Moving towards a latex-free environment: advice from experiences in US dentistry

Latex allergy and filaggrin null mutations

OBJECTIVES

Natural rubber latex (NRL) contains over 200 proteins of which 13 have been identified as allergens and the cause of type I latex allergy. Health care workers share a high occupational risk for developing latex allergy. Filaggrin null mutations increase the risk of type I sensitizations to aeroallergens and it is possible that filaggrin null mutations also increase the risk of latex allergy. The aim of this paper was to examine the association between filaggrin null mutations and type I latex allergy.

METHODS

Twenty latex allergic and 24 non-latex allergic dentists and dental assistants, occupationally exposed to latex, were genotyped for filaggrin null mutations R501X and 2282del4. Latex allergy was determined by a positive reaction or a historical positive reaction to a skin prick test with NRL.

RESULTS

41 individuals were successfully genotyped. Three individuals were filaggrin mutation carriers. One (2.4%) was a 2282del4 heterozygote and two (4.9%) were R501X heterozygote. No homozygote or compound heterozygote carriers were detected. No association between filaggrin null mutations and type I latex allergy was found (p=0.24). Patients with type I latex allergy more often reported contact dermatitis.

CONCLUSIONS

This is the first study to examine a highly plausible association between filaggrin null mutations and type I latex allergy. The study subjects were occupationally exposed to latex but no association between latex allergy and filaggrin mutations were detected. Sensitization to latex in the cases in this study may not have occurred through direct skin contact but through the respiratory organs via latex proteins that are absorbed in glove powder and aerosolized.

A laboratory-based study to assess the performance of surgical gloves

The inherent tear resistance and elasticity of latex and the touch sensitivity it provides has made it the traditional material of choice for surgical gloves, protecting both health care workers and patients from the transmission of bloodborne infections. Although increased incidence of latex allergy has led to increased use of nonlatex surgical gloves, the effectiveness of these gloves as a barrier to infection has not been examined thoroughly. This laboratory-based study compared the performance of latex and nonlatex surgical gloves in a simulated stress protocol. The propensity of surgical gloves to fail was dependent on glove material, manufacturer, and stress. Nonlatex neoprene and nitrile gloves were comparable to latex and can provide a good alternative to latex for allergic patients and health care workers. In this study, isoprene was found to be inferior to latex and other nonlatex materials. The presence or absence of glove powder had no significant influence on the probability of glove failure.