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Allergies Explained

Quick Facts

  • An allergy is a heightened sensitivity to a foreign substance (called an allergen) that causes the body's defense system (the immune system) to overreact when defending itself.
  • The severity of an allergic reaction can vary from mild discomfort (as with a chemical allergy/type IV allergy) to life threatening situations (which could result from latex allergy/type I allergy).
  • Medical gloves may cause:
    • Latex allergies caused by a body's immune system reaction to the latex proteins. Therefore, this reaction is limited to natural rubber latex (NRL) gloves,
    • Chemical allergies can be triggered by both latex and non-latex gloves as both contain chemical accelerators, unless specifically formulated without, such as the Ansell poly-chloroprene range.
  • Of the total healthcare worker population, clinical evidence shows that latex allergies represent up to 12%,22 while chemical allergies represent up to 30%, 9,10,11 with 80% caused by chemical accelerators.13,17
  • The most effective treatment is allergen avoidance.
  • The GAMMEX® range of surgical gloves includes latex-free products and chemical accelerator free options to help prevent the two allergic reactions that may be associated with glove usage.

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Introduction

An allergy is a heightened sensitivity to a foreign substance (called an allergen) that causes the body's defense system (the immune system) to overreact when defending itself.

Normally, the immune system should only react if a harmful substance, such as bacteria, attacks the body. For people with allergies, their immune systems are working too hard and react even when relatively harmless substances, such as pollen and chemicals, are present. The severity of an allergic reaction can vary from mild discomfort (as with a pollen allergy or chemical allergy/type IV allergy) to life threatening situations (which could result from bee strings or latex allergy/type I allergy).

A reaction to allergens may present as an irritation or a sensitization.

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Irritation

Irritation is a state of inflammation or painful reaction. A stimulus or agent which induces the state of irritation is an irritant. Irritants are typically thought of as chemical agents (for example phenol and capsaicin), but mechanical, thermal (heat), and radioactive stimuli (for example ultraviolet light or ionizing radiations) can also be irritants.

  • Irritation is a delayed response (hours) generally occurring after the first exposure to an irritant/allergen.
  • Chronic irritation is a medical term signifying that afflictive health conditions have been present for a period of time, e.g. more than 3 months. There are many disorders that can cause chronic irritation; the majority involves the skin, eyes and lungs.
  • An example of chronic irritation is chemical allergy.

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Sensitization

Sensitization is a reaction in which specific antibodies develop in response to an allergen. This exposure to an allergen results in the development of hypersensitivity.

  • Sensitization generally occurs from subsequent exposures to an allergen.
  • An example of sensitization is latex allergy. In the case of latex allergy, the immune system identifies latex as a harmful substance and triggers certain cells to produce immunoglobulin E (IgE) antibodies to fight the latex component (the allergen). Symptoms range from runny nose to wheezing to anaphylaxis. With subsequent exposures to latex, the IgE antibodies sense it and signal the immune system to release histamine and other chemicals into the bloodstream. The more exposure, the more the immune system is likely to respond to latex (sensitization).
  • People can be in a sensitized status and not realize they are developing a latex allergy.

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Glove associated - allergies

Latex allergies are limited to natural rubber latex (NRL) gloves, however, chemical allergies can be triggered by both latex and non-latex gloves as both contain chemical accelerators, unless specifically formulated without, such as the Ansell poly-chloroprene range.

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Latex allergy

NRL sensitization in the general population varies from 1 to 6%.1, 2, 3 In the U.S. alone, the number of atopic individuals (those prone to allergies) is currently estimated at more than 50 million people.4 The sensitization and allergy rates are higher on some patient populations such as paediatric, where children having multiple surgeries present sensitization levels of up to 50%.1

For healthcare workers (HCWs), the risk of sensitization depends on the degree of exposure. For staff working outside the operating room, the incidence rate reported is from 0.8% to 3%. However, for staff working in the O.R., it reaches 10% to 17%.5,6,7 It is important to understand that some sensitized individuals may not present clinical signs or be aware of their sensitized status, however, they are at risk of developing clinical allergic symptoms in the future should contact with latex continue.

A latex allergy refers to an adverse reaction by the body's immune system to the latex proteins. The specific symptoms that can result can vary amongst patients depending on the type and duration of exposure and individual response.

  • Treatment for latex allergies is primarily based on fighting the symptoms as there is no cure for latex allergies. This may include:
    • Allergen avoidance and minimization of exposure to the allergen
    • Medications may be used to alleviate some symptoms and suppress the immune system in serious cases

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Chemical allergy

Chemical allergies represent approximately 30% of occupationally induced skin irritations/diseases8,9,10,11 and are the second largest occupational disability reported to OSHA. 11 The chemicals used in the manufacture of gloves fall into broad classifications including: accelerators, accelerator activators, stabilizers, antidegradants, retarders, fillers and extenders. It is the accelerator group of chemicals, especially thiurams and carbamates, and, to a lesser degree, the thiazoles, aldehydamines and guanidines, that induce the majority (80%) of the skin dermatitis reactions. 12,13

A chemical allergy refers to an adverse reaction by the body's immune system to a chemical. The specific symptoms that can result vary amongst patients depending on the type and duration of the exposure and individual response. Symptoms may include: skin redness, swelling, itching, blisters and irritation. The symptoms generally disappear when exposure to the chemical is avoided.

  • Treatment for chemical allergies is primarily based on fighting the symptoms and may include:
    • Allergen avoidance and minimization of exposure to the allergen
    • Medications may be used to alleviate some symptoms (e.g. antihistamines)
    • Moisturizers can alleviate skin symptoms
    • Antibiotics may be needed if secondary skin infections develop from initial skin symptoms such as rashes
  • Curative treatment, which is not targeted against the symptoms, but the cause of an allergy, may be achieved by “allergen immunotherapy,” better known as “desensitization.” This is done by administering increasing doses of the allergen (e.g. pollen, dust mites, etc.) to acclimate the body to the substance which causes the allergy, thereby inducing a specific long-term tolerance against the allergen. However, for desensitization, a detailed diagnosis is imperative to identify the causative allergen.

Allergies can be developed to chemicals in cosmetics, clothing, or other products used on the skin such as hand soap, surgical scrubs, lotions, and perfumes. Symptoms are almost always localized, showing up as a persistent rash where the product is applied. These types of allergies are diagnosed with patch testing, which involves placing small samples of the substance against the skin for two to three days to see if a rash forms at the application location.

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General accelerator information

There are a variety of chemical accelerators (Thiurams, Mercaptobenzothiazoles, Dithiocarbamates (Carbamates) and Diphenyl guanidine (DPG)) which are used in the manufacture of medical gloves.

Thiurams

The universal vulcanizing agent for rubber is sulfur, but sulfur donors, such as thiurams, are often more efficient. Formulations containing thiurams allow manufacturers to produce gloves at higher outputs, thus reducing the overall cost of the gloves. Thiurams are most commonly regarded as the primary cause of chemical allergy. 14,15,16,17

  • Account for 60% of accelerator related skin irritation18

Dithiocarbamates / Carbamates

Dithiocarbamates absorb sulfur and carry it into the glove material to facilitate cross-linking and curing. There are more than 34 types of these compounds. They contain zinc, which is important to the solubility of the accelerator in natural rubber and synthetic rubber and its ability to react with sulfur. 16,18

  • Account for 30% of accelerator related skin irritation18

Mercaptobenzothiazoles (MBTs)

MBTs react well with zinc, assisting with the cross-linking of the sulfur bonds and adding tensile strength to the glove. The incidence of sensitization to this group of compounds is lower than other accelerator compounds. 16,18

  • Account for between 1% and 5% of accelerator related skin irritation18

Diphenylguanidine (DPG)

Typically used as a secondary accelerator in dry rubber vulcanization. DPG exhibits better storage stability compared to thiuram and dithiocarbamates but is not so active. It is mostly used in poly-isoprene gloves to enhance cross link density and boost tensile properties. The incidence of sensitization to this chemical is on the rise following the increase in non-latex glove usage.

  • Allergic reactions to this chemical are on the rise according to some recent reports. 19,20,21

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Diagnosis

By using state of the art diagnostic skin testing, patch testing, and/or allergy blood testing, the causative agent in most allergy conditions can be determined.

  1. Skin testing is the preferred method and is the most accurate diagnostic test used by a trained allergist/immunologist. It is a simple procedure that is best described as tiny scratches that are generally on the surface of the skin on your back. The scratches are created using a small instrument, similar to a plastic toothpick. The instrument contains small amounts of common allergens. The skin is lightly scratched on the surface with a tiny amount of the allergen. If an allergy to a substance exists, a small mosquito bite-like bump will appear. If no reaction is observed to this type of skin test, an intradermal process may be performed (similar to a TB test). Using these tests, the allergist can determine a person's specific allergy profile. Because everyone is unique in their specific allergy triggers, knowing what allergies exist is important for effective treatment.
  2. Patch testing is a way of identifying whether a substance that comes in contact with the skin is causing inflammation. The test involves the application of various test substances to the skin under adhesive tape that is then left in place for 48 hours. The skin is examined again after another 48 hours for any delayed response. This can help the doctor decide which allergens elicit an allergic reaction and identify those that could be aggravating a person's dermatitis.
  3. Allergy blood tests detect and measure the amount of allergen-specific antibodies in the blood. When contact is made with an allergen, the body makes antibodies against it. The antibodies tell cells in the body to release certain chemicals. These chemicals are what cause allergy symptoms. Immunoglobulin E (IgE) is an antibody that's strongly linked to the body's allergy response.

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The Ansell solution

Ansell has a range of products delivering unprecedented sensitivity and comfort. The GAMMEX® range of surgical gloves includes latex-free products in two materials, polyisoprene and poly-chloroprene. Amongst these are products that are both chemical-accelerator free and natural rubber latex-free, to help prevent the two allergic reactions that may be associated with glove usage. To learn more about Ansell non-latex solutions and to discuss how to eliminate latex gloves from your hospital, contact Ansell today by email.

References:

  1. Capelli, Chloé. Eviction Du Latex En Chirurgie Pediatrique: Etude de Faisabilite Au CHU de Grenoble. MS thesis. Universite Joseph Fourrier. Faculte De Pharmacie De Grenoble. France. 2011. Print
  2. Poley GE and Slater JE. Latex Allergy. Journal of Allergy and Clinical Immunology. 105, no. 6 (2000):1054-62.
  3. Neugut AL, Ghatak AT, and Miller RL. Anaphylaxis in the United States: An Investigation into Its Epidemiology. Archives of Internal Medicine 161, no. 1 (2001):15-21
  4. American Academy of Allergy, Asthma and Immunology (AAAAI). The Allergy Report: Science Based Findings on the Diagnosis & Treatment of Allergic Disorders. 1996-2001.
  5. De Queiroz M, Combet S, Berard J, Pouyau A, Genest H, Mouriquand P, Chassard D. Latex allergy in children: modalities and prevention. Paediatric Anaesthesia 2009; 19: 313-319
  6. Brehler R and Kütting B. Natural rubber latex allergy.Archives of Internal Medicine 2001; 161: 1057-1064
  7. Yunginger JW, Jones Rt, Fransway AF, Kelso JM, Warner Ma, Hunt LW. Extractable latex allergens and proteins in disposable medical gloves and other rubber products. Journal of Allergy and Clinical Immunology 1994; 93: 836-842
  8. Holness DL, Mace SR, Results of evaluating health care workers with prick and patch testing. Gage Occupational and Environmental Health Unit and the Division of Allergy and Chemical Immunology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada, Am J Contact Dermat. 2001 Jun; 12(2):88-92.
  9. Rosemary Nixon. Occupational dermatoses. Australian Family Physician Vol. 34, No. 5, May 2005.
  10. Schnuch, A. et. al Contact Allergies in Healthcare Workers. The Prevalence of Allergic Contact Sensitization of Practicing and Student Nurses | Akan | The International Journal of Occupational and Environmental Medicine The International Journal of Occupational and Environmental Medicine, Vol. 3, No 1 January (2012).
  11. Thompson R. Chemical Allergy "The Other Latex Allergy". Source To Surgery - January 1996, Vol. 4 Issue1.
  12. Heese A, Hintzenstern J.V., Peters K et al. (1991)“Allergic and irritant reactions to rubber gloves in medical health services J Am Acad Dermatol, 25:831-839
  13. Nick Gardner, SHIELD Scientific October 2008 | Health & Safety International
  14. Cacioli P, PhD. Manufacture of Latex Gloves and Resultant Chemical Residues. Source To Surgery - January 1996, Vol. 4 Issue1.
  15. Fuch, Thomas MD. A Review of Glove-Related Allergic Contact Dermatitis. Source To Surgery - January 1996, Vol. 4 Issue I.
  16. http://www.latexallergyresources.org/sites/default/files/newsletter-attachments/The%20ALERT%20May%202012.pdf
  17. Heese A, Hintzenstern J.V., Peters K et al. (1991)“Allergic and irritant reactions to rubber gloves in medical health services J Am Acad Dermatol, 25:831-839
  18. EHS Today. Dealing With Dermal Allergies and Skin Reactions. Feb 1, 2000.
  19. Geier J, Lessmann H, Mahler V, Pohrt U, Uter W and Schnuch A. Occupational contact allergy caused by rubber gloves – nothing has changed. Contact Dermatitis, 67, 149–156
  20. Cao L., Taylor J, Sood A, Murray D, Siegel P. Allergic Contact Dermatitis to Synthetic Rubber Gloves. Changing Trends in Patch Test Reactions to Accelerators. Arch Dermatol, Vol. 146 (NO. 9), 2010.
  21. Ponten A, Hamnerius N, Bruze M, Hansson C, Persson C, Svedman C, Andersson K and Bergendorff O. Occupational allergic contact dermatitis caused by sterile non-latex protective gloves: clinical investigation and chemical analyses. Contact Dermatitis, 68, 103–110
  22. Schnuch, A. et. al Contact Allergies in Healthcare Workers. The Prevalence of Allergic Contact Sensitization of Practicing and Student Nurses | Akan | The International Journal of Occupational and Environmental Medicine The International Journal of Occupational and Environmental Medicine, Vol. 3, No 1 January (2012).

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