Allergic reactions due to glove-lubricant-powder in health-care workers

Occupational Skin Disease in Physicians: A Review of the Literature

OBJECTIVES

Occupational skin disease (OSD) arises from work-related activity. However, there is a paucity of literature on OSD in physicians. The aim of the this review was therefore to examine and summarize what types of symptomatic OSD physicians experience.

METHODS

We conducted a systematic literature search on Cochrane Library, Embase, and Pubmed.

RESULTS

Contact dermatitis from formaldehyde and glutaraldehyde were found in 11.5 and 13.5% of cases, respectively. In total 2.4-14.9% had latex allergy. The reported standardized incidence ratio of squamous cell carcinoma and melanoma was up to 2.15 [95% confidence interval (CI) 1.57-1.95] and 3.2 (95% CI 1.38-6.31). Transmission of human papilloma virus (HPV) particles during carbon dioxide laser wart ablation were found in 70% of samples collected from protective gloves and in 52% of samples from vapors.

CONCLUSIONS

The most frequently reported OSD in physicians is contact dermatitis from allergens in disinfectants and rubber gloves. There is also a risk of cutaneous reactions to latex. The incidence of skin cancer was higher in physicians than in the general population, and the reason for this remains unexplained and potentially biased. There are no reports of transmission of patient HPV to surgeons during wart ablation, possibly because of proper use of protective equipment.

Work-related allergy in medical doctors: atopy, exposure to domestic animals, eczema induced by common chemicals and membership of the surgical profession as potential risk factors

PURPOSE

To investigate the risk factors associated with work-related allergy-like symptoms in medical doctors.

METHODS

Self-administered questionnaire survey and CAP test were conducted among medical school students in the 4th grade of their 6-year medical course in 1993-1996 and 1999-2001. Follow-up questionnaires were sent in 2004 to the graduates. These questionnaires enquired into personal and family history of allergic diseases, lifestyle, history of allergy-like symptoms including work-relatedness and occupational history as medical doctors. Relationships between allergy-like symptoms and relevant factors were evaluated by multivariate logistic regression analysis.

RESULTS

Of 261 respondents at the follow-up survey, 139 (53.3%) and 54 (20.7%) had a history of any allergy-like symptoms and any work-related allergy-like symptoms, respectively. Female gender and family history of allergic diseases were significantly associated with any allergy-like symptoms. Personal history of allergic disease, exposure to domestic animals, eczema caused by rubber gloves, metallic accessories, or cosmetics during schooling days, and membership of the surgical profession were significant risk factors for work-related allergy-like symptoms. On the contrary, to work-related allergy-like symptoms, gender, age, and smoking status were not significantly related, and consumption of prepared foods was inversely related.

CONCLUSIONS

Personal history of atopy and eczema induced by common goods and the history of keeping domestic animals may be predictors of work-related allergy-like symptoms in doctors. After graduation from medical school, physicians start with exposure to various allergens and irritants at work, which relate to work-related allergy-like symptoms, especially for surgeons.

Final Report of the Safety Assessment of Cosmetic Ingredients Derived From Zea Mays (Corn)

Many cosmetic ingredients are derived from Zea mays (corn). While safety test data were not available for most ingredients, similarities in preparation and the resulting similar composition allowed extrapolation of safety data to all listed ingredients. Animal studies included acute toxicity, ocular and dermal irritation studies, and dermal sensitization studies. Clinical studies included dermal irritation and sensitization. Case reports were available for the starch as used as a donning agent in medical gloves. Studies of many other endpoints, including reproductive and developmental toxicity, use corn oil as a vehicle control with no reported adverse effects at levels used in cosmetics. While industry should continue limiting ingredient impurities such as pesticide residues before blending into a cosmetic formulation, the CIR Expert Panel determined that corn-derived ingredients are safe for use in cosmetics in the practices of use and concentration described in the assessment.

Corn contact urticaria in a nurse

A 33-year-old nurse presented with persistent hand dermatitis. Radioallergosorbent tests showed moderate to strong reactions to latex, avocado and banana. Despite avoidance of latex gloves, she failed to improve. Patch testing was negative. Prick testing showed a negative reaction to latex, but a strong reaction to corn, with relevance to cornstarch powder present in many medical examination gloves. She was diagnosed with corn contact urticaria, irritant contact dermatitis and type I hypersensitivity to latex fruits.

Occupational allergens in dentistry

PURPOSE OF REVIEW

Dental professionals and their physicians frequently do not recognize, accurately diagnose or appropriately manage occupational allergies. Dental allergen identification, diagnostics and practical avoidance strategies are summarized in this review.

RECENT FINDINGS

Methacrylates, natural rubber latex proteins, rubber glove allergens, and glutaraldehyde are the predominant allergens in dentistry. Reactions range from cell-mediated contact allergy to urticaria and occupational asthma.

SUMMARY

Despite recent advances in allergen characterization and increased awareness of selected allergens, treatment of occupational allergies can be improved. Better information and improved cooperation between dental workers and their clinicians is needed.

Prevention of latex allergy among health care workers: evaluation of the extractable latex protein content in different types of medical gloves

BACKGROUND

Since the 1980s, there has been increased use of latex gloves by health care workers and a concomitant increase of irritant and allergic reactions. The total protein content and the latex allergenic protein content in different types of medical gloves commonly used in our hospital were evaluated to acquire information useful for preventing latex allergy in our hospital personnel.

METHODS

The total protein content and the allergic latex protein contents were evaluated with Lowry modified method and RAST inhibition assay in samples and extracts of 29 different types of medical gloves.

RESULTS

The highest concentrations of total proteins and allergenic latex proteins were found in examination powdered latex gloves and in surgical powdered latex gloves; a significant amount of latex proteins was found in some brands of nitrile gloves.

CONCLUSIONS

The clear association between the total protein levels and the allergenic latex protein levels suggests that the gloves with highest total protein content have the greatest allergenic potential. Therefore, it is recommended that manufacturing companies should provide package inserts including the total protein contents and possibly allergenic latex protein levels. They should declare whether they have added latex to their nitrile glove formulation. RAST-inhibition assays directly on glove samples instead of glove extract seems to be a good reliable and faster alternative for the evaluation of the allergenic potential of latex gloves.