An old enemy lurking in the shadows: The problems associated with latex products are still with us

Anne Guignon, RDH, reminds us that the problems associated with latex allergies, often triggered by dental products, has not gone away.

Sep 1st, 2017
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By Anne Guignon,RDH, MPH, CSP

Latex allergies need to remain on the radar of all dental professionals, especially those practicing from the early 1990s forward.

First, a history lesson; then, the reality of a continued, potentially life-threatening situation.

In the early 1980s, reports swirled about a dangerous new viral infection that scientists named HIV/AIDS. Ten years later, a television report implicating the transmission of the human immunodeficiency virus to a dental patient hit the airways. The public went wild. People were scared to undergo dental treatment. Dental health-care workers were scrambling for answers on how to protect themselves.

Evolution of PPE

The world of health care turned upside down. The Centers for Disease Control and Infection (CDC) started sending out infection control protocols right and left. Dental supply companies worked as fast as they could to fill the mounting orders of gloves, masks, gowns, disinfecting chemicals, and other barrier techniques.

Dental professionals had to learn to work differently. Seasoned clinicians complained about losing tactile sensitivity, poor glove fit, sweaty hands, and itchy skin. Clinicians heard the public outcry and were worried about their safety. New regulations for personal protective equipment (PPE) soon became the standard of care, and workers learned to adapt. Manufacturers looked for products that would protect from bloodborne hazards and provide increased comfort. No one ever imagined that products health-care workers were required to wear would lead to the demise of their clinical careers.

Most gloves at that time were made from natural rubber latex (NRL), a stretchy material that conformed well to the hand. Wearing a latex glove is like covering one’s hand with a thin rubber-band-like film; compression keeps gloves in place. Workers complained that gloves were hot and hard to don. In response, companies added powder.

Health Issues Arise

Health-care professionals around the world began to experience dermatitis issues on their hands that often cleared during a vacation or long weekend. Many sought relief by wearing cotton liners under their gloves.

There were more reports from health-care workers regarding asthma and other symptoms now associated with severe allergic reactions. Workers experiencing this strange cluster of symptoms were diagnosed - they were allergic to latex. For many, this meant leaving their beloved workplaces that were now toxic. The health-care community lost thousands of talented medical and dental providers to this new phenomenon.

Twenty years ago it was not well understood that latex gloves, products that were intended to provide workers with protection, could cause the demise of so many clinical careers. Dental health-care workers were at a heightened risk. They wore gloves all day for protracted periods of time. Others in the health-care community often donned exam gloves for a quick check.

Some workers approached their places of employment and suggested a latex-safe environment. Some employers agreed and others did not. Without changes, untold numbers of dedicated health-care workers were out of a job. Most offices were unwilling to adapt. Latex-sensitive workers had to deal with losing their jobs, income, and professional identity.

Brave souls sought counseling to deal with their inevitable depression. One afflicted hygienist remembers the sense of relief she felt when a counselor told her it was perfectly natural to mourn the loss of her clinical career. From her perspective, her body had betrayed her and she felt abandoned by the dental professionals she had worked with for so many years.

Why did this huge spike in latex allergies happen 25 years ago? When the demand for gloves spiked in the mid 1990s, manufacturers were desperate to meet the demands of health-care workers. Some companies focused on the immediate sale opportunity and released products that were improperly processed. Manufacturers eliminated some steps that would have reduced unnecessarily high levels of latex protein. Adding powder to the gloves created an even bigger time bomb. Latex proteins now had an added aerosol vector. End users and patients were exposed to levels of natural rubber latex protein, speeding up the sensitization process in those who were susceptible.

The CDC estimates the prevalence for a latex allergy is up to 6% in the general population, and higher for those who have had multiple latex exposures via numerous surgical procedures. The risk for health-care workers is now estimated to be somewhere between 12% and 17%. With the growing interest in infection control and chemical barrier protection, other workers now at increased risk include housekeepers, law enforcement, firefighters, cosmetologists, emergency rescue, funeral home employees, gardeners, painters, food service employees, sanitation workers, and workers in factories where natural rubber latex products are manufactured or used.

Striving for Latex-Free

Most dental offices and educational institutions now strive to create latex-safe environments. It’s almost impossible to ensure that latex is not in one’s environment. It is well documented that certain foods have a high cross-reactivity to latex proteins. Research has shown that up to 50% of those with a latex allergy are also sensitive to one or more fruits, a condition called “latex-fruit syndrome.” The list of foods with the potential to create a problem is extensive.

While there is no clear-cut evidence of a genetic predisposition to a latex allergy, allergy experts recognize that those at risk may have a history of other types of sensitivities to foods, a history of hay fever, or have eczema or contact dermatitis issues.

Even if a person is not currently classified as allergic to latex, will an allergic reaction show up the next time the person eats a banana, bites into a sandwich prepared at a restaurant, or walks into a room filled with balloons? Hidden sources of latex can create havoc. Did the person in the food prep area wear latex gloves when he or she spread the mayo on the bread? Is the stopper in your flu vaccination made from NRL or is it a synthetic? Is the glue used to seal your power bar wrapper safe? What about the balls in the school gym or your child’s playground equipment? These are tough questions that plague everyone who knows they are sensitive to latex or have been identified as having a latex allergy.

For 26 years, the American Latex Allergy Association was instrumental in informing the public about latex. The association closed December 31, 2016, due to lack of funding, but still maintains a Facebook page. A link to a basic latex allergy screening tool and other valuable information is still available on the association’s website at (latexallergyresources.org).

Legislation banning the use of latex gloves by any food service company is now in effect in Rhode Island, Hawaii, Connecticut, and Arizona. This ban includes restaurants, schools, catering facilities, and anyone preparing food for human consumption, and this creates a safer environment for patrons and employees. During the expert testimony in one state considering a latex ban in food establishments, legislators were shocked to learn about latex allergy risks and even more disconcerted to learn that alternative glove options were more cost effective. Many medical emergencies have been averted since these bans have been instituted.

Many consumer products, as well as those routinely used in health-care settings, are now latex free. Many educational institutions no longer stock latex gloves or athletic equipment that contains latex, and many schools have banned latex on campus. Awareness is growing.

Some glove companies claim that low-protein latex products are safe, but for those with a true latex sensitivity or allergy, life is never free of concern. Given our relative risk as health-care workers, particularly those of us in dentistry, why gamble? Take care of your body and reduce every possible exposure to latex, especially if you’ve had any sensitivity to products that contain latex or foods that are known to cross react. Allergic reactions at any level should not be ignored.

Products that can contain natural rubber latex (NRL)

Health care products

  • Gloves
  • Dental dams
  • Orthodontics
  • Airway and IV tubing
  • Syringes
  • Stethoscope tubing
  • Catheters
  • Bandages and dressings
  • Blood pressure cuffs
  • Tourniquets
  • Vial stoppers
  • Gutta percha

Consumer products

  • Balloons
  • Athletic shoes
  • Condoms
  • Diaphragms
  • Tires
  • Tools
  • Clothing waistbands
  • Stretchy, form-fitted clothing
  • Shower caps
  • Rubber toys
  • Baby bottles, nipples, pacifiers
  • Rubber bands, glues
  • Adhesive bandages
  • Exercise / therapy / resistance bands
  • Dishwashing gloves
  • Erasers
  • Latex mattresses
  • Carpet backing
  • Buttons on remote control devices

Latex allergy symptoms

  • Skin redness
  • Hives or welts
  • Itching
  • Stuffy or runny nose
  • Sneezing
  • Coughing
  • Red, itchy, or teary eyes
  • Scratchy, sore throat
  • Hoarse voice
  • Skin swelling
  • Headache
  • Trouble swallowing
  • Abdominal cramps
  • Vomiting
  • Diarrhea
  • Asthma symptoms such as wheezing, tight chest, and difficulty breathing
  • Anaphylaxis, which is severe breathing difficulties, and BP drop

Foods that are cross reactive to latex proteins

Some foods listed may not produce clinically significant reactions in latex‐sensitive individuals. Knowing foods that share major or minor allergens with latex can help minimize exposures to possible sources of provocative allergens. Understand the risks associated with these foods.

High

Avocado, banana, chestnut, kiwi

Moderate

Apple, carrot, celery, melons, papaya, potato, tomato

Anaphylaxis, which is severe breathing difficulties, and BP dropRDH

Resources

1. Employees with latex allergy. Job Accommodation Network. Department of Labor. askjan.org/media/downloads/LatexA&CSeries.pdf, February 27, 2013.
2. Allergenic cross-reactivity of latex and foods-A compilation from the literature. latexallergyresources.org/sites/default/files/attachments/TB10A%20Latex%20food%20cross-reactivities.pdf
3. Latex allergy symptoms and diagnosis. American Academy of Allergy, Asthma and Immunology. http://www.aaaai.org/conditions-and-treatments/allergies/latex-allergy
4. Latex allergy. www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/latexallergy.html
5. American Latex Allergy Association. www.latexallergyresources.org. The association closed December 31, 2016. Information is still available on the website. The ALAA maintains a current site on Facebook.


Anne Nugent Guignon, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at anne@anneguignon.com.

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