Avoidance of powdered latex gloves reduces both clinical symptoms and latex-specific IgE levels.
A clinical and serological follow-up study of health care workers allergic to natural rubber latex who had followed a latex avoidance programme
Article first published online: 2 AUG 2004
Volume 59, Issue 9, pages 1013–1014, September 2004
How to Cite
Hemery, M. L., Dhivert-Donnadieu, H., Verdier, R., Dujols, P., Godard, P. and Demoly, P. (2004), A clinical and serological follow-up study of health care workers allergic to natural rubber latex who had followed a latex avoidance programme. Allergy, 59: 1013–1014. doi: 10.1111/j.1398-9995.2004.00484.x
- Issue published online: 2 AUG 2004
- Article first published online: 2 AUG 2004
- Accepted for publication 3 December 2003
- avoidance programme;
- health care worker;
- latex-specific immunoglobulin E;
- occupational latex allergy
The appropriate treatment for allergy remains the total eviction of the allergen, whatever it may be. In the case of latex allergens in hospitals, total avoidance of such a component seems to be utopia. However, the avoidance of inhaled allergens by the exclusion of powdered latex gloves is a validated alternative (1–3).
This study involved 33 health care workers allergic to latex who were followed up at the allergy unit of the University Hospital of Montpellier during a median of 21 months (10–30) (25–75 percentiles). The diagnosis of latex allergy was set on the basis of a suggestive clinical history together with a positive skin prick test with the nonammoniated standardized extract from Stallergènes (Saint Denis, France). Seventeen of the health care workers were nurses (51.5%), five auxiliaries (15.1%), three housekeepers (9%), two physicians (6%), two laboratory workers (6%), two operating room nurses (6%), one physiotherapist (3%) and a stretcher-bearer (3%). The median age was 30 years (25–40) and the median time delay from latex allergy diagnosis to entry to the study was 0 months (0–54). The clinical manifestations of allergy in the workplace were urticaria (66.7%), rhinitis (54.5%), asthma (36.4%), conjunctivitis (21%) and angioedema (18%). Twenty-one subjects were polysensitized, only three were monosensitized to latex. Only three of 33 had bronchial obstruction (i.e. FEV1 <80% of the predictive value). Latex-specific IgE levels were elevated in 32 of 33 subjects, with a median value of 4.1 kU/l (2.1–10.1; K82, Pharmacia Diagnostics, St-Quentin-en-Yvelinie, France). All subjects underwent a questionnaire regarding their allergic symptoms, skin prick tests to the common aeroallergens of the Montpellier area, fresh and standardized extracts (Stallergènes) of the most common cross-reacting fruits. The follow-up consisted of a consultation at 3, 6 and 12 months and then every 6 months thereafter. It was based on a clinical and latex-specific IgE evaluation.
On the professional side, 11 subjects changed their workplace. Complete avoidance of powdered latex gloves was effective in all of the units where the subjects were working and the allergic health care workers received latex-free gloves for their own job. The complete biological follow-up was possible for 24 of 33 subjects followed up during a median of 21 months (13–28). It showed a dramatic decrease of latex-specific IgE throughout the period. This evolution was statistically significant (P < 0.001) with a median value at entry of 5.6 kU/l (2.5–12.0), 2.7 kU/l (0.8–5.6) after 9 months and 2.1 kU/l (0.4–4.0) after 19 months (Fig. 1). The nine subjects for whom we did not have at least three latex-specific IgE measurements over the follow-up period did not differ significantly from the 24 others, in terms of clinical symptoms, spirometry values and first specific IgE measurement.
In this survey we demonstrated that simple latex prevention measures in the workplace such as the replacement of powdered latex gloves by nonpowdered latex gloves for all health care workers and latex-free gloves for latex allergic health care workers lead to symptom relief and a dramatic decrease of latex-specific IgE. This is in accordance with a recent study about latex sensitization in a population of dental school students (4). These clinical and biological results encourage us to pursue the follow-up of those subjects and the avoidance of powdered latex gloves in all the units of our 3000-bed university hospital. Such an attitude is now widely recommended (5).