Medical Industry and Glove Manufacturers Address Latex Allergy Concerns of Healthcare Workers

Stacey Back is allergic to lots of things, but none are as dangerous for her as latex. The Delaware woman was diagnosed with latex allergy 10 years ago and the illness has become a giant struggle for Back, her friends and family.

It affects so many aspects of my life I cant begin to name them all, but to say that I must be forever vigil whenever I go out, what I eat, and what I wear is putting it mildly, says Back, who is now disabled, but who worked in early education for more than 20 years.

I must always be prepared for the possible exposure to latex and carry supplies with me at all times in case I am exposed and have a reaction, she says. My family and friends also needed to be trained in what to look for if I do have an exposure and how to treat any reactions I have.

Simple maneuvers become complex with a severe latex allergy and can result in skin rashes, hives, flushing, itching, sinus symptoms, asthma and occasionally, anaphylactic shock.¹ There are the times Id like to go to a fair in the park but I see balloons everywhere so I have to leave or I just want to go to the mall shopping and some store has a display of latex balloons so again, I cant go in, Back adds.

A latex allergy is particularly egregious for those in the healthcare industry.

The obvious culprits are latex gloves, but the following items can also be troublesome: face masks, bandages, wound drains, urinary catheters, tourniquets, electrode pads, injection ports, rubber syringe stoppers, medication vial stoppers, adhesive tape, and bulb syringes.

Avoiding these products is difficult at best for healthcare workers and the consequences are high, says Milt Hinsch, technical services director for Mölnlycke Healthcare.

Healthcare workers with latex allergies are often severely affected (and this can result in) job changes, loss of job, medical problems and latex allergic reactions, Hinsch says. Many hospitals and healthcare facilities have made efforts to accommodate latex-allergic employees and patients by using powder-free, low-allergen latex gloves for those without latex allergies and latex-free gloves for those who are allergic.

Allergies can occur in people who have cumulative latex exposure, as well as people who undergo lots of surgeries. Symptoms can stay benign, or progress rapidly and unpredictably to anaphylaxis.²

From Where it Hails

Latex products have been used for about a century and are derived from the sap of commercially grown rubber trees, Hevea brasiliensis. The sap is extracted and heated and chemicals are added. Latex contains low-molecularweight soluble proteins, which are the cause of (some) allergic reactions.² At least 13 different proteins have been implicated, Hinsch says.

The mixture is poured into molds or is used in a dipping process to make gloves, balloons, condoms and other items. During the manufacturing process, cornstarch powder is applied to some gloves to prevent stickiness. Latex protein particles adhere to the powder, however, and can aerosolize when the gloves are removed.² Early cases of latex sensitivity were reported in the 1970s and peaked in the 1990s. Knowledge of this allergy increased since then, especially after more than a dozen young spina bifida patients died after having contact with the latex cuffs used on the tips of barium enema catheters, according to the U.S. Food and Drug Administration.

Ten to 17 percent of healthcare workers are sensitive to latex, and more than 2 percent have occupational asthma due to latex exposure.²

Danger Zone

Latex symptoms can be broad. The nonspecific nature of these symptoms is why latex allergies are often misdiagnosed.² According to the American Academy of Family Physicians, people who may have a latex allergy should answer the following questions. Replies of yes imply a possible latex aversion:

• Do you have a history of asthma, eczema, hay fever allergies or rashes?

• Are you allergic to bananas, kiwi, avocados, or chestnuts?

• Have you ever had surgery, spina bifida, a urinary tract problem or required a catheter?

• Have you ever had swelling, itching, hives, shortness of breath, cough or other allergic symptoms during or after blowing up a balloon, undergoing a dental procedure, using condoms or diaphragms, or following a vaginal or rectal exam?

Indeed, seemingly mundane objects and tasks can be a huge stressor to people with the allergy, Back says.

My most frequent problems are simply things that most people never have to think about, she says. When I go to the grocery store they might be displaying latex balloons or using latex gloves somewhere in the store, which means I cant go to that storeIf I want to go out to eat I must call ahead to find out if latex gloves are used in the restaurant because if someone wears them and touches my food or dishes I might have a reaction, and of course we have to ask if they have balloons in the restaurant also.

Latex allergies can vary widely from person to person, according to the National Institute of Occupational Safety and Health (NIOSH), which is part of the Centers for Disease Control and Prevention.

Allergic contact dermatitis (delayed hypersensitivity, also sometimes called chemical sensitivity dermatitis) is from the chemicals that are added to latex during the production process. The results are similar to those caused by poison ivy. The rash usually begins 24 to 48 hours after contact and may spread and lead to oozing skin blisters.¹ Other latex allergy reactions are redness, hives, itching and a range of respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat, coughing spells, wheezing and difficulty breathing. Occasionally, shock may occur; but a life-threatening reaction is seldom the first sign of a latex allergy.¹

Pyrogens and Endotoxins

Most healthcare workers know that latex can irritate and hurt some people, but few are aware of how latex glove powder can spread pyrogens and endotoxins.

Pyrogens and endotoxins are very important, Hinsch says.

They can cause everything from fevers to death and everything in between, he adds. They are what their names imply fever producing and toxic chemicals.

Hip and knee surgical implants, intraocular lenses, stents, tubing, connectors, needles and some fluids such as sterile saline, lactose, etc., should all be non-pyrogenic.

So, how does one handle drugs (pharmacy, dispensaries on floors, etc.), surgical implants, IV components with powdered or non-powdered gloves contaminated with pyrogens and endotoxins and not contaminate the surgical implants, wounds, sutures, IV devices, and drugs that are required to be non-progenic before use? Hinsch asks. It is a problem.

In response, Mölnlycke has developed a pyrogen and endotoxin education campaign that will involve meetings with the American Academy of Orthopedic Surgeons and implant manufacturers.

It is too soon to say if the campaign will be successful or not, Hinsch says. We have our fingers crossed and are optimistic. It has taken us longer than hoped to get meetings with the industry about the pyrogen and endotoxin issues because of almost total ignorance about the subject.

Hinsch thinks more people need to understand the role that glove powder plays in spreading these fever-causing foes.

Is Enough Being Done?

As far as Back is concerned, the healthcare industry has not responded adequately to people with latex allergies.

I have had to explain to many doctors about the severity of the allergy as so many believe that it is only something that makes you itch, Back says. I also have gone to many doctors offices and told them in advance about my allergy and asked them to please have a room ready for me that is clean of latex, and they not only do not understand why I need this but many do not accommodate me either.

Back adds that surgeons and doctors have complained to her that nonlatex gloves dont fit well. This frustrates Black and makes her think that they dont understand that her life is on the line.

Most nurses who I have had care from have been very understanding but I believe that many doctors not only need more education but need to understand how difficult this allergy can be for their patients, she says.

Since the 1990s, the healthcare industry and medical glove manufacturing industry has greatly improved safety for people with latex allergies, says Esah Yip, BSc, PhD, director of the Malaysian Rubber Export Promotion Council, a non-profit information center for rubber products, particularly medical gloves. Malaysia is the largest medical glove supplier (latex and non-latex) in the world.

The advent of the low-protein latex gloves has therefore made it possible for healthcare workers to be well protected without being a serious allergy concern, Yip says. While latex allergic individuals should use synthetic gloves, it is essential they choose those that can provide reasonable effective barrier protection, such as nitrile, although these gloves may be more costly than latex and vinyl.

There is a great deal of latex allergy information available, but it might not be enough, Hinsch says.

Still, some facilities are responding well to the allergy, says Sue Lockwood, executive director and co-founder of the American Latex Allergy Association, a national non-profit, tax-exempt organization that creates awareness of latex allergy through education, and provides support to individuals who have been diagnosed with latex allergy.

A lot of hospitals are great and have worked hard over the years to make their hospital latex safe and developed a policy and implemented it, Lockwood says. They also have a latex team/committee that oversees the practice and policy but there still are many that either have a policy but dont use it or even some that dont have a policy and cant handle latex allergic patients.

Going Latex Free

Factions of the plastic surgery industry have taken notice too. Rodeo Drive Plastic Surgery in Beverly Hills, Calif., in August 2007, designated one of its operating rooms as permanently latex-free, to assure maximum safety for patients who have latex allergies. Plastic surgeon Lloyd Krieger, MD, is the medical director at the facility and says the allergy is a serious concern.

Our latex-free operating room was in fact latex free from day one, since we built it, Krieger says. No latex of any kind has ever been used in this operating room.

Minimizing latex is good not just for patients, but also for employees, Yip says.

After making these changes, latex allergic individuals donning non-latex gloves could now work alongside their co-workers wearing these low-protein latex gloves and showed no ill effects, Yip says. It was also reported that there was no need for allergic people to change jobs or retire now.

Regardless of what gloves are made from, it is important that healthcare workers keep the skin on their hands healthy and intact, says Lori Jensen, RN, a clinical consultant for Ansell Healthcare.

A healthy stratum corneum will ensure the prevention of cracks, which could be a potential portal for the entry of pathogens, Jensen says. HydraSoft technology gloves from Ansell actively retains moisture and rehydrates the skin during use. It is odorless and contains Glycerine, a skin-friendly humectant moisturizer that penetrates into the stratum corneum, where it attracts and retains water. HydraSoft technology is gentle to sensitive skin, yet provides robust protection from drying and cracking.

Allergy or no allergy, healthy skin is an excellent defense.

Products

The glove manufacturing industry, especially in Malaysia, has produced many types of latex gloves that are low protein, and therefore provide little risk of allergy.

The effectiveness of these gloves is evident by the publications of no less than 10 independent hospital studies in the U.S., Canada and Europe demonstrating that when the high protein gloves with excessive powder were replaced with the low-protein latex gloves, the incidences of latex allergy in hospitals were vastly reduced, Yip says.

Not all gloves or materials have the same level of effectiveness, however.

For example, numerous studies have shown the very inexpensive vinyl gloves have inferior barrier properties as compared to latex gloves and many other synthetic gloves, like nitrile and polychloroprene, Yip says. Latex gloves are in fact known to the gold standard, with their superior barrier properties, durability, resistance to tear, tactile sensitivity, great comfort and fit qualities that manufacturers of many synthetic gloves are attempting to duplicate.

One low-protein latex, Vytex (produced by Vystar Corporation) has been in development for seven years and may be useful in products such as gloves, foam mattresses, balloons, pacifiers, elastic thread, condoms, catheters, IV tubes, tourniquets, oxygen bags and rubber stoppers when it comes to market. Vytex is a natural rubber latex that has been processed to remove the antigenic proteins.

Vytex natural rubber latex is safe for use in most healthcare environments that previously called for only latex-free products, product literature states. With more than 40,000 products containing natural rubber latex, applications for Vytex natural rubber latex are enormous.

Many latex specialties exist. Dow Reichhold Specialty Latex LLC, for instance, produces nitrile, styrene butadiene, acrylic, vinyl acrylic, styrene acrylic, vinyl acetate and vinylidene chloride specialty latexes, which are used in a range of products from gloves to paper.

The more options, the better, since some products still lack solutions, Lockwood says.

There are a lot of alternatives for almost everything but the biggest problem is that there is no alternative to the latex balloon other than mylar, she says. We also would like to have consumer products labeled. It would help with the confusion on natural rubber latex products and synthetic rubber latex products.

In the healthcare industry, on the other hand, surgical and exam gloves are the biggest issue. Fortunately, the industry has responded well, according to Hinsch.

There are plenty of good latex-free gloves available, exam and surgical, he says. There are plenty of other medical latex-free products available. Only manufacturers of a few, very small volume (number of units used) latex products are having difficulty making the change to latex-free for economic reasons.

And for patients like Back, thats good news.