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RUBBER LATEX INDUCED CONTACT DERMATITIS

Allergy to rubber latex is an international health problem now. People who are at the highest risk of getting this disease are those working in the health care industry, rubber industry and those who have undergone multiple surgeries.

Types of allergies

There are three types of reactions to rubber latex; irritant contact dermatitis, allergic contact dermatitis (Type IV allergy) and immediate-type hypersensitivity reactions (Type I allergy).

Irritant contact dermatitis: Irritant contact dermatitis is non-immune eczematous reaction caused by moisture, heat and friction under the latex gloves. Severity of the reaction depends on the length of exposure, state of the skin barrier system and skin temperature. There is itching, scaling and erythema followed by thickening of the skin. The use of a cotton liner under NRL gloves can help.

Allergic contact dermatitis (Type IV allergy): This is a delayed-type hypersensitivity reaction and comprises 80% of all occupation related contact dermatitis. Out of 100 cases of chronic hand dermatitis in surgical personnel and dentists, 11 were found to be allergic to rubber latex hand gloves.

Allergic contact dermatitis is an immune system mediated sensitization to rubber accelerators, such as, thiurams and carbamates and to antioxidants in latex gloves. The reaction is usually confined to the area of direct contact. Glove allergy was caused by thiurams in 72% cases, carbamates in 25% cases and mercapto compounds in 3% cases. Repeated exposure to the same allergen, which caused the sensitization, generally worsens the condition. It can produce an eczematous reaction featuring erythema, scaling and vesiculation that may lead to the life threatening ‘Type 1’ allergy. Having both "Type IV" and "Type I" natural rubber latex allergy is both possible and worse than either type of allergy alone.

Diagnosis

The diagnosis is made by patch testing. The standard patch test screening series contains the chemicals found in rubber latex glove products. Patch testing with a thin piece of a rubber latex product may be helpful, but not in ‘Type 1’ allergy cases.

Hand dermatitis and atopic diseases are increased risk factors for rubber latex allergy.

Treatment

Once patch testing has identified the offending allergen, rubber products that do not contain those allergens, or do not contain chemicals which produce them, should be obtained. Patients who have undergone or will need to undergo multiple surgical procedures should be offered a latex-safe hospital environment.

Surgeons with rubber sensitivity may use Elastyren hypoallergenic surgical gloves. Unlike latex rubber, Elastyren is not vulcanized and therefore contains no metal oxides, sulfur, accelerators, or mercaptobenzothiazole, sensitizers commonly found in rubber products. Allerderm vinyl gloves, for household use, can be used with a cotton liner. Hypoallergenic vinyl gloves for examination are generally available.

Immediate-type hypersensitivity reactions (Type I allergy)

‘Type I allergy’ is also an immune system mediated reaction. Its development requires previous sensitization. Subsequent exposure to the offending allergen induces the release of histamine and other mediators.

Exposure of the skin to latex produces contact uritcaria and exposure to latex in the air causes allergic rhinitis, conjunctivitis, asthma, anaphylaxis, and even death. Patients, with allergy to rubber latex, are vulnerable in a hospital setting. Latex allergy can present itself as anaphylaxis during surgery, barium enema, or dental work. Intraoperative anaphylaxis and death can occur due to mucosal latex absorption at the time of surgery or procedure, because of exposure to the surgeon’s latex gloves.

Mucosal exposure can occur from airborne powder particles, used as dry lubricant in gloves. The powder acts as a vehicle for carrying the latex proteins in the air. These particles are dispersed when the gloves are removed and cause aerosol contamination, resulting in asthma.

Patients with Type I rubber latex allergy can have a cross-reaction to certain foods. Anaphylactic reactions to banana, avocado, or tomato, or local irritation when working with such foods have been reported.

Diagnosis

A RAST screening test to detect latex-specific IgE can be done on patients with a history of reactions from rubber exposure. If the RAST test is positive, no further tests are needed. If negative, a ‘use test’ using a latex glove in a supervised setting may be performed, first with one finger, then with the hand. If still negative, a skin-prick test should be done with eluted latex protein in solution. Anaphylactic reactions can happen with the ‘use’ and the skin-prick tests, so life saving equipment must be available.

Treatment

Health care workers, with type I reactions, should wear non-latex gloves, while low-allergen, powder-free gloves should be worn by other health care workers at that worksite Instead of single vinyl gloves, double-gloved vinyl gloves may provide greater protection during the mucosal examinations. Thermoplastic elastomer gloves are expensive but provide a protection as good as rubber latex gloves.