Identifying & Managing Adverse Skin Reactions

What Causes the Adverse Skin Reactions Associated with Glove Use?

Natural Rubber Latex

Gloves containing natural rubber latex provide excellent protection against the transmission of infectious agents and are an integral part of healthcare practice. However, natural rubber latex gloves have been associated with skin irritation in some users.

Chemical Accelerators

While allergic reactions and skin irritations may be a response to the natural rubber latex from which the glove is made, they may also be caused by chemical accelerators and other sensitising substances used in the manufacturing process.5 Diphenylguanidine (DPG) is a chemical accelerator used in glove manufacture. Chemical accelerators, like DPG, are the primary cause of contact dermatitis (type IV response).

Glove Powder

Historically, powder has been used as a lubricant in the manufacture of medical gloves in order to facilitate donning and to avoid blocking of the glove. Exposure to starch powder from both surgical and examination gloves can cause a number of undesirable reactions. Glove powder poses a risk to both healthcare workers and patients. To reduce the risk of glove powder complications in healthcare workers and to minimise glove powder infection risk, powder free gloves are recommended.

Risk to Patients

Powder not only acts as a vehicle for latex antigens, but can also enter the body during surgery. Glove powder may trigger an inflammatory response by the immune system, leading to the formation of fibrous bands and post- operative adhesions.1

The effects of adhesions have been very well documented concerning the peritoneal cavity, but they have also been reported in almost every anatomical site such as the eyes, oral region, cranial cavity, middle ear, thorax, bladder and scrotum among others. Uterine and fallopian tube adhesions resulting from glove powder are a significant risk to female infertility. Research papers advise that powder free gloves should be used even for routine vaginal examination.1

Glove powder has been implicated with decreasing the bonding strength of dental adhesives. Using powder free gloves will ensure that your dental bonds are not weakened by the interference of powder between the two surfaces.

Risk to Healthcare Workers

Prolonged contact with glove powder may have serious impact on the users skin condition.1

Powder may significantly lower skin hydration levels, producing dryness, which is the first sign of irritation. Glove powder may also act as an intra-cellular abrasive on the hands, by absorbing the lipids that normally maintain cell cohesion. When the epidermal barrier is compromised, the permeability to chemicals and other allergens increases.2 Switching from powdered to powder free gloves has proved positive in the reduction of hand eczema and itching on hands.

Powder in gloves has the capacity to bind with natural rubber latex (NRL) protein antigens. These allergen/protein coated powder particles can be aerosolised when the gloves are donned or removed. Inhalation or ingestion of this powder can lead to sensitisation and diverse allergic reactions to NRL (i.e. upper respiratory tract symptoms or eye irritation). It has been documented that a decrease in NRL specific IgE blood levels on sensitised individuals after switching from powdered to powder free glove is observed, and new workers’ sensitization is minimised when only powder free gloves are used.3

Other Causes of Sensitivity

In addition to natural rubber latex and chemical accelerators contained in both natural rubber latex and natural rubber latex-free gloves, an adverse reaction may actually be in response to the use of soaps, hand scrubs and abrasive hand towels, or caused by other substances such as:

      • Lanolin - Used as a glove softener by some other manufacturers (NOT used in Ansell products)
      • Polyoxypropyleneglycol - A coagulant used in the glove manufacture process (NOT used in Ansell products)
      • Colouring pigments, either organic or inorganic
      • Quaternary ammonium compounds
      • Antioxidants which are used to prevent the degradation of Natural Rubber Latex products
      • Preservatives

Types of Reactions

The four major types of adverse skin reactions associated with natural rubber latex glove use are:

Immediate hypersensitivity (Type I or natural rubber latex allergy)

A Type I response is a reaction to residual proteins found in natural rubber latex.4 The reaction is immediate, typically occurring 5–30 minutes after initial contact. The symptoms are commonly:

      • Swelling and redness, local to the site of exposure
      • Non-specific symptoms such as itching and burning

The symptoms can spread to areas remote to the site of contact with the glove, and can be accompanied by:

      • Conjunctivitis
      • Rhinitis
      • Bronchial obstruction

In rare cases, symptoms of anaphylaxis can occur.

Delayed hypersensitivity (Type IV or contact dermatitis)

A Type IV allergy is a reaction to specific allergens such as chemical residues from the glove manufacturing process (commonly chemical accelerators).6 The response is delayed rather than immediate, usually occurring 6- 48 hours after initial contact, although symptoms can last for up to 4 days.
The symptoms include:

      • Erythema
      • Swelling
      • Cracking
      • Itching
      • Weeping
      • Dryness of the skin at the site (dermatitis may extend beyond the area of contact)

Irritant contact dermatitis

Irritant contact dermatitis is a non-immune reaction affecting a number of glove users. It may be a local reaction to:

      • Detergents
      • Frequent hand washing
      • Inadequate drying
      • Climate extremes
      • Pre-existing dermatitis
      • Aggressive scrubbing techniques
      • Glove powder

The typical time of onset is within minutes to hours of glove contact. Symptoms are limited to the site of glove exposure and include:

      • Redness
      • Chapping
      • Chafing
      • Dryness
      • Scaling and cracking

Glove powder irritations

      • Eye irritation
      • Upper respiratory-tract disorders
      • Occupational asthma
      • Pleuritis,
      • Myocarditis
      • Irritation of the central nervous system

In some cases, carcinoma or tuberculosis misdiagnosis.1, 2

Minimising the Risk of Adverse Effects

Recognizing the Signs of an Adverse Reaction

Signs that you may have a sensitivity may include some or all of the following:

    • Redness and swelling of the effected area
    • Itching
    • Rash
    • Weal
    • Excessive tearing
    • Sneezing, itching and watery discharge from the nose
    • Swelling of the eyelids
    • Respiratory distress

Recurrent episodes of the symptoms are an indication that you should see your physician.

What to do if you Experience an Adverse Reaction

If you experience any of the above signs and symptoms it is generally recommends that you:

    • Switch to a natural rubber latex-free non-latex glove
    • Use chemical accelerator-free gloves or an Ansell glove that as they has been washed or leached during manufacture to reduce residual chemicals which may cause the allergy
    • Institute a regular skin care regimen
    • Always wash hands thoroughly after removing gloves
    • Always use a pH neutral hand wash
    • Wet hands before applying any hand wash and rinse thoroughly after use
    • Dry hands with a soft cloth/towel or low heat blow dryer
    • Use a moisturiser between hand washes. Choose a moisturiser that is pH neutral, lanolin-free and low in fats
    • Take care of fingernails

Irritant Contact Dermatitis

Irritant contact dermatitis is a condition affecting the skin and should not be confused with an allergy. Glove users can help reduce the risk of irritation by:

    • Minimizing contact with the causative agent
    • Instituting a regular skin care regimen
    • Avoiding oil/ fat-based hand creams
    • Wearing powder-free gloves

When to Seek Medical Advice

In the event of a persistent dermatitis, it is recommended to always consult a medical practitioner. This is due to the fact that the clinical manifestations of allergic contact dermatitis and irritant contact dermatitis, the most frequent type of dermatitis suffered by healthcare professionals, are very similar and it is not always possible to visually differentiate between these two types of dermatitis.

What Ansell is Doing to Help Reduce Allergic Reactions

Ansell is committed to reducing glove allergenicity at every stage of the manufacturing process. This is achieved by refining the use of chemical accelerators, like Diphenylguanidine (DPG), reducing residual protein levels throughout the production process and ongoing investment in research and development to produce the best glove products possible.

Recognising that chemical allergies and contact dermatitis are a growing concern in the healthcare industry, Ansell has developed a DPG-free polyisoprene formulation. The improved, DPG-free polyisoprene formulation provides total allergy prevention and latex-like comfort for healthcare workers suffering from latex allergies and Type IV allergies caused by DPG.

Innovation and Ansell’s Commitment to Continuous Improvement

Ansell is committed to offering quality alternatives for individuals affected by adverse glove reactions. Ongoing investment in research and development to deliver innovations in manufacturing technology has resulted in significant innovations from Ansell in glove manufacturing processes. These include:

      • Use of PV100 accelerator - Ansell has pioneered the use of this unique accelerator, which breaks down during the manufacturing process, leaving non-detectable residue and minimizing the risk of developing a Type IV delayed type hypersensitivity
      • Thiuram free formulations where possible
        Thiurams are the most potent sensitizers, so by eliminating them from the formulation Ansell reduces the risk of developing a Type IV delayed type hypersensitivity
      • Ansell medical gloves do NOT contain other chemicals linked to Type IV delayed Type hypersensitivity such as lanolin or polyoxipropyleneglycol
      • Ansell’s own Protein and Endogenous Allergen Reduction Leaching (PEARL) hot water leaching process ensures very low levels of residual chemical accelerators
      • Unique chemical accelerator free surgical and examination gloves
      • Ansell’s Advanced Rheology Technology (A.R.T.) improves film formation and eliminates glove weakness thus ensuring the highest quality standards are maintained
      • A combination of soft latex formulation and Ansell proprietary formers ensure high levels of tactility and comfort
      • Ongoing research and development of new formulations and manufacturing processes to constantly improve our products’ benefits by Ansell’s Science and Technology division

Comprehensive Product Range

Ansell is proud to offer the most comprehensive range of examination and surgical gloves on the market, including a specialised range of low-allergenicity gloves for the allergy sufferer. Ansell’s low-allergenicty range includes powder free latex products with non-detectable residues of chemical accelerator and latex-free and chemical accelerator-free gloves.

Natural Rubber Latex-Free Gloves

Surgical Gloves

GAMMEX® PF Isoderm®

GAMMEX® PF Isoderm® Sensitive

Examination Gloves

MICRO-TOUCH® Nitrile®

MICRO-TOUCH® Nitra-Tex®

MICRO-TOUCH® Nitra-Tex® EP

MICRO-TOUCH® Affinity®

Natural Rubber Latex-Free and Chemical Accelerator-Free Gloves

Surgical Gloves

GAMMEX® PF DermaPrene®

Examination Gloves

MICRO-TOUCH® NitraFree™

 

1 Nutter A. Contact urticaria to rubber. Br J Dermatol 1979; 101(5): 597-8.

2 Granady LSJ. The history and diagnosis of latex allergy. Immunol Allergy Clin North Am 1955: 22.

3 Yip Es. Comments to the Maine legislature on proposed prhibition of sales of non-sterile latex gloves. 2003.

4 O'Gilvie, W. Latex sensitization in the healthcare setting. Device Bulletin 9601 April 1996, The Medical Devices Agency of the Department of Health.

5 Guyton AC, Hall JE. Textbook of Medical Physiology. 10th ed. Philidelphia: WB Saunders, 2000.

6 Sussman G. The effects of interventions and glove changes in healthcare workers with latex allergy. Ann Allergy Asthma Immunol 2003; 90: 179-80.