Natural rubber latex hypersensitivity: incidence and prevalence of type I allergy in the dental professional.

The authors investigated the prevalence of immediate (Type I) hypersensitivity to gloves made from natural rubber latex, or NRL, by performing skin-prick tests on 2,166 dental workers over the course of a two-year period (with two one-year intervals). The investigator used two separate eluents made from different brands of natural rubber latex gloves. The study, conducted in 1994 and 1995 as part of the American Dental Association's Annual Health Screening Program, found that 6.2 percent of the participants (dentists, hygienists and assistants) tested positive for Type I hypersensitivity to NRL proteins.

Allergies associated with medical gloves. Manufacturing issues.

The increase in glove usage that followed the advent of Universal Precautions has been associated with a concomitant increase in glove-related allergic reactions, many of which are potentially debilitating. Manufacturing issues that can affect the allergenicity of natural rubber latex, thermoplastic elastomer, and polyvinylchloride medical gloves are therefore examined. This information can enhance the ability of the occupational dermatologist to diagnose specific allergens and to recommend appropriate treatment based on knowledge of a product's allergenic ingredients.

Latex hypersensitivity: an update.

Products containing natural rubber latex can cause both delayed and immediate hypersensitivity. Delayed reactions are induced by chemicals, primarily antidegradants and accelerators, integral to the manufacturing process. Immediate hypersensitivity is caused by protein antigen(s) that occur naturally in the latex. Different manufacturing stages can influence the concentration of these antigens, hence the allergenicity of the final product. The implications of manufacturing and regulatory issues for the diagnosis and treatment of natural rubber latex allergies are therefore discussed.

Permeability of latex and thermoplastic elastomer gloves to the bacteriophage phi X174.

BACKGROUND: Most studies challenging the integrity of the glove barrier have compared the permeability of vinyl and latex gloves. However, no studies of a new nonlatex, nonvinyl thermoplastic elastomer have been reported. This pilot study therefore compared the protective barriers provided by latex and thermoplastic elastomer surgical gloves against penetration of the bacteriophage phi X174. METHODS: Twenty thermoplastic elastomer gloves and 25 commercially available latex gloves (20 brand 1, 5 brand 2) were filled with a sterile serum surrogate and exposed to the phi X174 virus in a flask, with shaking for 180 minutes at 37 degrees C. Aliquots of 5 ml were withdrawn at baseline, 30, 60, 120, and 180 minutes and assayed by a standard plaque assay. The remaining contents of the gloves were then tested by an extremely sensitive qualitative assay (plaque assay without dilution of the sample). RESULTS: With the standard plaque assay, virus was detected in 30% of the brand 1 latex gloves, in 80% of the brand 2 latex gloves, but in none of the thermoplastic elastomer gloves. The qualitative assay, which can detect even a single virus in the entire glove contents, had positive results for 30% of the thermoplastic elastomer gloves, 70% of the brand 1 gloves, and 100% of the brand 2 gloves. CONCLUSIONS: Despite the small sample, the results of this stringent assay suggest that the mechanical barrier offered by thermoplastic elastomer gloves is equal to or better than that provided by the latex gloves tested. Clinical studies are needed to evaluate thermoplastic elastomer gloves, which may withstand mechanical stress better than latex or vinyl. Thermoplastic elastomer gloves may therefore be a desirable alternative for health care workers in high-risk settings or for individuals with latex allergies.

Update: immediate and delayed hypersensitivity to natural rubber latex.

Hypersensitivity to natural rubber latex, an ingredient of many medical devices and consumer products, appears to be increasing. Chemical additives induce T-cell mediated type IV delayed reactions while proteins that occur naturally in latex elicit antibody-mediated type I immediate reactions. The latter can be fatal. The clinical manifestations of these reactions, the risk factors for developing latex hypersensitivity, and diagnostic options are reviewed. The only reliable management strategy is allergen avoidance. Therefore, factors that can affect the levels of both type I and type II allergens in products are discussed.

PIP: Natural rubber latex is an ingredient in many medical devices and consumer products. In some people, however, chemical additives induce T-cell mediated type IV delayed reactions, while proteins occurring naturally in latex elicit antibody-mediated type I immediate reactions. It seems as though the prevalence of hypersensitivity to natural rubber latex is increasing. Delayed hypersensitivity may occur 4-48 hours after contact with the allergen and involve local redness, swelling, papules, or edema as well as diffuse reactions. These reactions may lead to permanent tissue damage. Immediate hypersensitivity reactions are potentially fatal and may be likened to reactions in some from bee stings. Clinical manifestations do, however, vary depending upon a subject's susceptibility to the antigen and the conditions of exposure. More than 80 anaphylactic reactions to natural latex rubber have been reported in the literature, many occurring intraoperatively Risk factors for developing latex hypersensitivity and diagnostic options are reviewed. Allergen avoidance being the only reliable management strategy, the authors discuss factors which can affect the levels of both type I and type II allergens in products.

Taking up the gauntlet: accepting the challenge of glove evaluation.

Cost-conscious purchasers may wonder what glove is best suited for the maximum number of applications. The Food and Drug Administration requires that products released for marketing meet the ASTM standards, which were developed by industry strictly to standardize production. Glove characteristics, such as length and cuff features, size, gauge, flexibility and elasticity, donning lubricants, sterility and color must be considered, and fact separated from mis-conceptions. A glove-related issue causing concern is allergic responses to latex and chemical substances used in the glove manufacturing process. Reactions to gloves can be categorized as irritation, delayed hypersensitivity and immediate hypersensitivity, all of which reflect different underlying causes. Industry, concerned consumers and the FDA are looking for ways to lower the allergen content in gloves. Glove deterioration and chemical permeability problems usually result from various environmental factors and improper use. Despite concerns about viral permeability of gloves, the literature indicates that intact gloves serve as adequate barriers to viruses. Controlling gloves costs requires their appropriate use.