Latex Allergy - Health & Safety and Stuff

What is Latex?

Approximately a quarter of the world's demand for elastic products is supplied by the natural rubber that is derived from the Hevea brasiliensis tree, which is widely grown in South East Asia, and other countries. Natural rubber latex (NRL) from this tree is used in the production of numerous rubber products found at home and at work.

What is Latex Allergy?

Latex allergy is an allergic reaction to latex proteins. The symptoms occur when allergic individuals are in contact with latex or the powder from latex gloves, and may include itchy red skin rash, itching eyes and nose, sneezing, coughing, or difficulty breathing and asthma. In rare cases, if an allergic person is exposed to latex it can lead to a severe allergic reaction and death.

Some individuals may have other reactions to natural rubber latex gloves that are due to irritation or to allergic reactions to other chemicals that are present in the rubber in the gloves. Such reactions often occur several hours after exposure to the natural rubber products are not included in this definition of latex allergy.

Natural rubber latex allergens attach to the cornstarch that is used in powdered gloves. This powder acts as a vehicle making the natural rubber latex proteins airborne when these gloves are used, enabling the allergens to be inhaled. This means that natural rubber latex allergic individuals may experience symptoms of an allergic reaction, by being in a room where powdered NRL gloves are used even though they are not in contact with these gloves directly.

What are the costs of ignoring the potential latex allergies in workers?
As well as the costs in terms of human suffering, there are also potentially large costs in terms of fines, business disruption and court appearances. A trainee nurse was awarded more than £300,000 compensation in an out of court settlement with Scarborough General Hospital NHS Trust after developing an allergy to natural rubber latex gloves.

In a recent case, damages were awarded to a nurse after developing a latex allergy by Leeds County. In this case, the nurse suffered facial swelling, anaphylactic shock and breathing difficulties. She who was moved to office work but was also unable to carry out this work due to latex present in equipment located in the office. Her situation was so bad that she also suffered reactions in shops, gyms, and swimming pools and she had to have her house modified to remove all latex containing items. The nurse was awarded just under £270,000 in compensation including payments for pain and suffering as well as loss of future earnings.

In another case, a nurse was awarded £354,000 compensation after she was forced to abandon her nursing career due to an allergy to latex.

How prevalent is latex allergy?

It is documented that allergy to certain latex proteins emerged as an occupational disease in the 1980s and that it continues to be an important occupational health problem because natural rubber products are being used increasingly all around the world, especially in healthcare.

Although there is a large body of research on latex allergy, few studies have examined occupational health interventions. This systematic review summarises current evidence and is intended to assist occupational health professionals, managers and other interested parties in providing advice on occupational health interventions to address the problem of latex allergy from both individual and institutional perspectives. The review is concerned particularly with issues relating to gloves, as these represent by far the main occupational use of latex. Latex allergy of the immediate type is distinguished in this review from contact dermatitis caused by delaying hypersensitivity (type IV allergy) to chemicals that are added to latex during processing. The main focus of this review is on type I or immediate-type allergy to latex proteins, which has a reported prevalence of up to 17% in certain occupational groups.

Latex allergy is an allergy to natural rubber latex (NRL), which is a milky fluid that is obtained from the Hevea brasiliensis tree, which is widely grown in South East Asia, and other countries. Natural rubber latex is an integral component in thousands of everyday consumer and healthcare items, such as gloves. In common with many other natural products, natural rubber latex contains proteins and it is these proteins to which some individuals may develop an allergy.

Which workers are at the greatest risk?

Several categories of workers are at risk of developing latex allergy. Some studies have shown that about 17% of healthcare workers are at risk of reactions to natural rubber latex. People with a history of certain food allergies, such as banana, avocado, kiwi and chestnut are thought to be more likely to develop a latex allergy as are people with atopic allergic disease (which is estimated to be about 30 - 40% of the UK population). Workers who are exposed to natural rubber latex on a regular basis are more likely to develop latex allergy. Typical worker in this category include: car mechanics, caters and workers in the electronics trades.

Is there more than one type of latex allergy?

There are two important types of allergy related to natural rubber latex. One allergy is caused by exposure to the natural proteins (this is referred to as Type I allergy) and the other exposure to the chemicals that are used to convert the natural rubber latex into a usable item (this is referred to as Type IV allergy). Also, some workers may experience an irritant reaction when using products made from natural rubber latex (known as irritant contact dermatitis) which is not a true allergy.

Type I Allergy
Type I natural rubber latex allergy is an immediate allergic reaction to natural rubber latex proteins and is potentially life threatening. There are a few reports of deaths due to latex allergy. The typical symptoms of Type I latex allergy include: urticaria (often called hives) and hay fever type symptoms, asthma. In some rare cases more severe symptoms, such as anaphylaxis (a condition where there is a severe drop in blood pressure leading to possible loss of consciousness or severe breathing difficulty), have been reported. The onset of the Type I allergy may occur after months, or even years, of the initial exposure. In many reported cases, the symptoms become progressively more severe on repeated exposure to the natural rubber latex and so it is essential that work is organised so that sensitised individuals can avoid further contact with natural rubber latex proteins.

Type IV Allergy
Type IV allergy occurs in some people who react to the chemicals used in the manufacturing process, mostly the accelerators. The chemicals most likely to cause this reaction are thiurams, dithiocarbamates and mercaptobenzothiazoles (MBT). This is a delayed hypersensitivity reaction which occurs 6 - 48 hours post-exposure. The symptoms of Type IV allergy include: red itchy scaly rash which is often localised to the area of use (such as the wrists and forearms) but which may spread to other areas.

What products containing natural rubber latex are workers likely to be exposed to?

Natural latex rubber is used widely in several industry sectors. There are, for example, many medical and consumer products that contain natural rubber latex.

Examination and surgical gloves
Erasers
Hand grips and gym mats
Oral and Nasal airways
Rubber bands
Swimming cap
Endotracheal tubes
Balloons
Goggles
Intravenous tubing
Adhesives
Tyres
Surgical masks
Washing up gloves
Rubber aprons
Baby teats
Catheters
Hot water bottles
Stethoscopes
Rubber buttons on calculator, remote controls, etc
Etc

What steps can I take to avoid my employees developing latex allergy?

Natural latex rubber is a substance hazardous to health and, as such, it falls under the Control of Substances Hazardous to Health Regulations 2002 (COSHH). Under COSHH, employers must assess all the circumstances in which employees may be exposed substances hazardous to health, including natural latex rubber. Employers must consider how to either prevent exposure or otherwise implement precautions that will adequately control any risks. In terms of practical guidance in the matter of reducing the risk of natural latex rubber allergy, the employer should consider the following precautions:
• Where possible, powdered latex gloves should not be used in the workplace as the risk of developing latex allergy is highest with the use of powdered latex gloves.
• Using either powder-free latex or non-latex gloves for the whole workforce.
• Employees with latex allergy, latex sensitivity or latex-induced asthma should use non-latex gloves and co-workers should use powder-free low protein gloves or non-latex gloves.

Risk Assessment

As with all aspects of the management of health and safety at work, the risk assessment is the most useful tool in identifying areas where staff are at risk of developing latex allergy. It is not possible to know who will develop allergic reactions to latex, and so all workers must be protected through a risk assessment. The risk assessment should look at the work carried out and the need to protect workers from, for example, infection. Where there is a risk of infection, latex gloves may be provided to protect the workers. Employers, however, can also use the risk assessment to look at ways of eliminating the risk from unnecessary exposure to latex, substituting other materials where feasible, such as vinyl or nitrile gloves, and generally limiting exposure to latex. It is essential for the risk assessment to question the need to use natural rubber latex products to complete this work and the use of an alternative should be considered. It should be recorded and staff given appropriate training and health information based on its findings to enable them to protect themselves.

What action should I carry out if a worker develops latex allergy?

If a worker develops suspected latex allergy, you should refer them to your occupational health department or to their own Doctor (GP) if you do not have one. Also, under the duties imposed under the Reporting of Injuries, Disease and Dangerous Occurrences Regulations 1995 (RIDDOR), you have to report incidents of occupational dermatitis and asthma attributable to latex to the appropriate enforcing authority (i.e. the Health and Safety Executive or your local authority) and keep a record of such incidents.

Are there suitable alternatives to natural latex rubber gloves?

Gloves made from a range of different materials (such as: polyvinyl chloride (PVC), neoprene and vinyl) are now available. These should be considered as a useful option for eliminating or reducing exposure to natural rubber latex in the workplace. However, alternatives to latex gloves have other associated problems, particularly with user satisfaction and barrier effectiveness.

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