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1. Type I allergy specific to natural latex gloves

According to the Gell & Combs classification, type I allergy is a reaction that immediately follows exposure to an environmental antigen, i.e. an allergen. This is the immediate allergy. Latex proteins are the main cause of Type I allergies. More than 240 proteins have been identified in natural latex.

People at risk of sensitization are atopics1 , people with high exposure to these proteins (health care and rubber industry professionals), patients who have undergone numerous procedures, people with hand dermatitis.

 

These latex reactions can be divided into several types:

      • Local reactions (skin, respiratory)
      • Systemic reactions: chemical irritation reactions and allergic reactions requiring sensitization, either delayed (type IV) or immediate (type I) 2

Immediate-type reactions cause lesions that appear within minutes of contact with latex. They may be centered on the area of contact but may also spread to other areas or become generalized. They are of erythematous, oedematous, popular, pruritic type and disappear within a few hours after the contact with the allergen is stopped.

These allergies are not to be taken lightly as they can lead to anaphylactic shock.

Anaphylaxis, or anaphylactic shock, is a serious medical emergency caused by an immediate and generalized allergic reaction: there is a risk of death if action is not taken quickly. It is a rapid and violent reaction (5 to 20 minutes). In anaphylactic shock, several symptoms are associated:

  • Respiratory (asthma)
  • ENT (rhinitis)
  • Cardiac (tachycardia)
  • Cutaneous (giant urticaria, angioedema)
  • Digestive (vomiting)3

2. Type IV allergy common to all latex and nitrile gloves

Type IV allergy is a delayed type of allergy. This hypersensitivity is mainly manifested by skin involvement.

In this situation, the allergens involved are mainly vulcanization accelerators. The most allergenic: thiurams, dithiocarbamates, benzothiazoles.

Thiurams are the most common cause of positive skin tests. In a 2012 German study of patients with suspected occupational allergies to gloves, thiurams were responsible for 16.2% of positive skin tests 4

 

Dithiocarbamates are most commonly used in medical gloves, particularly in latex and nitrile gloves. In 2012, Geier et al. reported that dithiocarbamates cause positive reactions in 3.5% of glove allergic individuals, with ZDEC continuing to be the most important allergen in examination and surgical gloves.5

3. Irritant contact dermatitis

Allergic contact dermatitis (eczema) is a type IV allergic reaction. It accounts for more than 80% of reactions to latex gloves and causes significant discomfort with consequences for quality of life.

The lesions are usually localized at the site of contact, but distant extensions are possible. They occur between 48 and 72 hours after exposure. In general, sensitization is directed against antioxidants or rubber vulcanisation accelerators.

These type IV allergies are also becoming more frequent with the use of nitrile gloves increasing sharply at the expense of latex gloves.

In addition, this contact dermatitis increases the risk of blood-borne pathogens, because the body’s most effective defence barrier – healthy skin – is weakened.6

The average cost for each disability claim due to dermatitis was estimated at $3,552.7

This amount includes:

  • The total amount awarded for temporary disability
  • Medical treatment
  • The amount for permanent partial disability
  • The costs of professional rehabilitation

The average disability period is estimated at about 23.9 days and affects the organization of health care facilities.8

How can these allergies be prevented?

How do you become allergic ?

L’exposition chronique est une raison probable. Les chirurgiens, infirmières, dentistes et autre personnes qui portent des gants en caoutchouc ou dérivés synthétiques à des fins professionnelles peuvent souvent développer une sensibilité au latex de caoutchouc naturel et aux accélérateurs de vulcanisation.

 

The diagnosis

The diagnosis of allergy always begins with a precise anamnesis (questioning) of :

  • The type of reaction
  • The temporal reaction with exposure to the allergen
  • The importance of exposure
  • Risk factors

 

Prevention

Prevention is mainly based on avoiding contact with the allergen. There are 3 techniques:

  • Avoidance of latex gloves or devices containing latex
  • The use of sub-gloves (polyethylene) to substitute allergens such as thiurams with allergens having a lower allergenic power
  • The use of less allergenic gloves

A new generation of nitrile gloves without a vulcanization accelerator can limit these type IV allergies.

Discover our solutions to prevent allergies on Polsyem.medical.

Sources:

[1] Dolez P, Institut de recherche Robert-Sauvé en santé et en sécurité du travail. Document d’information pour la sélection des gants de protection contre les risques mécaniques guide technique [Internet]. Montréal: IRSST; 2010 [cité 22 juin 2020]. Disponible sur : http://collections.banq.qc.ca/ark:/52327/2047241

[2] Sussman GL, Beezhold DH, Kurup VP. Allergens and natural rubber proteins. J Allergy Clin Immunol. août 2002;110(2 Suppl):S33-39.

[3] L’anaphylaxie – AFPRAL [Internet]. [cité 22 juin 2020]. Disponible sur: https://allergies.afpral. fr/allergie/decouvrir-les-allergies/anaphylaxie

[4] Geier J, Lessmann H, Mahler V, Pohrt U, Uter W, Schnuch A. Occupational contact allergy caused by rubber gloves–nothing has changed. Contact Dermatitis. sept 2012;67(3):149-56.

[5] Alikhan A, Lachapelle J-M, Maibach HI, éditeurs. Textbook of Hand Eczema [Internet]. Berlin Heidelberg: Springer-Verlag; 2014 [cité 22 juin 2020]. Disponible sur: https://www.springer.com/gp/book/9783642395451

[6] Qu’est-ce qu’une allergie aux produits chimiques ? [Internet]. [cité 17 juin 2020]. Disponible sur : http://www.ansellhealthcare.com/images/ansellprotects/allergy_brochure_fr-3.pdf

[7] Sussman GL, Beezhold DH, Kurup VP. Allergens and natural rubber proteins. J Allergy Clin Immunol. août 2002;110(2 Suppl):S33-39.