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CLINICAL COMPENDIUM

BACKGROUND

There is an 8-17% prevalence of an occupational natural rubber latex allergy. Many health care facilities have hesitated in switching to a non-latex conversion environment due to the costs associated with this change.

OVERVIEW

3 healthcare facilities (Tertiary-Care hospital, Community-Based hospital, and Out-patient clinic) in Georgia were compared on the amount of workers that would need to be fully or partially disabled for the facilities to "break-even" on converting from latex gloves to a latex-safe environment. Glove cost and use, diagnostic costs, disability costs, and excluded costs were all figured into the analysis.

RESULTS

If only the cost from latex to non-latex gloves were considered it would be a cost increase for each facility. If the cost of the non-latex gloves and the probability/possibility of healthcare workers being partially or fully disabled due to their rubber latex allergy then it would be cost favorable to have each facility to convert to latex-free gloves.

CONCLUSION

For the largest use of sterile/non-sterile gloves, the Tertiary-Care hospital, to have a "break-even" point to convert to a latex-free glove environment, it would be 1.07% (5 people) becoming fully disabled due to their natural latex allergy or (more probable) 1.88% ( 9 people) becoming partially disabled. With all factors involved, this study proves that is cost beneficial for all 3 facilities to convert to a latex-safe environment by using non-latex gloves.

By: LTC Daniel J. Reese, DE USA: COL Robert B. Reichi, DE USA; COL Judith McCollum, DE USA

Background

During the 1990’s, a latex allergy became the new epidemic. In 1987 the CDC mandated the use of PPE for any healthcare worker who could potentially have contact with body fluids. In 1982, OSHA established the Blood Borne pathogen standards. As more gloves were needed and produced, the manufacturing processes were altered and began including more chemicals that resulted in more proteins.

Overview

This article gives an overview of all latex concerns, testing, cost inhibitors, and prevention strategies. There are three different types of reactions to Latex Gloves. The individual groups that are at the highest risk for developing NRL are health care providers, children with spina bifida, and workers manufacturing NRL products. It is also suspected that there is a strong correlation that individuals with food allergies are at high risk for NRL. It is recommended that Health Care Providers be aware and better educated on the treatment, symptoms, signs, and potential consequences of latex allergies.

Results

The article looked at Clinical and Cost implications if latex allergies are not addressed. Clinically it was established that gloves are the greatest source of latex exposure in healthcare and it is encouraged to have healthcare workers look at a non-latex glove conversion. It is recommended for healthcare administrators to look at all variables of implications of a latex allergy for their employees outside of cost alone, and to consider that disability from a latex allergy is available to workers under the worker’s compensation law.

Conclusion

The health care setting is the greatest threat to NRL allergic individuals. It is highly recommended that risk managers move to a latex-free work place to prevent employee and patient sensitization to latex, and also to avoid potential liability.

By: V.J. Lewis, M.M.U. Chowdhury, and B.N. Statham

BACKGROUND

50 NRL (Natural Rubber Latex)- allergic patients were followed-up with a postal survey to see if they had experienced any lifestyle or quality of life changes since they had been tested and diagnosed as positive for NRL between 1994-2003.

OVERVIEW

The postal survey was sent out to 50 patients that had been tested and diagnosed with NRL allergies. The questions that were asked to the patients were: if they had experienced any changes with symptoms, occupation, other food allergies, and lifestyle since diagnosis.

RESULTS

(72%) 36 of 50 patients that responded to the survey were in constant contact with latex. 42% were nurses and 61% were healthcare workers. All participants in regular contact with latex 85% saw improvement in their allergy symptoms by switching to latex-free gloves. 58% felt that their employer had been receptive in assisting them with their allergy and 25% had to change their occupation due to their NRL allergy.

CONCLUSION

The study concluded that employers, dentists, and doctors, are still not well informed on NRL allergies and how to assist their employees, and patients. They are in need of further education and awareness of this common allergy on how to address their patients’ needs in treatment. Approximately 33% of patients had experienced difficulty with allergic reactions to latex when visiting their physician. It is also important that employers, dentists, and doctors address their employees’ needs in the workplace.

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By: Sultan Al-Otaibi, Susan M. Tarlo, and Ronald House

BACKGROUND

This study was conducted to look at allergy clinic patients that have been diagnosed with a natural rubber latex allergy. Once the patients were diagnosed, the impact on their Quality of Life (QOL) was reviewed.

OVERVIEW

A questionnaire was mailed to 56 participants who had diagnosis of contact dermatitis, contact urticaria, angioedema, rhino-conjunctivitis, and anaphylaxis. The participants were asked to rate on a scale of 0-6 the effect of their latex allergy on various activities important to their QOL and also the severity and frequency of their symptoms related to their QOL.

RESULTS

Out of the 56 questionnaires mailed, 31 were completed and mailed. 30 of the 31 respondents were health care workers. 43% of patients that responded with anaphylaxis reported a "3" or higher on a "feeling of distress or anxiety" because of their reaction. 13 respondents out of 31 changed their job due to their latex reactions. 17 patients (55%) reported that their co-workers made changes to their use of powdered-latex gloves due to their latex sensitized co-workers.

CONCLUSION

Through the course of time after the diagnosis of a latex allergy, there is less impact to a patient’s QOL.. The positive results of this study demonstrate that even with various manifestations of latex allergy/sensitivity there is no substantial significance to QOL. Most patients were able to make changes within their occupations and/or their workplace was able to make changes in avoidance of natural rubber latex to accommodate their needs.

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By: E. Turillazzi, P. Greco, M. Neri, C. Pomara, I. Riezo, V. Fineschi

Background

There are many different groups of individuals that are at risk for anaphylactic latex reactions during surgical and medical procedures. One of these groups is the gynecologic and obstetric population. Obstetrical and gynecological procedures account for approximately 50% of all latex reactions.

Overview

The authors investigated an un-diagnosed latex allergy in a 33-year-old woman who had an anaphylactic latex reaction during her caesarean section. During a surgery the day after the caesarean section she had another anaphylactic latex reaction incident that caused cardiac arrest. There was no known latex allergy prior to her third caesarean section and her subsequent follow-up surgery. Her reported cause of death was Latex-induced fatal anaphylactic shock. The study looks at all factors which can be attributed to an un-diagnosed latex allergy and factors that lead to the high risk of latex reactions in gynecological and obstetrical patients.

Results

There are several factors that lead to gynecological and obstetric patients being at such a high risk for latex anaphylaxis. Women are naturally predisposed to NRL (Natural Rubber Latex) items at work and in everyday life. Another factor is the exposure of latex during vaginal examinations and vaginal deliveries through mucosal contact. Finally the injection of oxytocin to increase uterine contractions could potentially cause the release of latex fragments from the uterus into the blood stream.

Conclusion

It is recommended that clinicians look at several medical factors of their patients prior to gynecological and obstetric procedures. Patients that have had multiple surgical procedures, and patients that have a fruit allergy (i.e. chestnuts, figs, banana), are at higher risk for a latex allergy. Latex-induced anaphylactic shock is difficult to diagnose due to so many indicators that are identical to other clinical indications, and due to its delayed onset after the surgical procedure started.

By: C. Karila, D. Brunet-Langot, F. Labbez, O. Jacqmarcq, C. Ponvert, J. Paupe, P. Scheinmann, J. de Blic

BACKGROUND

68 children were reported to the Pediatric Pneumology and Allergology Dept. in Paris, France due to an occurrence of anaphylaxis during general anesthesia. This study looked at different tests to see what agents were responsible for this reaction.

OVERVIEW

During the period of time between 1989 and2001, 68 children were tested based on their experience of anaphylactic shock during general anesthesia. The study looked at which drugs were involved, and whether it is important to perform skin testing to manage future anesthetic procedures.

RESULTS

In the findings of the 12-year study, 51 children were diagnosed with IgE-mediated anaphylaxis. (60.8%) or 31 children for neuromuscular blocking agents (NMBA) and (27%) or 14 children for latex. It was discovered that every 1 in 2100 anesthetic procedures resulted in a IgE-mediated anaphylactic incident. This number is much higher than anticipated.

CONCLUSION

NMBA and Latex are the two biggest contributors to an IgE-medicated anaphylaxis reaction in children. The use of latex should be avoided when operating on children who have had numerous surgical procedures under anesthesia. It was also discovered that it is beneficial to have a consultation with both an anesthesiologist and allergist once an anaphylactic event occurs, and after a positive skin test, so to prevent the incident from occurring again.

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By: I. Murat and A. Greco

Background

The risk of mortality from anesthesia is quite low. There have been reports of morbidity/mortality in infants less than one year old that are related to anesthesia. Mortality due to pediatric anesthesia, although low, should not be the only indicator of risk factors for pediatric anesthesia.

Overview

The focus of this review is to look at all of the risk and contributing factors in pediatric anesthesia morbidity and mortality and to look at possible prevention proposals. Risk factors in pediatric anesthesia observed were: cardiac arrest, intraoperative bradycardia, respiratory complications, lack of assessment of blood loss, and inhalations of gastric fluid. These were all of higher incident in children under the age of 1.

Results

Regional Anesthesia was observed to have a very high success rate when good anesthesia practices were followed. It is observed when looking at the causes of death due to pediatric anesthesia, (timing and giving of blood transfusions and iatrogenic hypernatremia) that experienced and un-experienced anesthesiologists should be given additional education on current best practices and also to look at a reorganization of their current practices.

Conclusion

A factor that can help decrease the risk of pediatric anesthesia is an anesthesiologist that spends a major part of their time anesthetizing children. The incident of complications in pediatric anesthesia went from 7 in 1000 patients when an anesthesiologist had treated less than 100 pediatric patients to 1.3 in 1000 patients when the anesthesiologist treated more than 200 children a year. Several other improved practices in anesthesia have lowered the overall risk and complications. Replacement of halothane to sevoflurane, is recommended for regional anesthesia in children, as well as improved monitoring, and new local anesthetics on the market.

By: F. Delaunay, V. Blasco

BACKGROUND

Over a 5-year period of time, there were 2 cases of anaphylactic shock during a caesarean section linked to latex allergens in Guadeloupe (French West Indies). It was decided to further investigate any further environmental concerns as well as surgical procedures that could impact this reaction.

OVERVIEW

The two reported cases of anaphylactic shock occurred during a C-Section as a result of latex. The cause of this incident needed to be further investigated since there was no reported history of latex allergy.

RESULTS

The study identifies the further need to investigate that latex sensitivity can be much more frequent due to the presence and contact with the Hevea brasiliensis tree and/or tropical fruits. The Hevea brasiliensis tree is common to the West Indies.

CONCLUSION

The study concluded further investigation needs to occur in tropical overseas countries where further environmental factors might have an effect on latex allergies. Furthermore, this study also identified the cost-effectiveness and need for non-latex on maternity wards. This could lead to withdrawing latex from maternity wards and/ or put proper prevention strategies into place.

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By: H. Hollnberger, E. Gruber, and B. Frank

BACKGROUND

An investigative study of an 8-year-old boy who was undergoing elective surgery, and had a severe case of anaphylactic shock. The anaphylactic shock was caused by a latex allergy, but was not known by clinicians prior to surgery.

OVERVIEW

The incident of severe anaphylactic shock is 1:6000 under general anesthesia or 1:7741 in children. In children 76% of the anaphylaxis is related to latex and 95% is attributed to muscle relaxants. This case report looked at all factors at which health care works, children, adults, and children with spina bifida come to become latex sensitive.

RESULTS

Children with Spina Bifida had a 72% chance of latex hypersensitivity, Children with one or more operations before the age of 6 months had a 25% chance of latex hypersensitivity, people allergic to particular fruits, healthcare workers (physicians, OR nurses, and Anesthesia with the highest) had anywhere from a 5-17% chance of latex allergy, and individuals who had experienced 8 or more surgical procedures had an increased risk to a natural latex allergy.

CONCLUSION

The 8-year-old child did not have a history of a latex sensitivity allergy, but was considered high risk due to the amount of surgical procedures he had endured. Although anaphylactic reactions are rare under anesthesia, latex allergies cause the majority of these events to occur and have a high incident of morbidity and mortality. Allergies to fruits also increase the potential for a latex allergy. Clinicians should have asked questions regarding food allergies and total surgeries undergone. It is strongly recommended that hospitals should look to only use latex free protocols as their standard operating procedure.

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By: Mathilde de Queiroz MD, Sylvie Combet MD, Jerome Berard MD PhD, Agnes Pouyau MD, Helene Genest RN, Pierre Mouriquand MD PhD and Dominique Chassard MD PhD

BACKGROUND

The prevalence of natural rubber latex (NRL) allergy or immediate hypersensitivity in children varies depending on population and detection methodology. Children with high NRL allergy risk profile include those with spina bifida, children with surgical procedures during neonatal period, and other children that require frequent surgeries. In 1997 a two year old child undergoing a minor emergency procedure died as a consequence of a latex anaphylactic shock followed by two other cases of serious latex anaphylaxis.

OVERVIEW

NRL is prevalent in the hospitals posing a life-threatening risk. NRL allergy is the second cause of intraoperative anaphylactic reaction. Implementing a latex-free environment is an important strategy to minimize the development of latex sensitization and potential anaphylactic reaction.

RESULTS

In 2002, the hospital implemented a latex avoidance strategy. In the five years that followed, no latex anaphylaxis had been recorded in patients or healthcare workers, with over 25,000 surgical procedures performed. Any additional cost incurred in the conversion to a non-latex environment had been offset through the elimination of allergen testing, reduced hospital stay for allergic events and reduced worker compensation.

CONCLUSION

NRL allergy is a significant health risk and latex contact should be reduced especially in neonates, children, HCW and all atopic individuals. Complete avoidance of latex in the OR and perioperative area is the most effective measurement.

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By: K. Blumchen, P. Bayer, D. Buck, T. Michael, R. Cremer, C. Fricke, T. Henne, H. Peters, U. Hofmann, T. Keil, M. Schlaud, U. Wahn & B. Niggemann

BACKGROUND

Spina bifida (SB) children are at risk of a latex allergy. In the Charite group, before latex-free was introduced, SB children showed almost double the atopy than other children and a 50% sensitization incidence rate with 33% of SB children experiencing a clinical latex allergy. Non-latex surgeries were instated 10 years ago for SB children leading to a decrease in both sensitization and allergy incidence in this group.

OVERVIEW

Natural Rubber Latex (NRL) is very prevalent in hospitals posing a life-threatening risk. NRL allergy is the second cause of intraoperative anaphylactic reaction. Implementation of latex-free environments is the most important action to minimize the development of latex sensitization and possible anaphylactic reaction.

RESULTS

120 SB children between 6 months and 12.5 years old were evaluated between September 2005 and October 2006. These patients were compared with 87 SB patients born before latex-free prophylaxis was instated in Germany (1994) and who had latex surgery. Only 5% of SB children showed latex IgE vs. 55% of control group, 10 times more. The clinically relevant latex allergy was also lower, only 0.83% (1/120) vs. 37.2% (32/86) in the control group. The prevalence of latex atopy and allergic diseases in the SB children that were operated on in a latex-free environment are comparable with the weighted population of 12,403 children.

CONCLUSION

NRL sensitization is dramatically reduced in a latex-free environment. This is an example of primary prevention where SB children were not sensitized via direct tissue contact. Implementing a latex-free environment for SB children from their first day of life prevents both allergic sensitization and a clinically relevant allergy to latex.

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By: Antonio Nieto, MD, Angel Mazón, MD, Rafael Pamies, MD, Amparo Lanuza, MD, Alberto Muñoz, MD, Francisco Estornell, MD, and Fernando García-Ibarra, MD

BACKGROUND

Spina bifida (SB) children are at risk of latex allergy. This article reviews the prevalence of latex sensitization on SB children treated only with non-latex gloves in the 6 years following the introduction of non-latex in hospital La Fe, Spain vs. a control group born before the non-latex primary prevention was implemented.

OVERVIEW

Natural Latex Allergy (NRL) is very prevalent in the hospitals and poses a life-threatening risk. NRL allergy is the second cause of intraoperative anaphylactic reaction. Creating a latex-free environment is the most important action to minimize the development of latex sensitization and possible serious anaphylactic reaction.

RESULTS

Twenty-two SB children born after the non-latex conversion was implemented were evaluated and compared with a control group of fifteen children born before September 1994 with no preventative measurements for latex sensitization/allergy. The first group showed a latex sensitization incidence of 4.5% (1/22) vs. a 26.7% in the control group (4/15).

CONCLUSION

Using latex for diagnostic and therapeutic procedures poses a prominent risk. The use of non-latex gloves as a primary prevention has showed a 6-fold decrease reported in the latex sensitization incidents. This preventative measurement should be applied to other children requiring multiple surgeries, especially if these take place at an early age.

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By: A Bueno de Sá, R Faria Camilo Araujo, S Cavalheiro,2 M Carvalho Mallozi, D Solé

BACKGROUND

Latex allergy is a culprit for occupational allergies. This article addresses the prevalence of latex sensitization and its risk factors on children and adolescents with myelomeningocele.

OVERVIEW

Myelomeningocele patients are at risk of developing latex sensitization and allergy as they undergo various surgical procedures. Myelomeningocele itself can be itself a sensitization risk.

RESULTS

Fifty-five children and adolescents between 9 months and 14 years old were evaluated between October 2007 and October 2008 during a 6 month period. The results showed that 45% (25/55) of the patients had a latex reaction, of these 25% (14/55) were sensitized and 20% (11/55) were allergic to latex.

CONCLUSION

Latex sensitization/allergy is high in myelomeningocele patients. Controlling the exposure to latex is the main recommendation for allergic patients.

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By: C. Rendeli, E. Nucera, E. Ausili, F. Tabacco, C. Roncallo, E. Pollastrini, M. Scorzoni, D. Schiavino, M. Caldarelli and D. Pietrini

BACKGROUND

This article discusses the prevalence of latex sensitization and allergy in children with myelomeningocele in the Spina Bifida Centre of the Policlinico Gemelli (Rome). These patients are in contact with latex through repeated operations, catheterization and the implant of latex material.

OVERVIEW

Myelomeningocele patients are at risk of developing latex sensitization and allergy as they undergo various surgical procedures. The prevalence of latex sensitization in SB children is the highest in the general population.

RESULTS

Sixty patients between the ages of 1 year and 22 years were evaluated with a mean of 4.3 surgical procedures. 50% (29/60) of those showed sensitization to latex with 15% (9/60) showing a clinical allergy. The sensitized patients are at risk of suffering anaphylactic reaction if in contact with latex.

CONCLUSION

The implementation of latex-free operating rooms and the provision of non-latex products to spina bifida patients are important to minimize latex sensitization/allergy. Due to the high level of sensitization, prophylactic measurements are important to avoid exposure and prevent potentially serious allergic events. This has been implemented in the Spina Bifida Centre of the Policlinico Gemelli.

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By: V.L. Phillips, Dphil, Martha A. Goodrich, MD, MPH, and Timothy J. Sullivan, MD

Background

There is an 8-17% prevalence of an occupational natural rubber latex allergy. Many health care facilities have hesitated in switching to a non-latex conversion environment due to the costs associated with this change.

Overview

3 healthcare facilities (Tertiary-Care hospital, Community-Based hospital, and Out-patient clinic) in Georgia were compared on the amount of workers that would need to be fully or partially disabled for the facilities to "break-even" on converting from latex gloves to a latex-safe environment. Glove cost and use, diagnostic costs, disability costs, and excluded costs were all figured into the analysis.

Results

If only the cost from latex to non-latex gloves were considered it would be a cost increase for each facility. If the cost of the non-latex gloves and the probability/possibility of healthcare workers being partially or fully disabled due to their rubber latex allergy then it would be cost favorable to have each facility to convert to latex-free gloves.

Conclusion

For the largest use of sterile/non-sterile gloves, the Tertiary-Care hospital, to have a "break-even" point to convert to a latex-free glove environment, it would be 1.07% (5 people) becoming fully disabled due to their natural latex allergy or (more probable) 1.88% ( 9 people) becoming partially disabled. With all factors involved, this study proves that is cost beneficial for all 3 facilities to convert to a latex-safe environment by using non-latex gloves.

By: Mathilde de Queiroz MD, Sylvie Combet MD, Jerome Berard MD PhD, Agnes Pouyau MD, Helene Genest RN, Pierre Mouriquand MD PhD and Dominique Chassard MD PhD

BACKGROUND

The prevalence of natural rubber latex (NRL) allergy or immediate hypersensitivity in children varies depending on population and detection methodology. Children with high NRL allergy risk profile include those with spina bifida, children with surgical procedures during neonatal period, and other children that require frequent surgeries. In 1997 a two year old child undergoing a minor emergency procedure died as a consequence of a latex anaphylactic shock followed by two other cases of serious latex anaphylaxis.

OVERVIEW

NRL is prevalent in the hospitals posing a life-threatening risk. NRL allergy is the second cause of intraoperative anaphylactic reaction. Implementing a latex-free environment is an important strategy to minimize the development of latex sensitization and potential anaphylactic reaction.

RESULTS

In 2002, the hospital implemented a latex avoidance strategy. In the five years that followed, no latex anaphylaxis had been recorded in patients or healthcare workers, with over 25,000 surgical procedures performed. Any additional cost incurred in the conversion to a non-latex environment had been offset through the elimination of allergen testing, reduced hospital stay for allergic events and reduced worker compensation.

CONCLUSION

NRL allergy is a significant health risk and latex contact should be reduced especially in neonates, children, HCW and all atopic individuals. Complete avoidance of latex in the OR and perioperative area is the most effective measurement.

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By: Robert H. Brown, M.D., M.P.H.; Mary A. McAllister, M.A.; Ann-Michele Gundlach, Ed. D.; Robert G. Hamilton, Ph.D.

BACKGROUND

The Johns Hopkins Medical Institutions began converting to a latex free environment in 1997 by putting together a Latex Free task force. After many years, and looking at all variables, they began the non-latex conversion to two different glove manufacturers and 5 different non-latex gloves in May 2007.

OVERVIEW

The article describes John Hopkins' journey through the implementation of a latex free environment. It was not just a product (Glove) change, it included leadership buy-in, on-going education, personnel involvement, and training.

RESULTS

Johns Hopkins' looked at new alternative ways in which to convert their facilities into all Non-latex Sterile Gloves. They explored sole manufacturing supplier opportunities, gained organizational support throughout, and buy-in from chiefs of surgery. They sent out RFPs to 4 glove manufacturers and eventually chose the 2 lowest bidders to evaluate. Upon evaluation it was decided to use both companies.

CONCLUSION

Upon the evaluation of the two glove manufacturers, 412 health-care workers completed 608 evaluation forms. There was a high overall acceptance rate of latex-free sterile gloves. If only one manufacturer was chosen 25% of the staff would not be happy with the chosen manufacturer. Through leadership buy-in, continued education, surveillance, and a systematic approach to a latex free environment, Johns Hopkins was able to make a cultural change for the better.

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By: Lauren Y. Cao, BS: James S. Taylor, MD; Apra Sood, MD; Debora Murray, LPA; Paul D. Siegel, PhD

BACKGROUND

One of the largest causes of contact dermatitis has been linked to rubber gloves. This is especially most prevalent in health care workers.

OVERVIEW

It is investigated in this study that allergic contact dermatitis (ACD) can be caused not only by rubber gloves, but occur with non-latex products as well. Most of the contact allergies have been linked to the accelerators used in rubber to speed up the vulcanization process.

RESULTS

626 patients were tested between 5/1/07 and5/31/09. Out of 626 patients 23 patients tested positive to dermatitis due to 1 or more chemicals found in rubber gloves. Many different accelerator chemicals found in gloves could be a contributor to a patients’ ACD. Since the mid-1990's the largest chemical contributor to sensitization, Thiurams, has appeared to be on a decline, whereas a carba mix, ZDEC, ZBDC, and DPG appear to have increased. As manufacturers have looked for alternative ways to lower or eliminate certain accelerator chemicals others have been introduced.

CONCLUSION

The only way to cure diagnosed chemical-induced ACD due to glove use, is to use gloves that are allergen free from what the patient was tested to be positive to, and/or to stop wearing gloves. Patch testing appears to be the best way in which to uncover all chemicals that a patient might be exposed and reacting to. The changes from ACD and sensitization to rubber glove accelerators from thiurams to a carba mix are happening most frequently in the healthcare setting.

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By: Ann Ponten, Nils Hamnerius, Magnus Bruze, Christer Hansson, Christina Persson, Cecilia Svedman, Kirsten Thorneby Andersson, and Ola Bergendorff

BACKGROUND

Over a recent period of time, operating room personnel, i.e. surgeons and surgical nurses have seen an increase in occupational contact hand dermatitis. It is suspected that the chemistry of the rubber additives found in surgical gloves could potentially be an indicator.

OVERVIEW

The objective of this study was to assess patients that were diagnosed with occupational contact dermatitis due to their gloves. The second part of this study was to evaluate the gloves that they wear, a baseline series, and a rubber series of gloves. A patch test method of was used. The inside and outside of the gloves were analyzed as well.

RESULTS

7 out of 8 patients reacted to cetylpyridinium chloride. 8 out of 16 patients showed an allergic reaction to thiuram mix. 12 out of 16 patients had an allergic reaction to DPG. Cetylpyridinium and DPG were found on both inside and outside of the glove, but had a stronger concentration on the inside of the glove. Most patients had been working for decades in their current occupation and only over the last several months reported hand dermatitis.

CONCLUSION

It is concluded in this study that the change of glove material due to latex allergies to latex-free gloves has unfortunately not lowered the risk of sensitivity to rubber accelerators found in gloves. The rubber accelerator DPG, and cetylpyridinium chloride, which is a lubricant, was found to be a positive reaction of a potential cause for occupational contact dermatitis.

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By: Johannes Geier, Holger Lessman, Vera Mahler, Ute Pohrt, Wolfgang Uter, and Axel Schnuch

BACKGROUND

Allergies that result from rubber gloves causing contact dermatitis have been heavily attributed to accelerators. Of all the allergens identified, Thiurams were the most frequent, with dithiocarbamates coming in as second most common.

OVERVIEW

This study looked at data from the Information Network of Departments of Dermatology (IVDK) from 2002-2010. The authors looked to see if there was a pattern in patients that had allergic contact dermatitis through rubber gloves.

RESULTS

7From 2002-2010; 93, 615 patients were tested. 14, 148 patients (15.1%) were diagnosed as occupational dermatitis. Out of the 14, 148, 3,448 (24.4%) were given additional testing to see if they reacted to a glove allergy. The 3,448 were given patch tests of typical allergens used in glove manufacturing to increase elasticity of the glove. They were Thiuram mix (1%), ZDEC ( 1%); MBT (2%) and mercapto mix (1%). Thiuram was the most frequent allergen at 13.0%.

CONCLUSION

It was strongly recommended that glove manufacturers have a mandatory labeling of chemical accelerators on the glove packaging. Over the last 17 years the contact allergy to accelerators found in elastic gloves is still prevalent and has remained un-changed. It was also recommended that thiuram-free gloves be introduced to the marketplace to hopefully prevent further thiuram sensitization.

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By: Margo J. Bendewald, Sara A. Farmer, and Mark D.P. Davis

BACKGROUND

There is a continued increase in allergic contact dermatitis due to chemicals found in rubber. Synthetic rubbers (non-latex) are increasingly common in medical and household products due to latex sensitivity allergies. The rubber allergens are now an important contributor to allergic contact dermatitis.

OVERVIEW

The authors conducted a patch test study on patients from January 1, 2000 through December 31, 2007. The patients were patch tested with a standard allergen series and a specialized rubber allergen series. All patients were previously suspected of having an allergic contact dermatitis and were referred to the Mayo Clinic for patch testing. The goal of the study was to report results from the standard allergen and specialized rubber allergen series to uncover the total allergic patch-test rubber reaction rate.

RESULTS

The most common site of allergic contact dermatitis was the hand (49.7%), and the most common occupation that a patient with dermatitis had was healthcare worker (16.3%). Patients were tested with a rubber allergen series of 27 allergens and a standard series including 6 rubber allergens. Out of the 773 patients, 739 patients were tested with both standard and rubber allergens. 245 patients (31.7%) had a positive reaction to at least one rubber allergen. In the rubber series, 4,4-dithiodimorpholine 1% yielded the largest number of positive reactions (9.8%). The second highest level of allergic reactions was thiuram mix at 7.6%.

CONCLUSION

When a special rubber allergen series was used in this study the number of patients with positive patch-tests doubled when diagnosing a rubber allergy. Consideration should be given to including special series of rubber allergens when testing patients for contact dermatitis allergic rubber allergies.

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By: Marie Baeck, Benedicte Cawet, Dominique Tennstedt and An Goossens

BACKGROUND

Latex surgical gloves were eliminated and replaced by non-latex gloves (Esteem micro; Medline international). Since this was implemented, the hospital has experienced an increase of contact allergic events by surgeons, OR nurses and anesthetists. The majority of this HCW did not have a past history of hand dermatitis despite working for decades.

OVERVIEW

This article discusses the increase of contact allergies from Cliniques Universitaires Saint-Luc and University Hospital KU Leuven (Belgium) after replacing their latex gloves for non-latex gloves. Both latex and non-latex gloves contain rubber additives.

RESULTS

Eight operating room workers from two hospitals suffered hand eczema between December 2010 and October 2011 related to the use of non-latex gloves (Esteem Micro). Patch tests showed a positive reaction to the gloves. 1.3-Diphenylguanidine (DPG) has not been considered as a frequent sensitizer, however, in this samples 62.5% (5/8) patients reacted to this chemical in the last year due to the use of non-latex gloves. As a possible explanation to the non-latex gloves allergy increase, is the use of cetylpiridinium chloride, an irritant in itself, that can increase the risk of sensitization to rubber additives or a use of higher concentration of chemical accelerators.

CONCLUSION

There is an increase of the level of allergic contact allergies following a move from latex to non-latex gloves (Esteem micro). DPG was involved in the majority of cases and this coincides with other recent report that indicates a rise on the contact allergies caused by 1.3-Diphenylguanidine

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By: G. Piskin, M. M. Meijs, R. van der Ham and J. D. Bos

BACKGROUND

Chemicals are used in the manufacture of rubber gloves and they can lead to the development of occupational and non-occupational hand dermatitis.

OVERVIEW

There was a recent marked increase in the number of OR worker referrals for occupational hand dermatitis at the Academic Medical Centre of the University of Amsterdam (The Netherlands).

RESULTS

Five OR workers were referred to the dermatology department between April and June 2005. 80% (4/5) demonstrated a positive reaction to 1.3-Diphenylguanidine (DPG) and this was the most frequent cause of allergic contact dermatitis related to rubber chemicals. This chemical is generally used in industrial rather than in rubber gloves, which will explain lower sensitivity in previous studies. However, since 2001, in this hospital, latex gloves were gradually replaced by non-latex gloves, containing DPG, which may explain this increment.

CONCLUSION

1.3-Diphenylguanidine (DPG) was the most frequent cause of allergic contact dermatitis related to rubber chemicals reported in this article, but the samples size is small.

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