NURSING MATTERS
Nursing Matters fact sheets provide quick reference information and international perspectives from the nursing profession on current health and social issues.

International Council of Nurses on Latex

Latex allergy or hypersensitivity is now recognised as a health problem and an occupational risk for health care workers. An estimated 8-20% of health care workers are allergic to latex. Anaphylactic reactions to latex can be fatal.

Latex has been in use for about 100 years and has proven protective capability. It is found in as many as 40 000 consumer products, including rubber gloves, condoms, balloons, athletic shoe soles, tires, underwear, leg and waist bands, rubber toys and pacifiers. Latex can be found in many medical supplies including disposable gloves, intravenous tubes, syringes, stethoscopes and bandages. Dipped rubber products such as gloves, condoms, and balloons, which are made by dipping moulds into liquid latex, seem to be the major causes of reactions. The first latex fatalities (reported in the US) resulted from the catheters used for barium enemas, which were subsequently removed from the market. No deaths have been linked with the use of latex gloves although an increasing number of allergic reactions are being reported.

Exposure
Latex proteins enter the body through skin, mucous membranes, intravascularly, or via inhalation. Cornstarch powder used in latex gloves is a carrier of the protein. Because proteins in the powder can be airborne for hours after donning and removing gloves, this allergen can be inhaled or settle on clothing, skin, or mucous membranes long after disposal of the gloves from the immediate environmentⁱ.

The allergic reaction follows a period of sensitisation where the immune system develops cells that react to the allergens found in the latex. This abnormal response may take many years to happen as exposure builds up. The three commonly occurring reactions to latex gloves are:

Irritation:  Redness, soreness, dryness or cracking of the skin in areas exposed to gloves. In the case of irritant reactions, once the irritant agent has been identified and its use discontinued, the symptoms will disappear and not recur.

Type I:  This is the more serious reaction and occurs almost immediately. The allergy is irreversible and no cure is currently available. The symptoms include localised or generalised rash, conjunctivitis (red and swollen eyes with discharge) and asthma like symptoms. In some cases anaphylaxis could occur. This has the potential to be fatal.

Type IV:  This is an allergic response to the chemical additives used in manufacture. The symptoms are dermatitis and itching, with oozing red blisters. It occurs between 10 and 24 hours after exposure and can get worse over the subsequent 72 hours. This type of allergy is also irreversible and without cure.ⁱⁱ

Occupational hazard for nurses

As demand (universal precautions) and the industry grew, latex processing and product manufacturing changed. “The risk of developing a latex allergy keeps rising, not just because more people are using the gloves, but because each use may mean exposure to higher levels of allergen.”^iii Your employer should be required to provide staff with suitable personal protective equipment if exposed to risk in the workplace. A risk assessment must be carried out to ensure that the protective equipment is suitable. Powder-free latex gloves are more expensive than powdered gloves, and latex-free gloves are more expensive than latex gloves.

Are you at risk? Do your hands break out when you wear latex gloves? If you use any latex gloves, whether low powder, low protein or powder-free, do you have swelling around your eyes, itching or hives? Do you have multiple allergies or have you had multiple surgeries or dental procedures? Do you use your inhaler or have asthma attacks more often at work? Do you wheeze or do your lips and face swell when you blow up a balloon? Do you have vaginal irritation, swelling or discharge after gynaecological exams? Do you have swelling or sores in your mouth or on your face after a dentist visit? Do you have any food allergies? Latex allergy is also associated with allergies to certain foods, especially avocado, potato, banana, tomato, chestnuts, kiwi fruit and papaya. Any "yes" answers may indicate sensitivity to latex. Contact your health care provider for further testing and your national nurses' association. The American Nurse, Sept/Oct 1999

The literature indicates that the ideal glove, if it is latex, should be powder free, very low in extractable latex protein, and have the smallest concentration and the fewest number of residual chemicals from manufacture.
Do not rely on the term “hypoallergenic” which does not mean a low protein content but refers to a reduction in the use of other chemicals. Gloves should be removed promptly after completing a procedure and hands should be washed to reduce skin contact time with potential allergens. Avoid touching the eyes, noses, or mouth while wearing latex or immediately after removing a latex glove, in order to avoid potential latex sensitisation via these mucosal routes.^iv

Health care facilities must develop policies to include screening employees for latex allergy, reporting and documentation requirements, the provision of suitable protective equipment and a plan for educating all employees about latex allergy. In addition, care must be given to avoid endangering patients and/or colleagues with latex allergy or sensitivity. Furthermore, health care professionals need to lobby industry for the development of non-latex containing gloves and medical equipment to further reduce the workplace and environmental risks.