).
2. Appropriate skin barrier lotion protection is necessary when handling infectious materials**. If you choose latex gloves, use powder-free gloves with reduced protein content.***
3. When wearing latex gloves, to reduce latex-related problems and maintain glove barrier protection.
4. Frequently clean work areas
5. Frequently change the ventilation filters.
6. Learn to recognize the symptoms of latex allergy: skin rashes; hives; flushing; itching; nasal, eye, or sinus symptoms; asthma; and shock.
7. If you develop symptoms of latex allergy, avoid direct contact with latex gloves and products until you can see a physician experienced in treating latex allergy.
8. If you have latex allergy, consult your physician:
• Avoid contact with latex gloves and products.
• Avoid areas where you might inhale the powder from the latex gloves worn by others.
• Tell your employers, physicians, nurses, and dentists that you have latex allergy.
• Wear a medical alert bracelet.
Take advantage of all latex allergy education and training provided by your employer.

Dust produced by removing a latex glove containing powder.

*In this warning sheet, the term "latex" refers to natural rubber latex and includes products made from dry natural rubber. Natural rubber latex is the product manufactured from a milky fluid derived mainly from the rubber tree, Hevea brasiliensis.

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**CDC (Centers for Disease Control and Prevention) [1987]. Recommendations for prevention of HIV transmission in health-care settings. MMWR 36(S2).

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***The goal of this recommendation is to reduce exposure to allergy-causing proteins (antigens). Until well accepted standardized tests are available, total protein serves as a useful indicator of the exposure of concern.