By Jennifer Turney MSN, RN, CNS, CPN
For healthcare workers, the average work day is spent alternating between washing their hands and putting on gloves. It is not uncommon for clinicians to have red, itchy, cracking and scaling hands. At the end of the day, when you look at your hands, ask yourself, should I be worried, could this be a bigger problem?
Approximately 8% to 17% of health care workers have some form of allergy to latex (American Latex Allergy Association [ALAA], 2018a).
Latex allergy is an allergic reaction to substances in natural rubber latex (NRL) (Asthma and Allergy Foundation of America [AFAA], 2015 & American College of Allergy, Asthma & Immunology [ACAAI], 2014). The exact cause of latex allergies is unknown, but it is the thought that repeated exposure to latex and rubber products may induce latex sensitivity (ALAA, 2018b).
There are 3 types of reactions that can occur from latex:
• Irritant contact dermatitis (ICD):ICD is not a true allergic response. It is a result of direct injury to the skin from overaggressive scrubbing, inadequate drying of hands, especially before putting gloves on, use of abrasive or irritating hand soaps and prolonged use of gloves causing hands to sweat and maceration to occur (AFAA, 2015). ICD is most commonly seen on the hands. Its onset is usually gradual (ALAA, 2018b). Although, ICD is not an allergic response the injury to the skin barrier allows latex particles to enter the body, increasing the exposure to latex allergens (AAFA, 2015). ICD is the most common precursor to the development of latex sensitivity and latex allergy (AAFA, 2015). Preventing ICD is one of the most important steps that non-allergic healthcare professionals can take to minimize their risk of developing latex sensitivity (AAFA, 2015).
• Cell Mediated Contact Dermatitis (Type IV)/ Allergic Contact Dermatitis (ACD):The most common allergic reaction to latex which produces skin lesions or a crusty thickened appearance of the skin (ALAA, 2018b). The reaction usually appears 48 to 96 hours after the time of contact, so latex sensitized individuals may not always associate it with latex gloves (ALAA, 2018b). The reaction is limited to the area where the skin came into contact with the latex (ALAA, 2018b). Symptoms usually resolve spontaneously. Four out of 5 people who develop an IgE-mediated sensitivity (Type 1) will have allergic contact dermatitis first (AFAA, 2015).
• Immunoglobin E (IgE)-mediated sensitivity (Type I):In this response, the immune system makes IgE antibodies upon exposure to the latex proteins (AFAA, 2015). Reactions can occur within minutes after exposure to latex (ACAAI, 2014). Individuals develop respiratory symptoms such as rhinitis or bronchial asthma, or eye symptoms such as conjunctivitis and urticaria (hives) (ACAAI, 2014). Type I immediate hypersensitivity is the least common and most life-threatening allergic response. (AFAA, 2015 & ACAAI, 2014).
Latex gloves are the main source of allergic reactions in healthcare workers, although latex is also used in other products such as medical devices, including catheters, syringes, and stethoscopes (ALAA, 2018c). There are many everyday products that also contain latex, such as erasers, balloons, condoms and rubber bands (ALAA, 2018c). It is important to be aware of all objects containing latex because once sensitivity is developed; it can become more severe with continued exposure (ALAA, 2018c).
The Occupational Safety and Health Administration (OSHA) (2008) recommend that all healthcare workers reduce the risk of developing latex allergies by "reducing unnecessary exposure to NRL products.” In the 1980’s and 1990’s there was an increase in cases, however with hospitals implementing use of latex-free gloves, latex -free environments and protocols to address patients and employees with latex allergies the incidence has decreased (AAFA, 2015).
Healthcare workers wash their hands, and don and doff gloves several times a day. Practicing recommended hand hygiene, in addition to using the various medical devices that contain latex, places healthcare workers at risk of developing a latex allergy. There are ways to protect yourself. To learn more about Latex Allergies, take the RN.com course: An Overview of Latex Allergies for the CNA.
American College of Allergy, Asthma & Immunology [ACAAI] (2014). Latex allergy: overview. Retrieved from: https://acaai.org/allergies/types/skin-allergies/latex-allergy
American Latex Allergy Association [ALAA] (2018a). About latex allergy: statistics. Retrieved from: http://latexallergyresources.org/statistics
American Latex Allergy Association [ALAA] (2018b). Definitions. Retrieved from: http://latexallergyresources.org/definition#
American Latex Allergy Association [ALAA] (2018c). Common latex products. Retrieved from: http://latexallergyresources.org/common-latex-products
Asthma and Allergy Foundation of America [AAFA] (2015). Latex allergy. Retrieved from: http://www.aafa.org/page/latex-allergy.aspx
Occupational Safety and Health Administration [OSHA] (2008) Safety and health information bulletin 01-28-2008: potential for sensitization and possible allergic reaction to natural rubber latex gloves and other natural rubber products. Retrieved from: https://www.osha.gov/dts/shib/shib012808.pdf
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