Learn About Latex Allergies

Natural rubber latex allergy is a significant medical concern in healthcare today. Latex-sensitive patients and healthcare workers face a serious risk from any product containing latex, with exposure to latex gloves presenting a particular concern. To date, there is no known cure for latex allergy except eliminating exposure to latex products.

One of the quickest ways to reduce this risk is obvious: switch to natural rubber latex-free gloves. Yet, some dental practices seem reluctant to make the change.

Latex Sensitivity and Latex Allergy

The three common reactions associated with latex glove use are:

1. Irritant Contact Dermatitis: The result of damage to the skin caused by factors like soaps and cleansers, multiple handwashings, inadequate hand drying, rubbing inside powdered gloves, or certain chemicals used in manufacturing gloves. Symptoms include dry, crusty hard bumps, sores, and horizontal cracks on the skin.1

2. Allergic Contact Dermatitis, or delayed hypersensitivity: A Type IV immune reaction, caused by chemical additives used in glove manufacturing, rather than latex itself. Onset of Type IV reactions is slow, usually beginning 18 to 24 hours after exposure and peaking at 48 hours after exposure. Each exposure may lead to increased sensitization and more severe reactions, with symptoms such as red, raised, palpable area with bumps, sores, and horizontal cracks that may extend up the forearm.1

3. Latex allergy: Characterized by immediate hypersensitivity, a true latex allergy is a systemic Type I IgE-mediated response to plant proteins in natural rubber latex, leading to local swelling, redness, edema, itching, and systemic reactions. Type I reactions are immediate; usually within minutes, symptoms occur such as rhinitis, conjunctivitis, urticaria, laryngeal edema, bronchospasm, asthma, angioedema, anaphylaxis, and death.1

Both irritant contact dermatitis and allergic contact dermatitis can lead to latex sensitivity. Latex sensitivity is a condition that can develop after repeated exposed to natural rubber latex. The broken skin barrier caused by dermatitis increases the amount of exposure by allowing latex proteins easy access through the skin. When the level of sensitization reaches the individual's unique threshold level, he or she will express symptoms on subsequent exposure to latex allergens and is considered latex allergic. Anyone with latex sensitivity is at risk of a life-threatening reaction and should be treated in the same manner as a latex allergic individual.

Among the General Population

Estimates of the prevalence of latex sensitivity vary from less than 1% to 6% of the general population.2,3 However, due to repeated exposure to latex products, latex protein sensitivity is increasing.4 Expanding use of latex gloves for various household tasks and glove availability at mass market retailers may be factors in the continuing growth of latex sensitivity.

Among Healthcare Workers

According to a 2004 report from the National Institute of Environmental Health Sciences, natural rubber latex sensitivity is estimated to occur in 5-18% of healthcare workers, a rate two to three times greater than among the general population. Also, latex exposure has been one of the leading causes of occupational asthma in healthcare workers over the last several years, both in the U.S. and Europe.5,6

It has been estimated that one in fifty healthcare workers becomes sensitized to latex each year through exposure to latex gloves.7

Sensitization develops in individuals genetically predisposed to latex allergy after multiple exposures to natural rubber latex over a highly variable period of time. The latency period ranges from several weeks to as long as 30 years.8

As it is impossible to predict when an exposed individual will become latex allergic and express symptoms, no thresholds for specific latex allergens can be established.

Impact on Patients

Unknowingly exposing a latex allergic patient to latex gloves and other latex products can be fatal.9 Without testing every hospital patient, whether or not they're in a high-risk category, it's impossible to tell which ones may be latex sensitive or latex allergic. Therefore, all patients should be assessed for a history of latex allergy.4

Impact on Healthcare Facilities

In a healthcare facility, a latex allergic employee means treatment costs that must be covered by Workers' Compensation insurance, possible litigation costs, federal or regulatory guideline compliance concerns, rearranging work schedules, and dealing with morale issues among the rest of the staff.

Treatment Costs

It can cost between $5,000 and $25,000 to treat a single anaphylactic episode resulting from latex allergy. Overall treatment for Type I allergy, ranging from diagnosis to emergency care following an anaphylactic episode, is estimated at $218,000 per employee.10

For those who cannot return to work due to natural rubber latex allergy, the average total cost, paid by Workers' Compensation insurance and the healthcare facility, can be as high as $1,163,740 per employee.11

To reduce the risk to latex sensitive patients and workers, every facility should take the steps necessary to become latex-safe, which includes identifying acceptable alternatives to known latex-containing products.4

Switching to a synthetic glove, such as nitrile, that is comparable to latex in maintaining excellent barrier protection during use and comparable in its fit and feel, is an important step in creating a latex-safe environment.40

Standardizing on nitrile gloves eliminates confusion and the possibility of accidental latex glove use when treating a latex- sensitive patient. It can also provide cost savings for your facility through code consolidation.

According to a 1999 study by Rego and Roley,40 nitrile is "an equally effective non-latex glove alternative", a synthetic polymer "that exhibits rubberlike characteristics and barrier properties comparable with latex. Nitrile or latex should be the glove of choice for high-risk situations, including exposure to bloodborne pathogens."

Nitrile gloves, with a failure rate of 1% to 3%, were comparable to latex, with a failure rate of 0% to 4%, during manipulations designed to simulate patient care procedures.40

Because of the high failure rate of vinyl gloves-12% to 61% in simulated in-use conditions-they cannot be considered as adequate protection for healthcare workers in moderate to high-risk applications.40

In the United States, a study41 at three Georgia institutions-a tertiary care hospital, a community hospital, and an outpatient clinic-was designed to determine the percentage of at-risk employees who would have to become fully or partially disabled to offset the costs of switching to latex-free gloves.

The cost of a worker who qualified for total disability was calculated at $109,000. As little as 1.1% of workers in the tertiary hospital, 0.45% in the community hospital, and only 0.02% in the outpatient clinic would have to become totally disabled due to latex allergy to offset the additional cost of switching to latex-free gloves.

The cost of a worker who qualified for partial disability was calculated as $62,000. Only 1.9% of workers in the tertiary hospital, 0.8% in the community hospital, and only 0.04% in the outpatient clinic would have to become partially disabled due to latex allergy to offset the additional cost of switching to latex-free gloves.

Studies have shown that economically feasible measures to reduce natural rubber latex exposure in healthcare facilities-including switching to non-latex or reduced protein, powder-free latex gloves-can successfully allow most latex-allergic individuals to continue working.22,25,42

It's clear that the best way to reduce risk to patients, employees, and healthcare facilities themselves is to create a latex-safe environment, in part by switching to nitrile gloves.

Converting to nitrile will:

- Greatly reduce absenteeism and occupational disability costs due to latex allergy/ sensitivity over time.
- Provide cost benefits by standardizing on fewer glove types, reducing both the number of suppliers used and order frequency, and by increasing order quantities.
- Improve morale among existing employees and help attract new staff members.
- Minimize confusion over choice of gloves.

Helping You Make the Switch

A change in gloves is a major decision that will impact every hygienist, assistant and dentist in your facility, as well as your administrators. Halyard can help by providing the information you need to make the best possible latex-free choice for your dental practice in terms of performance and cost.

We can provide you with the test data from numerous studies assessing nitrile, vinyl, and latex performance characteristics and educational materials on latex sensitivity. Our sales staff will conduct a comprehensive review at your dental practice to demonstrate precisely what the financial impact of a switch to nitrile gloves should be. We will assist in educating your employees as to the benefits and proper use of nitrile gloves.

When you're ready for the better alternative to latex, let your Halyard representative help you make the switch. Knowing that your patients and employees are safer and your practice is better equipped to serve their needs is one less thing for you to worry about. 13

 

References:

1. AORN 2004 Standards, Recommended Practices and Guidelines. "Latex Guideline" (2004):103, 106-108, 111-112.

2. Poley GE and Slater JE. "Latex Allergy." Journal of Allergy and Clinical Immunology 105, no. 6 (2000): 1054-62.

3. Neuget AL, Ghatak AT and Miller RL. Anaphylaxis in the United States: An Investigation into Its Epidimiology." Archives of Internal Medicine 161, no. 1 (2001): 15-21.

4. David BR. "Perioperative Care of Patients with Latex Allergy." AORN Jounral 72 (July 2000): 47.

5. Amr S and Bollinger ME. National Institute of Environmental Health Sciences. "Latex Allergy and Occupational Asthma in Health Care Workers: Adverse Outcomes." Environmental Health Perspectives 112, no. 3 (2004) 378-81

6. Van de Bovenkamp JM, Gallis B and Miedema EP. "Cost Benefit Analysis of Introducing Non-latex Gloves into Hospitals." TNO Publication SFZW 920.033.71. September 2003.

7. Brown RH, Schauble JF and Hamilton RG. "Prevalence of Latex Allergy Amongh Anesthesiologists: Identification of Sensitized buy Asymptomatic Individuals." Anesthesiology 89 (1998): 292-99.

8. Green-McKenzie A Hudes D. National Institute of Environmental Health Sciences. "Latex Induced Occupational Asthma in a Surgical Pathologist." Environmental Health Perspectives 113, no. 7 (July 2005):888.

9. Position Statement of the Organization of Main Nurse Executives. Approved January 26, 2001.

10. Gelman JL. "United States Workers' Compensation Programs are Becoming Sensitized to Latex." Update on the Law...Latex Allergy Litigation 21, no. 7 (November 1999.)

11. Gelman JL. "The Iowa Supreme Court Makes it Easier for Latex Sensitized Employees to Obtain Workers' Compensation Benefits." Update on the Law...Latex Allergy Litigation 22, no. 3 (February 2000).

12. Kohn P. "The Legal Implications of Latex Allergy." RN 62, no. 1 (1999):63-65.

13. Aiken LH, Clarke SP, Sloane DM, Sochalski JA, Busse R, Clarke H, Giovanetti P, Hunt J, Rafferty AM, Shamian J. "Nurses' Reports on Hospital Care in Five Countries." Health Affairs 20, no. 3 (May 2011): 45-53.


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