Contact urticaria from rubber gloves after dermatitis from thiurams

The problems of rubber hypersensitivity (Types I and IV) in chronic leg ulcer and stasis eczema patients

The prevalence of Type I and Type IV hypersensitivity to rubber allergens in patients with stasis eczema and/or venous leg ulcers over an 18-month period was studied by prick and patch testing. Results from 109 patients were analysed. Positive patch tests were found in 71 patients (65%). Delayed-type hypersensitivity to rubber chemicals was found in 17 patients (15.6%). However, only 1 patient who had additional risk factors showed Type I hypersensitivity to natural rubber latex. We therefore conclude that, although Type IV hypersensitivity to rubber chemicals is relatively common in our patients, Type I hypersensitivity to natural rubber latex remains rare.

Latex allergy: a review for the dental professional

Reactions to latex products are reportedly occurring with an increased frequency both in patients and in health care providers. Natural rubber latex is found in numerous products, and adverse latex reactions range from contact dermatitis to life-threatening anaphylaxis. A complete understanding of the pathophysiology of latex allergy provides the foundation for the proper diagnosis and treatment of patients with latex allergy. This article provides the reader with a review of latex allergy and suggests strategies for the management of patients with latex hypersensitivity.

Latex hypersensitivity: its prevalence among dental professionals

Reports of hypersensitivity to latex are growing among oral health care workers, who have a high degree of exposure to latex products. The authors undertook a study to determine the prevalence of latex hypersensitivity among oral health care workers in a hospital dental practice. Among the 34 people who participated in the study, 12 percent had positive results in a skin prick test for latex. This suggests that the true prevalence rate of immediate hypersensitivity to latex in this group of oral health care workers is similar to that in other health care workers who use latex gloves frequently.

Occupational latex exposure: characteristics of contact and systemic reactions in 47 workers

BACKGROUND

Recent reports have noted an apparent increase in the prevalence of natural rubber latex (NRL) allergy among workers with occupational latex exposure (OLE). The risk factors for and the natural history of NRL allergy in this population are not well delineated, and the utility and comparability of immunoassays as confirmatory testing are unclear.

METHODS

Serum samples and medical histories were obtained from 47 symptomatic workers with OLE, from nine other individuals with a history consistent with NRL allergy, and from 10 atopic asymptomatic NRL-exposed control subjects. Sera were coded and analyzed in a blinded manner for latex-specific IgE, using a variety of antigen sources, including ammoniated and nonammoniated raw latex preparations and three finished glove preparations.

RESULTS

Risk factors for the latex allergy in workers with OLE appear to include a history of atopy or preexisting dermatitis involving the hands. In this population, NRL allergy is commonly preceded by latex glove-associated contact dermatitis. Serologic testing confirmed the suspected diagnosis in 62% of workers (15 of 24) with systemic symptoms but was only positive in 27% of workers (4 of 15) with symptoms limited to contact urticaria.

CONCLUSIONS

The appearance of a latex glove-associated contact rash may precede the development of NRL allergy, particularly in atopic persons. Workers at risk should be advised to use alternate types and brands of latex gloves or to switch to nonlatex gloves entirely.

Latex-associated allergies and anaphylactic reactions

The recent reports of severe anaphylactic reactions and several fatalities caused by contact with latex-containing products raised concerns in the medical community. Although hypersensitivity to natural rubber has been widely reported in the literature, the prevalence and severity of reactions have rapidly increased in the last few years. Latex proteins, constituents of natural latex, appear to be responsible for the sensitization. Many investigators, including our laboratory, are focused on the identification of proteins in raw latex and latex products, specifically those responsible for the elicitation of allergic responses. This paper summarizes available information on the mechanism and epidemiology of latex sensitivity and reviews research efforts toward the identification of the antigen(s) responsible for the reactions. The questions of proper diagnosis and testing, heightening awareness, and prevention of reactions are also addressed.

Contact dermatoses from disposable glove use: a review

Contact dermatoses from disposable gloves are being reported with greater frequency. A variety of eruptions can occur. These have become increasingly relevant for dermatologists, who for most procedures now use disposable gloves. This article represents a review of the relevant issues about the use of disposable gloves by dermatologists. Methods of management and prevention of morbidity associated with disposable glove use will also be discussed.

Contact urticaria and anaphylaxis to natural latex

Immediate allergic reaction to natural latex of Hevea brasiliensis has been well documented. We report 17 cases, all in women. Twelve had an anaphylactic reaction during surgery and five had contact urticaria. Reactions to prick tests done through a washed surgical glove and with natural latex were positive in 15 of 17 patients and in 16 of 16 patients, respectively; specific IgE was found in 12 of 17 patients. In 206 control subjects, results of a prick test through a surgical glove were negative.

Anaphylaxis produced by rubber glove contact. Case reports and immunological identification of the antigens involved

A study was carried out on six subjects suffering from anaphylactic reactions including asthma, rhinoconjunctivitis, contact urticaria and hypotension following contact with rubber gloves. All of them showed skin sensitivity and serum specific IgE to various preparations of natural latex, and not to other chemicals used in glove manufacturing. Immunoblotting techniques demonstrated that at least four soluble polypeptides from natural latex had the ability to bind specific human IgE. The results suggested that natural latex proteins present in rubber gloves can cause severe specific hypersensitivity reactions.

IgE-mediated allergy to natural rubber in 30 patients with contact urticaria

30 patients who had experienced contact urticaria after exposure to gloves, contraceptives, balloons or dental cofferdams went through a detailed examination including interviews on: exposure to rubber; local and distant symptoms; provocation tests; skin prick tests with (among other substances) latex extracts from the rubber tree Hevea brasiliensis; patch testing, IgE and RAST analyses. 23 patients (77%) reported additional symptoms from distant organs. 13 belonged to medical occupations; 25 were classified as atopics based on history; 21 had raised IgE-values; 25 were RAST-positive to the extracts from Hevea brasiliensis. 13 had a pre-existing hand dermatitis, of whom 6 were patch test positive to standard allergens. Skin prick tests with extracts from Hevea brasiliensis were the most sensitive diagnostic tool, while the RAST analysis was positive in 25/30 cases. These tests and analyses including RAST were negative in 40 control subjects. Provocation tests are of great value, but difficult to standardize. Several patients reported severe reactions at medical and dental examination/treatment situations (surgical gloves, dental cofferdams), and the risk of life-threatening anaphylactic reactions is emphasized.

Incidence of immediate allergy to latex gloves in hospital personnel

Latex surgical gloves may cause contact urticaria and serious allergic reactions in sensitized persons, but the frequency of this allergy is not known. In the present study, 512 hospital employees were screened with a latex-glove scratch-chamber test; 23 (4.5%) were suspected and 15 (2.9%) were proven allergic with latex prick and use tests. All of them were doctors and nurses, and 12 had had contact urticaria but no serious symptoms. They could continue their routine work using cotton or vinyl undergloves or special latex surgical gloves. Atopy, hand eczema and surgical work seemed to be predisposing factors. In operating units, 7.4% of the doctors and 5.6% of the nurses were allergic; the frequency was lower in non-operating units and among laboratory personnel. The high frequency of latex glove allergy, especially in operating units, focuses attention on the quality of surgical latex gloves.

Contact dermatitis. A review

In recent years, there has been a dramatic rise in our understanding of contact dermatitis. This paper is a review of our knowledge of the mechanisms involved in contact dermatitis and related phenomena, the investigation of these events and the emergence of significant new allergens during the last 5 years.

IgE-mediated anaphylactoid reactions to rubber

Delayed hypersensitivity to rubber chemicals is well known, but there are only a limited number of case reports on an immediate type of hypersensitivity inducing contact urticaria. We have recently seen several patients with rubber glove-induced contact urticaria who have had both positive skin prick tests and positive RAST tests to natural latex from the rubber tree (Hevea brasiliensis). We now report on five patients who also developed systemic reactions. It is clear that sensitized subjects are at risk of developing anaphylaxis during medical examination or surgery when rubber gloves are used. The occurrence of IgE-mediated allergy to rubber is probably underestimated.

Discomfort from rubber gloves indicating contact urticaria

Rubber glove intolerance is a common dermatological problem and hypersensitivity of both delayed and immediate types occur. In order to study immediate skin reactions induced by rubber gloves, 15 patients with discomfort and itch produced by rubber gloves were examined. The patients were provoked by wearing rubber gloves, scratch tested with gloves, rubber chemicals and powders. RAST-tests were performed using an extract from the rubber tree (Hevea brasiliensis). In 6/15 patients, contact urticaria was confirmed, in 3 of whom IgE antibodies to latex were demonstrated.

Dermatitis and urticaria from rubber and plastic gloves

The number and nature of allergic occupational glove dermatoses were analysed. 542 cases of allergic contact dermatosis were diagnosed during 1974-1983. Amongst these, 68 (12.5%) were caused by rubber or plastic gloves. 2 patients had contact urticaria due to rubber gloves. Gloves were the main cause of occupational allergic rubber eczema, inducing 63 (58.3%) of 108 rubber eczema cases. 38 of them had positive reactions to rubber chemicals and glove material, 14 to glove material only, and 11 to rubber chemicals. 5 cases of allergic eczema from plastic gloves were diagnosed, all due to polyvinyl chloride (PVC). 2 cases of contact urticaria from natural rubber gloves were diagnosed by a provocation test. Epicutaneous testing with material of natural rubber gloves and rubber chemicals was negative. The present study shows that allergy to rubber gloves is usual, while allergy to plastic gloves is rare. Thus, plastic gloves should be used, when possible. Patch testing with protective gloves should always be used when patients develop prolonged hand dermatitis and where the possibility of glove eczema exists.