Latex aeroallergen quantification in hospitals of Moscow, Russia

Impact of Converting to Powder-Free Gloves: Decreasing the Symptoms of Latex Exposure in Operating Room Personnel

This study examined health care worker satisfaction with the use of non-powdered natural rubber latex (NRL) surgical gloves to determine the impact of non-powdered NRL gloves on the NRL sensitization of operating room personnel. The study used a 1-year longitudinal design to obtain recall information from employees about their NRL exposure. Additionally, a survey was completed by participants related to their satisfaction with non-powdered NRL gloves. Informed consent was obtained from 103 employees. After conversion to an operating room using non-powdered NRL, there was a significant decrease in reported symptoms with NRL exposure (42% pre- and 29% post-conversion, Fisher's exact, two-tailed, p = .0001). This study demonstrated that the conversion to non-powdered low-protein NRL gloves resulted in decreased symptoms because of NRL exposure.

Different latex aeroallergen size distributions between powdered surgical and examination gloves: significance for environmental avoidance

BACKGROUND

Proactive medical institutions implement latex allergen avoidance to protect workers and patients with latex allergy and to prevent latex sensitization in these groups by creating latex-safe environments that include replacement of natural rubber latex examination and surgical gloves, especially those that are powdered, with synthetic alternatives. We have hypothesized that an apparent decreasing trend in new latex allergy cases in hospitals using only synthetic examination gloves but the occasional powdered latex surgical glove might result from constitutive differences in allergen content (particle size distribution and quantity) between powdered surgical gloves and examination gloves.

OBJECTIVE

Because aerodynamic particle size determines where inhaled airborne allergen deposits in the airway, the aim of this study was to investigate the differential particle size distribution of latex allergen released from powdered latex examination and surgical gloves.

METHODS

Powdered and nonpowdered latex examination and surgical gloves were processed to create an aerosol in a glove box equipped with air sampling equipment capable of total particle number and mass measurements. Air particulate generated in the glove box was collected on impactors with less than 2.5-microm, 2.5- to 10-microm, and greater than 10-microm particle size limits (4 L/min for 4 hours). All filters were extracted, and latex allergen was quantified by using a latex-CAP inhibition assay with a human IgE anti-latex serum pool.

RESULTS

Latex aeroallergen on powdered sterile surgical gloves resided primarily on particles greater than 10 microm in size (P <.006). In contrast, powdered examination gloves released the highest total latex aeroallergen content, with 68% of the particles sized in the respirable 2.5- to 10-microm range and carrying 56% of the airborne latex allergen.

CONCLUSIONS

Significantly lower quantities and larger sizes of latex allergen-containing particles released from surgical gloves provides one potential explanation as to why an apparent decrease in new cases of latex allergy can occur in hospitals that successfully replace latex examination gloves with synthetic gloves but continue occasional use of powdered surgical gloves.

Quantified environmental challenge with absorbable dusting powder aerosol from natural rubber latex gloves

BACKGROUND

There are few data that link quantified natural rubber latex (NRL) absorbable dusting powder aerosol to biologic responses in NRL-sensitized subjects.

METHODS

We conducted a study on 30 health care workers with possible occupational asthma. All the subjects but 2 had a positive skin prick test result with NRL extract. Quantified environmental challenge (QEC) with powdered NRL gloves was performed in a 7-m(3) chamber. The patients would don and discard a pair of gloves every 3 minutes up to a maximum of 60 minutes. The concentrations of NRL aeroallergen were measured by a competitive IgE immunoassay. Ocular and respiratory symptoms and pulmonary function were monitored.

RESULTS

Twenty-six patients (87%) had rhinoconjunctivitis, 19 (63%) had an asthmatic response (responders), and 1 patient developed eosinophilic bronchitis on QEC. The asthmatic responses were of the early type in 15 patients, dual in 3, and isolated late in 1 patient. The duration of exposures sufficient to elicit asthmatic responses varied from 3 to 114 cumulative minutes. Time-weighted average NRL aeroallergen concentrations during QEC with responders ranged between 199 and 1107 ng/m(3). NRL concentrations measured at various time points during exposure were reproducible. Measured concentrations of NRL aeroallergen between responders (677 +/- 281 ng/m(3)) and nonresponders (611 +/- 351 ng/m(3)) were not statistically different. The cumulative inhaled NRL aeroallergen dose required for an asthmatic response ranged between 25 to 515 ng.

CONCLUSION

The total dose of latex aeroallergen eliciting an asthmatic response during QEC was mostly affected by the duration of exposure and varied widely from person to person.

Prevalence of skin test reactions to natural rubber latex in hospital personnel in Russia and eastern Europe

BACKGROUND

Allergic reactions to natural rubber latex have increased during the past 10 years, especially in many health care workers (HCWs) who have high exposure to latex allergens. The prevalence of skin test reactions to natural rubber latex in Russia, the Commonwealth of Independent States (CIS), and eastern Europe is unknown.

OBJECTIVE

The purpose of this study was to determine the prevalence of skin test reactivity to natural rubber latex in a population of HCWs exposed to latex.

METHODS

Nine hundred one HCWs regularly exposed to latex were evaluated using an allergy history questionnaire. Subjects were tested for latex allergy by titrated skin prick test with a biologically standardized latex extract. The diagnosis of latex allergy was defined by the presence of clinical symptoms when exposed to latex along with a positive skin prick test to latex.

RESULTS

Forty-nine (5.4%) HCWs were skin test-positive to latex. Seventeen (1.9%) HCWs were classified as latex-allergic based upon positive skin tests to latex associated with allergy symptoms with exposure. Seven of 901 HCWs had experienced anaphylactic reactions to latex. The most frequently reported symptom related to latex exposure was contact urticaria.

CONCLUSIONS

The prevalence of latex allergy among HCWs in Russia, the CIS, and adjacent eastern European countries is considerably less than reported in HCWs exposed to latex in western Europe and the United States. The low prevalence of latex allergy in Russia and the CIS suggests that lessened exposure to natural latex powdered gloves may diminish the prevalence of latex sensitization in HCWs in Russia and the CIS.

Starch and natural rubber allergen interaction in the production of latex gloves: a hand-held aerosol

Starch powders continue to be used as donning agents on natural rubber (NR) gloves. NR aeroallergens are an important aspect of human sensitivity to latex. Asthma, upper airway, and ocular symptoms are associated with these airborne proteins. These bioaerosols feature starch as the carrier. The association of NR allergen and starch is demonstrated in NR glove manufacturing, in laboratory simulation, and as occupational aeroallergens in health care environments. Four aspects of latex allergen affinity for starch powders were examined by using a competitive IgE immunoassay for NR latex. Allergen content was assessed in finished gloves before and after powder process points and related to the allergen content of the raw latex source material. In another manufacturing process, allergen uptake by two different starch powders was quantified. NR allergen affinity for the starches was also determined under laboratory conditions. Finally, NR aeroallergens carried by starch powder in production facilities were measured. This article outlines the sources, mechanisms, and conditions for NR allergens to interact with two different starches. The quantitative airborne allergen data are used to compare and contrast various occupational indices of NR allergen exposure. Powdered NR gloves continue to cause concern; however, the technology used for contemporary glove powder applications may be advanced and improved enough to consistently produce powdered gloves with a low allergen content.