A Study of the Latex Allergy in Operating Room Nurses

Yim, Yong Soon; Park, Chun Wook; Lee, Cheol Heon

Abstract

BACKGROUND: Allergy to natural rubber latex has become an important occupational health concern in recent years, particularly among health care workers. Studies have estimated that the prevalence of latex allergy ranged from 2.8% up to 12.1% of health care workers. Latex sensitization is more common in operating rooms or with special care nurses whose jobs require frequent glove use. OBJECT: The present study was undertaken to assess the prevalence of latex sensitivity in operating room nurses, and to evaluate the relationship between questionnaire responses and skin tests.
METHODS
Eighty operating room nurses working in the Hallym Medical Center and 27 healthy controls were included in this study. The questionnaire was completed by a dermatology doctor during an interview. Skin prick tests(SPT) were carried out on the volar surface of the forearm using latex glove extract solution, commercial latex extract and several commercial fruit extracts. If SPT was positive, use test was performed. Patch tests for delayed type hypersensitivity were carried out with small piece of latex glove(as is), commercial latex antigen and rubber additives.
RESULTS
1. Twenty two(27.5%) of 80 operating room nurses reported at least one symptom when wearing gloves. Although the symptom development was increased as glove-wearing time increased, but the difference was not statistically significant. The history of atopy and dental care did not influence the prevalence of symptoms. Subjects with hand eczema had significantly higher prevalence of symptoms than without hand eczema. 2. In SPT, 9(11.3%) of 80 operating room nurses were positive to latex glove extract solution. This level was significantly higher than healthy controls who showed positive reaction in only one. The history of hand eczema and dental care did not influence the prevalence of symptoms. Although the difference was not statistically significant, the symptom development was increased as glove-wearing time and years of experience increased. The percentage of skin reactions to latex was 2.6 times higher in nurses with atopy than without atopy, but the difference was not statistically significant. Reactions to fruit extracts including tomato, banana, mixed nut and potato were 5.0%, 3.8%, 2.5% and 1.3%, respectively. Use test was done with 7 of 9 showing positive reaction to SPT, and all of them showed positive responses. 3. Patch tests revealed positive results for latex gloves in 3 (3.8%), for commercial latex extract in 2 (2.5%) and for thiuram mix in 1 (1.3%) of 80 operating room nurses. But there were no positive results with ZnBDC, ZnEDC, TMTD, mercapto mix and mercaptobenzothiazole in nurses. For all allergens in patch test, any healthy subjects did not show positive results.
CONCLUSION
Twenty two(27.5%) of 80 operating room nurses reported at least one symptom when wearing gloves. The most commonl compained symptom was itching, which was ceported in all of them. Localized wheal, generalized wheal and pain were reported in 8.8%, 5.0% and 2.5%, respectively. However, anaphylaxis was not reported. As the positive rate was 3.8% in patch test and 11.3% in SPT using latex glove extract, most of the symptoms related to the wearing of latex gloves appeared to be due to irritation. It could be considered that latex allergy could be induced by repeated wearing of latex gloves in operating room nurses.