Integrated approaches to prevent exposure risks related to latex-derived products

Natural rubber latex is a widely used industrial raw material to produce many consumer and commercial products. Chronic exposures to latex allergenic proteins residual in the finished products can promote hypersensitive immune responses, which affects millions of workers and the general public worldwide. Research has shown the average prevalence of latex allergy worldwide remains approximately 10% among healthcare workers, 7% among susceptible patients, and 4% among general population. Although most effective in preventing latex allergy, completely avoiding contact to latex-derived products is extremely challenging, given the fact that millions of products possibly contain latex, but few are regulated and properly labeled. Due to the difficulty to assure a product completely absent of latex allergens, the United States Food and Drug Administration has recommended to stop using labels like "latex-free" or "does not contain latex." Here we evaluate published data, industrial standards and regulations, identify possible countermeasures, and propose an integrated strategy, including some more practicable approaches (e.g., education/training, product labeling, the use of proper personal protective equipment, occupational selection, and searchable product database) and novel medical treatments (e.g., immunotherapy) to help decreasing latex allergy prevalence.

Durable and Nontoxic Natural Rubber-Based Composites with Antibacterial Properties

Natural rubber latex (NRL) has prophylactic properties and is used to make pathogen-isolating products like condoms and surgical gloves. However, obtaining NRL and casting it into durable products are challenging. Consequently, progress in the research and development of medical NRL products has been slow. This study aims to strengthen NR and induce it with bactericidal properties. In this regard, we introduce inorganic whiskers into the NRL and synthesize whiskers/NR composites with strong mechanical and antibacterial properties. The method proposed herein is a template method, which can rapidly and efficiently reveal the antibacterial effect of the composite latex, providing convenience for research institutions and factories studying antibacterial latex. A complete system is established for studying the antibacterial medical NRL, and a precedent is set for the relevant products.

Secondary prevention of latex allergy

PURPOSE OF REVIEW

The present review addresses the secondary prevention in healthcare worker, healthcare setting, and in patients outside the healthcare setting.

RECENT FINDINGS

There is sufficient knowledge of the broad aetiology of latex allergy for secondary preventive programmes to be widely adopted. Currently, avoidance of latex-containing surgical products is mandatory in the care of sensitized patients. They should also have a list of occult sources of natural rubber latex exposure and cross-reacting fruits. During all health-care procedures latex allergic patients should be treated in a 'latex-free' environment. Specific sublingual immunotherapy has been suggested as a suitable therapeutic option. It can be offered, in addition to symptomatic treatment, to selected patients, when avoidance measures are not feasible or effective. The use of omalizumab could also be extended as an adjunct to latex immunotherapy.

SUMMARY

Despite of the progress made in the secondary prevention of latex allergy, the disease still continues to be a global health problem.

The benefits of latex-free gloves in the operating room environment

Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.

Natural rubber latex allergy: implications for the orthodontist

Natural rubber latex (NRL) allergy can have potentially serious consequences, and reports of orthodontic patients reacting to NRL have increased significantly over recent years. It is therefore important for the orthodontist to know how to manage patients with an NRL allergy and how to deal with possible reactions to NRL. Safe and effective practice depends on recognizing patients who are at risk of NRL allergy, and an awareness of materials and equipment that contain NRL and the availability of suitable NRL-free alternatives.

Latex allergy in women's health care

Latex allergy in midwifery and women's health care is not a new concept, with numerous case reports documenting adverse reactions in pregnant women to natural rubber latex in the birthing room. The practising midwife, nurse and sonographer need to be aware of the signs and symptoms of latex allergy and the implications of a severe reaction to latex not only to the woman but also the unborn child.

Dental local anaesthetics and latex: advice for the dental practitioner

Natural rubber latex (NRL) is present in many medical products, including disposable gloves, adhesive tape and bungs in medicine vials. People sensitized to NRL are at risk of developing allergic reactions, which can present with delayed symptoms such as a localized red itchy rash, or with immediate symptoms such as itching of the skin and eyes, sneezing, bronchospasm or anaphylactic shock. People sensitized to NRL should avoid contact with all products that contain it, either in the product itself, in the packaging or introduced during the manufacturing process or storage. This paper highlights the implications of latex allergy in patients for dental healthcare staff, and provides a list of local anaesthetic preparations used in dentistry in the UK which are latex free.

CLINICAL RELEVANCE

All dental staff need to be aware of latex allergy and know where to find information on latex content of dental local anaesthetics.

Latex allergy: Position Paper

Correct management of latex allergy is essential to ensure adequate care of patients who are allergic to latex, which is ubiquitous in the health care setting. In this Position Paper, the Latex Committee of the Spanish Society of Allergology and Clinical Immunology provides guidelines for the management of latex allergy.

[2009 Japanese Society of Latex Allergy guidelines for the safe management of latex allergy]

Latex allergy is an IgE-mediated reaction to natural latex antigen. Operating room equipment frequently includes medical devices, such as surgical gloves, intravenous lines, and urinary catheters, which are made from latex or contain latex. These products can trigger an allergic reaction that can result in anaphylactic shock. Removal of natural rubber and latex-containing products from the operating room and avoidance of external and internal exposure of patients to latex antigen will prevent such allergic reactions. Updated guidelines for the safe management of latex allergy were published in 2009 by the Japanese Society of Latex Allergy. The previous guidelines regarding this topic were published in 2006. The new guidelines consist of 11 chapters that deal with background, exposure to latex antigen and development of sensitization, high-risk groups, natural rubber products, allergic reactions triggered by natural rubber products, diagnosis, latex-fruit syndrome, countermeasures and treatments in emergencies, prevention and safe management in the hospital, countermeasures in daily life, and limits for application of the guidelines. We had a case that required management according to the 2009 guidelines. A 49-year-old male doctor with a history of allergy to latex gloves was scheduled for laparoscopic cholecystectomy under general and epidural anesthesia for recurrent, acute cholecystitis. The anesthesia and operation were performed uneventfully with latex-free medical devices and machines in a latex-safe environment in the operating room under the new guidelines. Safe anesthetic management under the 2009 guidelines should be available for all operations in Japan on patients with latex allergy.

Prevention of occupational dermatitis

Occupational dermatitis is among the most frequent occupational diseases. Dermal exposure risk affects many professional categories such as healthcare workers, hairdressers, bakers, cleaning and kitchen employees. The economical burden of occupational dermatitis (OD) is huge (greater than 5 billion Euro per year in Europe), comprising direct costs (treatment, compensation), as well as indirect costs due to sick leave and lack of productivity. A scientifically based preventive program consisting of skin protection during work, cleaning and skin care after work has generally been recommended to prevent occupational contact dermatitis. However the rate of reported occupational skin diseases seems unchanged in the recent years. In cases of impaired skin condition the secondary prevention (i.e. therapeutic treatment by dermatologists and health-educational intervention seminars) is fundamental. For cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed (tertiary individual prevention). In the past years, various pilot-concepts to improve occupational dermatitis prevention have been successfully put into practice focussing on interdisciplinary (dermatological and educational) skin protection training programmes for high-risk professions. Currently a multi-step intervention approach is implemented which is aiming at offering quick preventive help at all levels of severity of occupational contact dermatitis. Recent data reveals that there are reliable evidence-based options for multidisciplinary prevention and patient management of occupational dermatitis using a combined approach by a network of clinics, practices and statutory social insurance bodies. At this stage, it seemed reasonable to form a European joint initiative for skin prevention. Recently a European network of preventive dermatology (European Initiative for the Prevention of Occupational Skin Diseases-EPOS) has been organized based on the German experience in the specific field.

Effects of latex avoidance on latex sensitization, atopy and allergic diseases in patients with spina bifida

BACKGROUND

Ten years ago, avoidance measures such as the performance of latex-free operations were implemented in children with spina bifida. Since then, latex sensitization and latex allergy have decreased in this high-risk group.

OBJECTIVE

To study the effect of primary latex-free prophylaxis on the prevalence of allergic diseases and atopy as a marker for sensitization spreading in children with spina bifida.

METHODS

One hundred and twenty children with spina bifida born after the introduction of latex-free prophylaxis and operated on under latex-free conditions ('current group') were examined for latex sensitization, latex allergy, sensitization to aero- and food allergens and allergic diseases. Results were compared to a 'historic' (not latex-free operated) group of children with spina bifida and comparable age (n = 87) and to a recent sample of children from the general population (n = 12,403).

RESULTS

In comparison with the 'historic group', latex sensitization (55% vs 5%, P < 0.001) and latex allergy (37% vs 0.8%, P < 0.001) were significantly reduced in the 'current group'. Furthermore, a significant reduction could be demonstrated for sensitization to aeroallergens (41.4% vs 20.8%, P = 0.001) and for allergic diseases (35% vs 15%, P = 0.001). The prevalence for atopy, sensitization to aero-/foodallergens and for allergic diseases in children of the 'current group' was similar to those in children of the weighted population sample.

CONCLUSIONS

Latex avoidance in children with spina bifida prevents latex sensitization and latex allergy. Additionally, it also seems to prevent sensitization to other allergens and allergic diseases which might be explained by the prevention of sensitization spreading.

Latex allergy

The prevalence of latex allergy in the general population is low; however, the risk of developing latex allergy is higher in persons with increased latex exposure, such as health care workers or persons who work in the rubber industry. Children with spina bifida and others who undergo multiple surgeries or procedures, particularly within the first year of life, are also at greater risk of latex allergy. Reactions to latex allergy can range from type IV delayed hypersensitivity (e.g., contact dermatitis) to type I immediate hypersensitivity (e.g., urticaria, bronchospasm, anaphylaxis). Latex allergy can be diagnosed with clinical history, skin prick testing, latex-specific serum immunoglobulin E testing, and glove provocation testing. The main goals of latex allergy management are avoidance of exposure to latex allergens and appropriate treatment of allergic reactions. The use of nonlatex products from birth may prevent potentially serious allergic reactions. Widespread adoption of nonlatex or low-latex gloves has decreased the incidence of latex sensitization in health care workers.

Patients monosensitised to Hev b 8 (Hevea brasiliensis latex profilin) may safely undergo major surgery in a normal (non-latex safe) environment

BACKGROUND

Natural rubber latex allergy is a condition at high risk of anaphylaxis during surgery. However, latex contains several protein allergens and not all of them may show the same clinical relevance.

OBJECTIVE

To investigate the clinical relevance of Hey b 8, the natural rubber latex profilin.

METHODS

Seven patients without a clinical history of latex allergy but identified as being latex hypersensitive by positive SPT (3/7) and or positive latex-specific IgE during routine pre-surgery allergy investigations were studied. All patients were monosensitized to Hev b 8 (Hevea brasiliensis latex profilin) as shown by the detection of specific IgE to recombinant latex allergen components. Ten subjects with a history of latex allergy (urticaria, asthma, and/or rhinitis), sensitised to latex allergens other than profilin were enrolled as controls. Both patients and controls underwent a latex glove-wearing test; in case of a negative test, patients underwent surgery in a normal surgical setting.

RESULTS

All 7 patients scored negative on latex glove wearing test and underwent major surgery (orthopaedic, Caesarean section, pilonidal sinus, vascular, tonsillectomy, uterine revision, and uretral surgery) in a normal (non-latex safe) surgical setting without any consequence. In contrast, 9/10 (90%) controls showed a positive latex glove-wearing test (p < 0.01).

CONCLUSION

Latex profilin is either clinically irrelevant or is no longer present in latex products. This study highlights the importance of a component-resolved diagnosis of latex sensitisation as a tool to get a more precise assessment of the risk and to reduce the costs of healthcare.

Latex hypersensitivity: a closer look at considerations for dentistry

Over the past several decades, latex hypersensitivity has become an increasingly common phenomenon in the dental setting. Exposure to latex via direct skin contact or inhalation of airborne allergens from powdered gloves poses the risk of sensitizing both clinicians and their patients. Adverse reactions to latex range from mild irritant contact dermatitis to potentially life-threatening hypersensitivity. The prevalence of these reactions is higher among medical and dental practitioners, those with prior allergies, patients with a history of multiple surgeries and those with spina bifida. The risk of developing latex hypersensitivity increases with prolonged and repeated exposure. The incidence of latex allergy may be reduced through such simple measures as using latex alternatives and powder-free, low-protein gloves. For patients with confirmed latex allergy or those at risk of hypersensitivity, it is critical for dental personnel to be familiar with the range of possibilities for latex exposure and to employ appropriate preventive procedures.

Acquiring allergen information from condom manufacturers: a questionnaire survey

BACKGROUND

Allergic contact dermatitis from condoms is a problem that carries significant morbidity and that has been increasingly reported due to the use of condoms to prevent sexually transmitted diseases as well as for birth control.

OBJECTIVE

The purpose of the study is to evaluate the process by which condom manufacturing companies divulge product allergen information to health care professionals.

METHODS

An interviewer-administered telephone questionnaire eliciting the staff member's knowledge of condom allergens was utilized. Eligible respondents were condom manufacturers' service staff over 18 years of age.

RESULTS

Complete surveys were obtained regarding 36 (85.7%) of the 42 subtypes of condoms. Telephoning was the primary (75%) method of obtaining allergen information. The majority (63.9%) of the information was obtained within minutes to hours of the initial contact. Nearly two-thirds of the interviews evaluated the condom manufacturers' service staff as good and effective in their knowledge base and in providing product information.

CONCLUSION

The study determined that the extent of knowledge, helpfulness, and effectiveness of the customer service personnel in relaying product allergen information to clinicians were generally good. The study additionally generated a reference table outlining the common allergens in major manufactured condoms.

[Allergy to latex in surgical ward. Nurses' operational protocol]

The authors propose a nurses' operational protocol to follow when dealing with a patient who has an allergy to latex in a surgical Ward, amplifying this protocol to the entire patient care areas in a hospital to provide integral treatment for such allergy patients. In this first article, the authors analyze those products, instruments and material which may or may not, contain latex.

[Consensus Document. Update on latex exposure and use of gloves in Italian health care settings]

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.

The prevalence of latex allergy in sixth-year medical students: assessment of knowledge, risk, and attitudes about future specialty direction

BACKGROUND

In the prevention of latex allergy, knowledge levels and risk determination for latex allergy of medical students gain importance.

OBJECTIVES

To evaluate the latex allergy knowledge levels of sixth-year medical students and their latex allergy risk.

METHODS

Students completed a questionnaire that assessed basic knowledge of latex allergy and that evaluated latex-related symptoms and latex exposure. The specialty branch students were going to choose in the Medical Specialty Examination was also asked. Skin prick tests (SPTs) with latex and inhalant allergens and patch tests with latex-related products were then performed. Finally, students were asked again about any changes in branch selection after learning their individual risks.

RESULTS

Two hundred twenty sixth-year students were enrolled. Forty-four percent of the students gave the right answer for description of latex. Correct identification of at least 1 latex-related product used outside and inside hospitals was 55.5% and 95.5%, respectively. The prevalence of latex sensitization was 4.4% according to SPT results. The positivity of SPT to any inhalant allergen was 35% (n = 64). None of the students changed their mind about their specialty branch after learning their latex allergy risk.

CONCLUSIONS

Last-year medical students have a remarkably low latex allergy knowledge level, which imposes a serious professional risk. Training strategies based on the benefit to this risk group and reevaluation are strongly recommended before graduation from medical school.

[Italian and international guidelines on latex allergy: revision and comparison]

BACKGROUND

Latex allergy is an important medical issue, particularly for some occupationally exposed categories (healthcare personnel). The increase in the number of cases reported, occurred as a consequence of the diffusion of latex use, prompted several scientific and institutional organisms, both on a local and international level, to create guidelines for risk management in healthcare environment.

OBJECTIVES

To review and compare, more than ten years after the first official guidelines, the directives on latex allergy currently used in different countries and in the Italian regions.

METHODS

We used the references contained in the relevant literature and in the regulations concerning prevention of latex allergy.

RESULTS

Epidemiologic data, together with the recent decrease of the number of papers on latex allergy, suggest a relevant, but still unsatisfactory reduction of the problem.

CONCLUSIONS

In the light of a recent study performed by National Health Service (NHS) in UK, we point out the need for a critical evaluation of the real application of the existing guidelines, which are often formally present but left unattended in the daily hospital practice.

[Old and new types of sanitary gloves: what has improved?]

BACKGROUND

During the eighties a large increase in latex gloves production was observed because of the high demand of gloves in health care settings. In this period a low compliance to minimal quality standard was detected and the poor glove quality was associated with an increase of both irritant and allergic glove-related diseases. Since the second half of nineties health care workers and manufacturers paid more attention to these problems and a trend to a gradual, even if slow, quality improvement was observed. Most frequently powder-free gloves and synthetic gloves were offered on the market.

OBJECTIVES

The aim of this study was to highlight what has improved about materials and types of sanitary gloves during the last ten years.

METHODS

The information are based on a review of the scientific literature and practical experiences.

RESULTS AND CONCLUSIONS

Today a large selection of gloves made of different materials are available and they should be addressed to specific tasks. The review of the scientific literature and the analysis of many technical sheets provided by the manufacturers pointed out a trend to a better latex gloves quality (less chemical additives and generally a lower total protein content); sometimes data about a lower extractable latex allergens content are also available. Unfortunately detailed information on glove composition are not usually provided by the manufacturers; purchasers should require the manufacturing company to give comprehensive information and verify their reliability. Moreover the regulation in force should be adapted to higher quality standards. Powder-free and synthetic gloves consumption has improved but the use of synthetic rubber gloves should be further enhanced since some materials (e.g. neoprene and nitrile rubber) have a good biocompatibility and seem to have physical properties and protective efficacy similar to latex. Moreover allergic reactions to synthetic gloves (some chemical additives) are only occasional.

[Natural latex allergy. Patient management: from clinic to prevention. A review]

The widespread use of latex devices has been followed, in the last 25 years, by an increase in IgE mediated sensitization. The clinical manifestations of latex allergy affect the skin (urticaria and angioneurotic oedema), the lower and the upper respiratory tracts (rhinoconjunctivitis, asthma and glottis oedema), and the cardiovascular system (anaphylaxis). There is also an anaphylactic risk during surgery and invasive diagnostic procedures. Vegetable food cross-reacts with latex so that more than half of the patients show specific IgE against some food. Further than traditional groups at risk, as health care workers, other work categories have to be protected, because of the inappropriate use of latex gloves (food or drug industry workers, mechanics, panel beaters and so on). Recently the latex most important allergenic fractions have been characterized and recombinant allergens are now available. The recombinant allergens allow a better standardization of the extracts for diagnostic use, the production of safer extracts for immunotherapy as well as a more accurate evaluation of food cross-reactions. The recombinant allergens will allow a more accurate dosage of latex concentrations in air and in objects and, in future, to establish threshold limit values. The main aims of prevention are the replacement of latex with alternative elastomers, the reduction of work and extra work exposure and an efficient health survey in working environment. The use of latex gloves and devices among general population has to be discouraged. Specific immunotherapy has to be considered a second choice and restricted to highly qualified workers in order to realize a rehabilitation to their previous jobs. The actually obtained protection must be verified.

[Latex allergy. Preventive measures in health care workers: a comparison of Italian experiences]

BACKGROUND

We have performed a transversal study in different Italian Regions to underline the problem related to natural latex allergy.

OBJECTIVES

The aim of the study was to determine the glove use on the basis of the materials gloves were made of, to identify the departments and the qualifications mainly interested in the latex allergy problem, to check the required features for gloves and other rubber devices at the moment of the purchase, as well as the presence of guidelines, of training and information activities for health care workers and procedures for sensitized patients.

METHODS

We sent a questionnaire to the local public Health Authorities (HA) in different Italian Regions.

RESULTS

Number and regional distribution of the answers received back did not have statistical significance. Anyway, from the elaboration of the data it has been possible to obtain some interesting observations on both a theoretical and an operational level. The results showed: a) the level of interest and attention to the latex allergy problem has increased a lot recently; b) there is a high use of latex gloves (>50% of HA), in particular in surgical and intensive care departments; c) there are differences on an operational level between HA, also between HA that are in the same Italian Region. It resulted a widespread delay in the replacement of latex devices (e.g. urinary and intravenous catheters) with devices made of alternative materials. However, we found a growing attention towards the procedures related to the purchase of gloves, towards the adoption of guidelines about the use of gloves and towards the training and the information of health care workers.

CONCLUSIONS

From this study it has emerged clear the need of Italian HA to focus on the prevention of latex allergy, goal already obtained in a few, almost isolated, realities.

Natural rubber latex allergy and dental practice

Natural rubber latex (NRL) allergy is a significant clinical problem with potentially life-threatening complications. Oral health care professionals must be able to screen for NRL allergy and refer patients or staff to a specialist for definitive diagnosis. Protocol for its management must be developed and incorporated into daily practice. Practitioners must be able to recognize and treat NRL exposure emergencies. Knowledge of the availability of substitute products and an adequate fresh stock of such products in dental practice can minimise the risk of adverse NRL sensitivity.

[Collateral effects of a project of latex rubber removal in a hospital institution]

Within a stepwise approach to remove natural rubber latex products from the hospital of Cuneo, latex gloves for examination were completely replaced by nitrile powder free gloves. About a month after their introduction in the whole facility, 31 health care workers (HCW) presented with symptoms of dermatitis characterized by erythema, itching, dryness and chapping on the dorsum of the hands. The symptoms typically appeared 1-3 days after the first nitrile gloves employment, 1-3 hours after they were put on. On the basis of both a detailed clinical examination and specific laboratory tests a diagnosis of irritant contact dermatitis was confirmed in all symptomatic HCW. Samples of nitrile gloves were submitted for analysis by a university toxicological laboratory. Evident traces of a powder containing calcium carbonate were found inside of the gloves. Therefore the declaration of the firm that the product was absolutely powder free must be considered wrong. We suppose that frequent and prolonged contacts between the alcaline pH of the powder found in the gloves and the acid pH of the skin of the hands - together with other individual and environmental factors - could have determined the onset of the symptoms in the HCW. In spite of this adverse reaction, a significant reduction (-68%) of the incidence of latex sensitization and latex-related symptoms was observed in 2006 compared to 2005. We conclude that the complete removal of latex gloves from the workplace is a favourable preventive measure and that switching to nitrile powder free devices is a safe and cost-effective alternative to the latex gloves. However, it is always advisable to demand to the producer a formal declaration of compliance to the security standards of the medical devices.

[Latex risk prevention in San Paolo Hospital in Milan]

Several epidemiologic studies have highlighted that latex sensitization prevalence rate has increased over twenty years both in the general and working population, mainly among health care workers. Such subjects can develop immediate local or systemic hypersensitivity reactions up to anaphylactic shock. First, at San Paolo Hospital in Milan, it has been determined latex sensitization and allergy prevalence rates in health care workers involved in health surveillance. Subsequently an interdisciplinary task group has been constituted in order to plan latex pathology preventive actions in health workers and to identify the preventive measures that must be applied in allergic patients. These facets are tightly one another linked. Since latex allergy primary prevention is the most effective, but difficult to put into effect. Operational protocols, by which recognize latex allergy risk factors and reduce exposure to this substance, have developed for both workers and users. Latex allergy and sensitization occurrence will not probably be erased by these procedures application, but they will be reduced within the limits as low as possible.

[Management of latex allergy in the Pisa University Hospital: analysis of data deriving from the Registry filing both allergic patients and employees]

Recently, Tuscany regional government has promulgated (Regional law n. 464/07) guidelines for setting up suitable sanitary rooms for patients allergic to latex. These guidelines enforced the managers of the Tuscany Local Health Units to promote educational activities and a correct methodology for the safe management of both health workers and patients who need latex-free diagnostical and/or therapeutical procedures. An other Regional law (n.345/05) had previously enforced all the Tuscany Local Health Units managers to implement and update a Registry of every latex-allergic patients ever hospitalized in their own local facilities. Since 2002 a multi-disciplinary task force of health operators, lead by the Preventive Medicine Section, has been elaborating and implementing a plan for the safety of latex-allergic patients of the Pisa University Hospital, along with a Registry where each of these patients were recorded. Moreover, since 2005 under the responsabilities of the staff of the Preventive Medicine Section, another Registry has been implemented and updated. In this Registry all the Hospital employees who have been diagnosed a latex allergy, through the medical exams performed within the occupational medical surveillance activity, have been filed. In this study we report the results of this preventive activity both aimed at patients and heatlh operators safety.

[Latex allergy in hospital workers--follow-up of symptomatic subjects]

Latex allergy may be manifested in a variety of clinical disturbances such as contact urticaria, angioedema, rhinoconjunctivitis, asthma, and anaphylactic reactions. The aim of this follow-up study was to determine whether a change in glove use from powdered to powder-free latex gloves at previously surveyed hospital workers reduced the work-related symptoms. 53 hospital workers with work-related symptoms where followed up 4,6 years after first investigation. On re-examination, 54.7% use both powdered and powder-free gloves, 37.7% used only latex free gloves and 7.6% stopped the glove use. At follow-up, in 68% of subjects there was the remission or the improvement of work-related symptoms. The improvement of symptoms was greater in workers using powder-free gloves than in others (p < 0.005). In conclusion our study shows that preventive measures, such as the use a powder-free latex gloves, are sufficient to induce a reduction of work-related symptoms.

Specific immunotherapy is effective in the prevention of new sensitivities

BACKGROUND

Allergen specific immunotherapy is the only specific and curative approach in the treatment of IgE-mediated allergic diseases such as bronchial asthma and allergic rhinitis. The safety and clinical efficacy of this treatment are well documented but data on the prevention of new sensitizations remain scarce.

OBJECTIVE

To demonstrate the efficacy of specific immunotherapy in allergic respiratory diseases in childhood and to determine whether this treatment prevents the development of new sensitizations in children sensitized to house dust mite or pollen species.

METHODS

Fifty-six patients received specific immunotherapy (43 sensitive to house dust mite and 13 sensitive to pollen). Fifty-one patients not receiving immunotherapy but treated with pharmacotherapy were enrolled in the control group. The patients were followed-up for at least 4 years and treatment efficacy and the development of new sensitizations were compared between the two groups.

RESULTS

The number of patients with symptoms was significantly decreased in both groups at the end of the treatment period. No new sensitizations were found in 35 of the 43 (81.39 %) patients in the house dust mite immunotherapy group and in 10 of 13 (76.92 %) patients in the pollen immunotherapy group. In contrast, 20 of 51 (39.21 %) patients in the control group showed new sensitizations. The difference between the house dust mite and pollen immunotherapy groups and the control group in this parameter was statistically significant (p = 0.033).

CONCLUSION

Our data demonstrate that administration of specific immunotherapy in allergic patients significantly reduced symptoms and the development of new sensitivities.