Rubber banned? The case against latex
the case against latex
executive summary 3
the latex irony 4
the human cost 7
prevention and cure 12
further information 14
This TUC report spells out the terrible irony of latex - a substance designed to protect which has led hundreds of thousands into a state of anxiety, illness and in some cases even worse. The cheaper latex gloves, used in the health service, are the main culprit.
Exposure to latex leads to various allergic conditions, including dermatitis and asthma. In severe cases it can lead to anaphylactic shock which can be fatal. Groups at risk of developing the allergy include health care workers (especially nurses and theatre workers), cleaners, police staff, food workers and hairdressers, and once allergic, any latex product can cause a reaction, such as gloves, balloons and condoms.
The TUC estimates that there are at least 100,000 NHS staff with latex allergies (including 25,000 with asthma), and between 500,000 and 3 million people in the population at large. In Germany, a third of all occupational asthma sufferers developed their asthma as a result of contact with latex.
This report proposes:
- a Europe-wide ban on those gloves that cause latex allergies;
- a legally enforceable Code of Practice on preventing asthma at work;
- including latex as one of the main asthmagens targeted by the Health and Safety Executive;
- that NHS Trusts (including ambulance Trusts) should make alternative products available to deal with people allergic to latex, as some have already; and
- compensation for people whose latex allergy could cause an anaphylactic shock.
In the 1980s and 1990s, nurses and other workers likely to be exposed to bloodborne diseases like hepatitis were increasingly urged to wear latex gloves to prevent infection. Latex gloves are good at preventing infection, flexible so that delicate work can be done with them on, and cheap.
But the cheaper gloves have very often proved, ironically, to have caused more illness than they were designed to prevent. Often coated in a fine powder which carries latex proteins and other substances into the air where it can be breathed in, or containing high levels of latex protein, the gloves have caused hundreds of thousands of people to develop an allergy to latex which can range from being irritating to being life threatening [2] .
The main effects of latex allergy are dermatitis and other skin conditions, asthma, and anaphylaxis, where the body goes into shock.
dermatitis
Dermatitis and other allergic skin conditions are usually caused by direct physical contact with latex. The commonest symptoms are itching, a rash, soreness and broken skin, and whilst unsightly and very uncomfortable, the condition is rarely serious although it often means that the sufferer has to change their job.
asthma
Asthma is a condition of the lungs which leads to wheezing, tightness of the chest, coughing and so on. It can, in extreme cases, even be fatal, and it often leads to restrictions on the way people lead their lives, although it is perfectly possible to live a healthy and active life with asthma. Sufferers often have to change their jobs to escape from the substances that caused their asthma in the first place (the only known cause of asthma is workplace exposure to substances known as asthmagens) or may trigger attacks, and research shows they usually have to take worse paying jobs.
anaphylaxis
Some people who are allergic to latex (eg those with 'type 1 latex allergy') are subject to anaphylactic shocks - a similar process to what happens with nut allergy. Months or even years of asymptomatic sensitisation may precede onset of symptoms, but in many cases the symptoms become progressively more severe on repeated exposure to latex allergens. For further information, contact the Latex Allergy Support Group (see further information below).
There is no way to predict how severe a reaction will be when a latex allergy sufferer comes into contact with the rubber, but the effects can be severe (as the case studies in the next section demonstrate) and even fatal.
who is at risk?
The main group of workers at risk are hospital nurses because they are working in an environment where exposures are highest (some measurements taken in hospitals suggest that the only reason patients have not been sensitised is because they tend to be in the hospital only for short periods - nurses are there day in, day out). And theatre staff (including doctors) are at the highest risk, often because of inadequate ventilation.
Other groups of workers using latex gloves are also at risk, including other health care workers (dentists and dental nurses, podiatrists, radiographers and so on), cleaners, police staff (such as scene-of-the-crime officers), food workers and hairdressers. Their chances of developing the allergy depend on the type of gloves used and the frequency with which they use them, which is why nurses develop the condition more often than other groups.
Once allergic, however, the sources of latex which can trigger attacks can be varied, including medical equipment and rubber gloves, but also balloons, condoms, squash balls and so on.
The TUC estimates that there are at least 100,000 workers in the NHS who are allergic to latex, including those with asthma, dermatitis and anaphylaxis. But the number could be twice as high - figures are not collected in Britain, and most of the research into prevalence among health workers has been done abroad.
According to the Survey of Work-related Occupational Respiratory Disease (SWORD), asthma due to latex is the fastest growing category of occupational asthma in Britain. The number of cases reaching the occupational lung and chest physicians involved in this scheme is still relatively small, but it is clear that the numbers are growing and that latex is now one of the main causes of industrial asthma - it is listed in the top eight substances which the Health and Safety Executive will concentrate its anti-asthma strategy on.
Studies in Germany, the Netherlands and elsewhere suggest that between one in eight and one in six workers in the health care sector are allergic to latex (remember that being allergic does not necessarily mean that people develop any further symptoms, but they are at risk). In Britain, where more than a million people work in the NHS, that means that at least 100,000 health care workers will be allergic to latex, and probably many more. Of course, people with the most extreme reactions are likely to have to leave their jobs, but the vast majority of latex allergy sufferers may not even be aware of their condition. About 25,000 health care workers have symptoms of occupational asthma (not all caused by latex), and in Germany, one on three cases of occupational asthma over all industries are caused by latex.
The studies cited above suggest that in the general population, anywhere between half a million and three million people in Britain (between one in a hundred and one in seventeen) are allergic to latex.
more statistics?
Behind these numbers, however, are the stories of those who have developed allergies, and who are now at risk of far worse.
Jacqueline Kershaw, a practice nurse from Halifax, has been working in the NHS for over 20 years.
'A colleague and I both noticed that our hands were covered in an itchy red rash. We couldn’t work out what was causing it. Then one evening, when I was in surgery, I put on a pair of gloves. A rash developed on my hands and spread up my arms almost straightaway. Then my neck started swelling up. Luckily for me the GP was in the room next door and I rushed in to him. He gave me medication on the spot.'
Jacqueline was diagnosed with type 1 latex allergy. 'Even leaning over a box of latex gloves gives me rashes on my face and neck. And because latex is in so many products, it affects my everyday life.'
When Janet was diagnosed with latex allergy it was to mark the beginning of the end of her career as a radiographer.
'I’d been complaining for 10 years about the effects of latex gloves on my hands, and was fobbed off by my supervisor who just told me I had ‘funny skin’.'
After reading an article in a professional journal, bells rang and Janet went to Occupational Health. 'I described the problems caused by latex gloves and, once, by blowing up balloons. I was immediately referred to an Asthma Specialist for skin testing'.
Janet was referred to a consultant: 'I was told I had a potentially fatal allergy to latex. Since then I have had to carry adrenaline, antihistamines, an inhaler and a mobile phone wherever I go.'
Janet rang her union (the Society of Radiographers) and was taken off work whilst the department was made safe. She says: 'Despite their efforts, I got back and found latex gloves in the room as well as a latex-equipped resuscitation trolley.'
The Society of Radiographers took Janet’s case to court and she was offered a settlement out of court last year. 'This was not for loss of earnings but for pain and suffering. Latex allergy is frightening, expensive, and a nuisance. But it is also avoidable - latex free gloves don’t cost much more than latex gloves, but people’s lives are constantly put at risk, all because of a bit of penny-pinching.'
Judith Barnes worked as a State Registered Chiropodist In Lancashire.
'I developed type 1 latex allergy through wearing powdered latex gloves at work in the NHS. Despite switching to wearing vinyl gloves everyone else continued to use latex gloves, which led to more allergic reactions. I was forced to take ill-health retirement - even though I was only 34.'
Judith decided to sue her employer and after a long battle, lasting over three years she finally won.
Her Health Trust admitted liability for causing latex allergy and made the medical environment safer.
Judith feels that her life now is totally changed. She cannot go swimming or to the gym anymore. Visits to shops have to be short and certain shops avoided altogether. She has learned to be vigilant at all times. 'This is not hypochondria' Judith says: 'I know how ill you can feel with latex allergy, and no matter what any doctor says, it is potentially life-threatening'.
Judith adds: 'On a hospital visit to a dermatologist who was using powdered latex gloves, I ended up in casualty surrounded by doctors, given oxygen, steroids and antihistamines. I have also had problems at the dentist and had to have a minor operation cancelled due to the risk of allergy in theatre.'
'All this is due to ignorance, but I and many others are left with a life long allergy which money alone cannot compensate.'
Fiona McKie-Bell worked at Newcastle’s Royal Victoria Infirmary where she wore latex gloves. She started to experience anaphylactic reactions to latex which included swelling up of the face, lips and airways whilst working and was eventually forced into medical retirement at the age of 25.
However the pain and suffering did not stop for Fiona after retiring.
Fiona was due to have a wisdom tooth removed under local anaesthetic at a large teaching hospital. Although the dentist knew she was allergic to natural rubber latex (NRL), a syringe with an NRL bung was inadvertently used, and Fiona suffered an anaphylactic reaction. She spent the next few days in the intensive treatment unit, where she had several more anaphylactic reactions. Since then she has been hospitalised 50 times in only eight months. She uses nebulised adrenaline to help her breathing and is virtually housebound.
Clare (not her real name) was working as a dentist in Yorkshire and had worn latex gloves seven hours daily since 1985. Low protein gloves were available but expensive at the time. Clare had problems with her hands for some years, but then started to get other symptoms.
'I started to get conjunctivitis and rhinitis. While investigations for possible latex allergy were being carried out, I also started to get asthma. I changed from low protein powder free latex gloves (which by then were becoming available at an economic price) to latex free, and my condition improved'.
However after about eight months, Clare’s wheezing started again, even though none of her colleagues were using latex gloves. Clare ended up using antihistamines every day and finally got to the stage where acute asthma attacks were happening within minutes of entering her workplace.
'I took a month off work to allow the condition to settle and then returned to work for one day a week, using antihistamines and steroid inhalers. But even staying in the room for an hour made the wheezing started again and my face swell up.'
A chest physician confirmed latex induced asthma and doubted whether it would be possible for the dentist to continue work, even for one day per week. 'It took two and a half years to get an NHS pension settled', says Clare, who is now working in administrative roles mainly from home. 'Although dentists are aware of latex allergy, they have no occupational health support. As (mainly) self employed, they are under pressure to continue working.'
Like other case studies featured in the report, Clare’s latex allergy pervaded her personal life: 'One of the most distressing things was being unable to spend much time with my mother who was terminally ill in hospital, because of airborne latex.'
'I cannot even go to parties anymore. I was recently invited to a formal dinner where my husband was to presented with an award. My face started to swell up and I couldn’t breath - just because the room had been decorated with a couple of hundred balloons.'
Prevention is better than cure, but there are already so many people sensitised to latex that prevention is no longer enough.
The TUC wants to see:
- a Europe-wide ban on the sale and use of those powdered latex gloves and high protein gloves most likely to cause allergies to latex;
- a legally enforceable Approved Code of Practice on preventing asthma, to focus employers’ attention on the need to eliminate (or at the very least control) exposure to substances like latex; and
- a strategy to focus attention on the top eight causes of occupational asthma, including latex, as proposed by the Health and Safety Commission.
what can health care providers do?
For those who are already sensitive to latex, we are calling on NHS Trusts, including Ambulance Trusts, to reduce their dependence on latex products, and to make available alternative products which do not involve latex. We recognise that going completely latex free may be difficult, although we think that it should be a long-term objective. We certainly believe that health care staff need to be made much more aware of the dangers of latex, partly so that they can help protect themselves and colleagues from sensitisation, but also so that they can avoid causing problems for those who are already allergic.
A Latex Allergy Support Group survey in 2000 found that nineteen out of twenty-four ambulance trusts surveyed did not have latex-free emergency equipment on their ambulances, although eleven provided latex-free gloves. The LASG cites the Royal Berkshire, South Yorkshire and Two Shires ambulance trusts as having the best policies on the issue, and the TUC believes that if the right steps can be taken as these examples suggest, then they must be taken.
compensation
Finally, although compensation is a poor solution to the problem, it can be a vital element in ensuring that people whose health suffers or whose life is in any way restricted are able to manage their allergy. Unions will continue to seek compensation from employers through the courts where we have to. People with asthma or dermatitis arising from latex are already entitled to benefits under the Benefits Agency’s Industrial Injuries Scheme, but the TUC wants to see that extended to people with anaphylaxis, and we would like to see a Preventive Supplement built into the scheme to assist people to leave jobs which are exposing them to latex.
The TUC has published a number of reports on asthma and on latex, and unions often produce their own guides. The main TUC reports are:
Asthma at work: causes, effects and what to do about them by Rory O’Neill, TUC/Sheffield Occupational Health Project, 1995 - £6
The gloves are off: latex and asthma by Julia Gallagher, TUC, 1997 - £5
Out of breath and out of work: managing asthma and Managing asthma at work, TUC/National Asthma Campaign (paper and report for a joint conference), 1998 - free with a large SAE.
The Health and Safety Executive produces guides to asthma and dermatitis at work and enforces the law on health and safety in the NHS and many other parts of the economy (local authorities enforce the law in much of the service sector). Their website is at www.hse.gov.uk and they have an information line at 0541 545500.
The National Asthma Campaign, Providence House, Providence Place, London N1 0NT provides lots of useful information and support for people with asthma. They run a helpline (0845 7010203) and local groups. Tel: 020 7226 2260, fax: 020 7704 0740, web: www.asthma.org.uk
The Skin Care Campaign brings together several charities dealing with skin diseases like dermatitis, eczema and so on. Contact them through their website at www.skincarecampaign.org which lists all the member organisations, or contact the National Eczema Society at Hill House, Highgate Hill, London, N19 5NA, tel: 020 7281 3553 Fax: 020 7281 6395.
The Latex Allergy Support Group is the main sufferers organisation providing help and advice, and campaigning, on latex allergies. They have worked with the TUC on developing this report, and we are very grateful to them and their members who provide the case studies above. They offer a help line from 7pm to 10pm at 07071 225838, and their website is at www.lasg.co.uk
contact: Owen Tudor on 020 7467 1325 or otudor@tuc.org.uk
Trades Union Congress
Congress House
Great Russell Street
London WC1B 3LS
Tel: 020 7636 4030
Fax: 020 7636 0632
Web: www.tuc.org.uk
[1] This report refers to natural rubber latex, not synthetic products. There is evidence to suggest that it is the modern manufacturing process which has led to the wider availability of cheap latex products which is to blame for the increase in allergic reactions, rather than the make-up of the latex itself.
[2] Some people may have a natural allergy to latex, and often people exposed to large quantities in other ways (eg young children requiring regular operations, such as those with spina bifida) develop an allergy as well. This report deals with preventing occupational exposures, but anyone with a latex allergy will benefit from the measures designed to prevent anaphylactic shocks.
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