Section one : a background note
Aleks Kinay (Latex Allergy Support Group) and Lesley Fudge (National Association of Theatre Nurses)
Latex allergy is an allergic reaction to Natural Rubber Latex (NRL) proteins from the Havea Brasilensis tree. These can, in sensitised people, cause reactions similar to those associated with nut allergy. Symptoms include dermatitis, asthma, hay-fever type symptoms and potentially life-threatening anaphylaxis in some individuals. There are two types of allergic reaction to latex - Type I (to latex proteins) and Type IV (to chemicals used in manufacturing). Type I can be life-threatening because of the risk of anaphylactic shock. Type IV allergy causes a contact allergic dermatitis, which is limited to the skin.
The main cause of latex allergies at work are latex gloves used in healthcare and other occupations to protect users from infections such as hepatitis and HIV. Cornstarch powder in gloves poses an additional hazard, as it binds to latex proteins and acts as a vehicle to make the proteins airborne, which allows the proteins to be inhaled. Exposure therefore results from direct skin contact with these gloves and via the respiratory route (in the case of powdered latex gloves), through inhalation of latex aeroallergen. Gloves with higher protein contents generally contain more latex allergens and are therefore more sensitising.
Occupational groups most commonly exposed to latex through the use of latex gloves include nurses, doctors, dentists, and professions allied to medicine, paramedics and other emergency services, laboratory workers, veterinary staff, hairdressers, cleaning and catering staff and workers involved in food preparation or food manufacturing.
Latex is also a risk for latex-sensitive individuals outside their workplace and as patients. In healthcare and emergency services, latex is present in many medical devices, and is particularly hazardous to sensitised individuals during invasive procedures such as surgery. In the home and in public places it is present in many objects including flooring, mattresses, soft furnishings, balloons, clothing and household gloves.
Asthma caused by occupational exposure to latex is the fastest-growing cause of work-related asthma in Britain. Up to 3.6 million people in Britain may be already sensitised to latex (including 17% of all nurses). Latex allergy costs the NHS alone millions of pounds in sick pay, lost staff, compensation payments and additional recruitment costs.
Latex allergy can be prevented. Alternatives do exist in the form of latex-free medical equipment and products In addition, since latex provides a good barrier against infection from blood-borne pathogens for non-sensitised individuals, the choice of low-protein and powder-free latex gloves, where the latex kind are selected for tasks with the risk of cross-infection from blood-borne pathogens, can help to reduce the risk of allergic reaction and sensitisation in at risk, non-sensitised workers.
Employers can develop policies and protocols to help address the problem at source. Appropriate standards can be developed and applied to glove manufacture and supplies. NHS Purchasing and Supply Agency, the NHS’ major supplier, has removed powdered and high-protein NRL gloves, known to cause latex allergy, from their catalogue. However these gloves are still available from other sources and are widely used in General Practice, dentistry and in non-healthcare work setting where safer alternatives exist.
Education and awareness-raising programmes can help to ensure that employers and employees know what they have to do to prevent workplace latex allergy and safely manage sensitised individuals when they present as patients. There are examples of best practice in providing education and advice, but much more remains to be done both inside and outside the healthcare sector.