Safe Use of Latex Rubber

TO THE EDITOR:

In their recent review of latex allergy, Sussman and Beezhold [1] recommend that patients with a positive latex challenge use nonlatex gloves. This recommendation raises the question of the effectiveness of the substitutes—vinyl or synthetic latex (for example, neoprene). The Centers for Disease Control and Prevention and the Occupational Safety and Health Administration have stated that there are no significant differences in barrier protection between intact latex and vinyl gloves. During regular use, however, vinyl appears to tear more easily and is therefore substantially more permeable [2, 3]. Are the authors aware of data on the effectiveness of nonvinyl synthetic gloves?

Latex gloves have been shown to differ 3000-fold in the amount of allergenic latex protein that can be extracted (with the highest levels in powdered gloves) [4]. We have found that many latex-sensitive patients can tolerate a lower allergenic powder-free glove (for example, Safeskin). Assuming that latex offers a greater barrier protection than vinyl, low antigenic latex gloves should be tried before a substitute is considered.

The review also mentions that health care workers often present with allergic rhinoconjunctivitis and asthma. At the New York Hospital, at least one professional in each unit with high glove use (for example, the operating room, intensive care unit, or laboratory) has significant asthma from latex and requires daily medication to continue working. Respiratory symptoms develop from inhaling latex attached to glove powder, which becomes airborne as gloves are used. A recent report found that airborne latex allergen in a medical center ranged from 13 to 268 ng/m³ in areas of frequent powdered glove use compared with 0.3 to 1.8 ng/m³ in areas in which powdered gloves were seldom or never used. Absorption of the antigen onto mucosal surfaces may also enhance the development of sensitivity in exposed workers and patients.

In view of the above factors, an interim approach to this problem should be the widespread use of powder-free gloves. A future theoretical treatment may be specific immunotherapy, but the relevant antigen has not yet been clearly defined. Powder-free gloves are generally more expensive, but this factor should be weighed against the potential costs of disability compared with those of enabling persons already sensitized to continue to work. Most importantly, further sensitization of both health care workers and patients should be prevented. Primum non nocere.

• Copyright ©2004 by the American College of Physicians