NIOSH alert boosts latex allergy activists

By Sheila Galatowitsch

Activists attempting to ban powdered latex gloves from health care facilities have been bolstered by a National Institute for Occupational Safety and Health (NIOSH) alert issued in June.

The 15-page alert, “Preventing Allergic Reactions to Natural Rubber Latex in the Workplace,” warns that workers exposed to latex gloves and other products containing natural rubber latex may develop allergic reactions. It describes existing scientific data on the history of latex allergy and provides recommendations to employers and workers for minimizing latex-related health problems.

“Here you have a federal regulatory agency coming out with language this strong: If you are not into infectious body fluids, you shouldn`t be in latex,” says Pat Toland, a health policy specialist with the Oregon Nurses Association (Portland,

OR).

The NIOSH alert “has made life so easy,” says Elizabeth C. Borel, DMD. Borel is the national director of the Education for Latex Allergy/Support Team and Information Coalition (ELASTIC) (West Chester, PA), a non-profit organization. She is also severely allergic to latex, a condition that has forced her to give up her dentistry practice.

“This is a government agency saying what individuals have been saying: Avoid unnecessary exposure. If latex is used, make sure it is powder-free or low-protein. This is a very big problem in terms of glove use, but the solutions are very simple,” Borel says.

NIOSH recommendations

The NIOSH alert targets workers who repeatedly use latex products, primarily workers in the health care industry, as well as those with less frequent glove use and in industries that manufacture latex products. Ongoing latex exposure puts workers at risk for developing latex allergy, the alert concludes. Reactions range from skin rashes; hives; nasal, eye or sinus symptoms; asthma; and, rarely, shock.

Research shows that the proteins responsible for latex allergies fasten to the powder that is used on some latex gloves. When powdered gloves are worn, more latex protein reaches the skin. When gloves are changed, latex protein/powder particles get into the air where they can be inhaled and contact body membranes. In contrast, the alert states, work areas where only powder-free gloves are used show low levels or undetectable amounts of the allergy-causing proteins.

The amount of latex exposure needed to produce sensitization or an allergic reaction is unknown, according to the alert. However, “reductions in exposure to latex proteins have been reported to be associated with decreased sensitization and symptoms,” the alert states.

Latex allergy can be prevented “only if employers adopt policies to protect workers from undue latex exposures.” NIOSH recommends that employers provide workers with non-latex gloves to use when there is little potential for contact with infectious materials. If latex gloves are chosen, employers should provide reduced protein, powder-free gloves. They should also periodically screen high-risk workers for latex allergy symptoms and remove symptomatic workers from latex exposure.

The alert advises workers who continue to use latex gloves to avoid oil-based creams or lotions unless they have been shown to reduce latex-related problems. After removing latex gloves, the alert recommends washing hands with a mild soap and drying thoroughly. If symptoms of latex allergy develop, NIOSH advises workers to avoid direct contact with latex gloves and other latex-containing products until consulting with a physician experienced in treating latex allergy. The NIOSH alert is available at www.cdc.gov/niosh/latexalt.html or by calling 800-35-NIOSH.

Legislation to ban powdered-latex gloves

Propelled by the Oregon Nurses Association, Oregon was the first state to attempt to ban powdered latex gloves from health care facilities. The legislation, which would also have required the use of low-protein latex products, died in the state senate`s Health and Human Services Committee this summer. The bill`s sponsor, Senator Thomas Wilde, says he plans to introduce a new bill with altered wording when the legislative assembly reconvenes.

The New York state senate passed a similar bill June 24 by a vote of 57 to 1. The bill would amend the state`s public health law to prohibit “the use by any health care provider of any latex product coated with a preparation in the form of fine particles of talc, cornstarch or other mineral as a prophylaxis.” The bill was delivered to the state assembly, but had no sponsor at press time.

Toland says that activists in California, Washington, Colorado, Minnesota and other states are also considering legislation. “Many states are sitting on the fence, waiting to see who goes over first,” Toland says. Meanwhile, powdered latex glove bans are being enacted at individual hospitals. “It shouldn`t be hospital by hospital. It should be national,” she says.

The Oregon Nurses Association got involved in the issue after one of its members, a nurse diagnosed with latex glove allergy, failed to convince the hospital where she was employed to remove powdered products. “People who aren`t sensitive don`t believe the problem exists,” Toland says. “If the chief of medicine is sensitive, a facility goes immediately to a powder-free environment.”

OSHA mandates that employers make reasonable accommodations by providing powder-free and appropriate substitutes, but Toland doesn`t believe the OSHA mandate goes far enough. “We would rather have had Oregon OSHA amend their administration rules, but they declined to do that,” Toland says. The proactive legislation “was the morally correct thing to do when all other avenues failed,” she says.

The Oregon Medical Association did not support the bill, but consumers and individual health care providers did, according to Toland. “The public is becoming aware and that will drive the market to powder-free,” she says. “We are not advocating a ban on latex. It is a great product if you are not sensitive.”

Cleanroom glove manufacturers say they welcome the NIOSH alert because it increases awareness about a serious issue. “We believe it is important for our customers to have all the information they need to make a good decision,” says Donna Gaidamak, manager of media relations at Allegiance Corp. (McGaw Park, IL). However, legislation banning certain products would limit customers` ability to choose and could drive up costs, she says.

“We all need to be focused on providing accurate information and understanding the issue in order to make a decision on what product to use and how to use it,” says Jim Gill, director of industrial marketing at Allegiance. “Our mission in life is to provide people with the right hand covering, whatever that might be, if it`s natural rubber latex or synthetic, that`s what our efforts will be focused on.”

“Anything which serves to create awareness and education is useful in this situation,” says Russell Thompson, general manager for the critical environments business at Ansell Edmont Protective Products Division (Eatontown, NJ). Thompson is also director of the company`s latex allergy research and education program, AnsellCares. The NIOSH alert takes the latex allergy problem “out the realm of health care workers and applies it to anybody using latex and makes them aware,” he says.

But the problem of latex allergies cannot be solved by “legislation, litigation or regulation. The problem has to be solved in the academic laboratories of scientists and the R&D laboratories of manufacturers,” Thompson says. The efforts to ban powdered latex gloves may be an overreaction on the part of frustrated health care workers, whose allergy problems were not taken seriously by their employers, Thompson says.

Impact on cleanroom users

Meanwhile, some cleanroom users of natural rubber latex are reporting cases of sensitivity even to the low-protein, powder-free products typically used in cleanroom environments. “We have had consumers and a couple of major end users that are considering a conversion to a nitrile glove,” says Ed Gallaher, president and CEO of Phoenix Medical Technology (Andrews, SC), a manufacturer of natural rubber latex, vinyl and nitrile gloves for both the medical and cleanroom industries. Vinyl and nitrile are non-allergenic alternatives to natural rubber latex. One Phoenix customer, a semiconductor fab, is “thinking of going latex-free,” Gallaher says.

Phoenix is selling six times as much of its powder-free latex glove product as it did five years ago, but Gallaher believes that low-protein and powder-free products are not a panacea. “Even though you reduce proteins by 99 percent, that 1 percent is enough [to cause a reaction in] one of these sensitive individuals,” he says.

There is a misconception that low-protein means low-allergen, says Thompson. “We have found a number of gloves which are low in protein but still highly allergic. Other gloves are high in protein, but are low in allergens. We know that there are over 240 different proteins in natural rubber latex and probably 50 of those are what we call allergens. Of those, we have identified eight specific proteins which probably cause the sensitization in the health care environment,” he says.

In addition, while powder is blamed as the source for much of the sensitivity to latex, it is not the primary source, Thompson says. “Contact between the skin and glove itself, in my opinion, is the primary source.”

Latex sensitization potential

The potential for latex sensitization in the cleanroom industry will not be nearly as severe as that affecting the health care industry, Thompson believes. He estimates that ratio of health care workers to cleanroom workers is about 4 to 1.

For cleanroom workers who are affected, there is hope. Most allergy symptoms are mild, and if caught early, can be dealt with successfully by using latex-free alternatives to gloves and other latex-containing products, such as hairnets and disposable garments.

For more information on sources of these products, access the Allergy to Latex Education and Resource Team`s (A.L.E.R.T.) web site at www.execpc. com/~alert/product.html. CR