The incidence of new cases of allergic reactions to natural rubber latex (NRL) gloves among healthcare workers in the UK has fallen significantly since its peak in the late 1990s. It is now thought to be of a similar scale to that of other types of dermatological complaint that are a recognised occupational health hazard for agricultural workers, butchers and food handlers, those working with industrial enzymes and others.
In the mid-1990s, latex allergy became a significant occupational hazard in healthcare following increased use of NRL gloves to protect against transmission of blood-borne viruses. Prevalence of so-called “type I” allergy (contact urticaria) was estimated to be as high as 17% in healthcare workers at the time. By comparison, prevalence in other occupational groups was reckoned to be of the order of 4% in cleaners, 6% in painters, 7% in construction workers and only as high as 17% in food handlers and hairdressers.
Nevertheless, latex allergy still affects many thousands of workers in the UK healthcare sector: approximately 1% of the NHS workforce, according to one estimate. Although usually a minor complaint – sometimes manifesting itself as an itch or mild reddening of the skin – NRL allergy may occasionally trigger serious reactions. And, as with other sensitisations and allergies, it is usually a permanent, even if manageable, condition and one that is neither easily diagnosed accurately nor prevented.
Because of the complexity of the problem, the banning of cheap, single-use, powdered latex gloves has been an attractive strategy for dealing with the problem. The Health and Safety Executive has never suggested such an outright ban but it has recommended that healthcare employers should develop policies for the management of NRL allergy, including on the management of sensitised individuals, and that health surveillance should be introduced for at-risk employees. The significant implications of this official recommendation prompted some trusts to consider complete bans on NRL gloves.
Two years ago, the HSE successfully prosecuted an NHS trust for failing to operate such a surveillance scheme.1
Last year, a conference held at the Royal Free Hospital, London, after considering the pros and cons of an outright ban on NRL gloves, concluded that “appropriately structured and managed control strategies” were preferable to the adoption of “latex-free workplace” policies.2 Two of the of speakers at the Royal Free conference were subsequently co-opted into a team of allergy, dermatology and occupational medicine specialists brought together by the recently established Royal College of Physicians (RCP)/NHS Plus Clinical Effectiveness Unit to produce an evidence-based national guideline on the management of NRL allergy, which was published in April.3
RCP/NHS Plus guideline
The key finding of the RCP/NHS Plus working group was that single-use, powdered NRL gloves “should not be used” but that there was no basis for a complete ban on all types of latex gloves.
The eight principal recommendations were as follows:
The use of powder-free, low-protein latex gloves as an alternative to powdered latex gloves significantly reduces the incidence of latex allergy and latex-induced asthma, as well as the prevalence of latex-related symptoms. Powdered latex gloves should therefore not be used in the workplace.
At a national and local level, a policy that encourages switching from powdered latex gloves to powder-free, low-protein latex gloves is a proven effective method of reducing the incidence of latex allergy.
Employees with latex allergy, latex sensitivity or latex‑induced asthma should use non-latex gloves.
In employees who are latex-allergic/sensitised, taking latex-avoidance measures results in cessation or diminution of symptoms. Markers of sensitisation decrease regardless of whether co-workers continue to use powder-free, low-protein latex gloves or latex-free gloves.
In employees with latex-induced asthma or rhinitis, the use of powder-free, low-protein gloves by their colleagues reduces symptoms and indices of severity in the affected employee to a similar degree as colleagues’ use of non-latex gloves.
All but the most severe cases of latex allergy and latex-induced asthma can be managed without the need for redeployment, ill-health retirement or termination of employment. Adjustments include careful personal avoidance of latex at work and minor changes in the workplace.
There is a lack of published primary research comparing occupational interventions for those who are sensitised to latex (without symptoms), with those with clinical latex allergy.
No reports of new cases of latex allergy arising from non-powdered, low-protein latex glove use were found.
The group concluded: “The evidence does not therefore support a complete ban on the use of latex gloves. Institutions should judge whether their needs would be met better by the use of latex-free or powder‑free latex gloves, or use of both in different settings, while taking into account the desirable and undesirable properties of both materials.”
The guidelines recommend further research, including: on optimal diagnostic procedures for latex allergy, to be used by occupational health services on the cost-effectiveness of switching to powder-free, low‑protein gloves, or latex-free gloves and on the long‑term effectiveness of targeted educational interventions in reducing latex allergy in healthcare workers.
Also called for are a study on immunotherapy treatment for individuals with clinical latex allergy, a comparison of NHS latex-allergy/glove-usage policies, a comprehensive comparison of properties of latex versus latex-free gloves and a follow-up study of UK healthcare workers diagnosed with latex allergy to determine employment outcomes.
1 “NHS Trust admits failure to screen for latex allergy”, Occupational Health Review 123, September/October 2006, pp.2-3, “
2 “Natural rubber latex: ban or plan?” Occupational Health Review 127, May/June 2007, p.13.
3 Latex allergy: occupational aspects of management – a national guideline, RCP Faculty of Occupational Medicine/NHS Plus Clinical Effectiveness Unit, ISBN 978 1 86016 331 9, downloadable from: www.rcplondon.ac.uk.
Use of single-use, powdered NRL gloves should be avoided wherever possible but the risk does not warrant a complete ban.
Where NRL gloves are used they should be of the powder-free, low-protein variety.
Health service managements should implement policies that give effect to the above two recommendations.
At the same time, research needs to be undertaken into more effective approaches to the management of those who have become sensitised.