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Acknowledgments

This document would not have been possible without the generous assistance of the many people and organizations who are concerned about preventing "latex allergies". In particular, the Workers' Compensation Board of B.C. would like to thank the representatives from the many organizations -- health associations, government ministries, universities, and hospitals -- who reviewed the draft of this document and contributed valuable comments and information.

To all who participated in this project, our many thanks.

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Introduction

"Latex allergies" is often used as a "catch-all" term to describe various health problems associated with the use of rubber products.

In particular, rubber-related health problems such as skin rashes and allergies have been noted in health care workers. Such problems may be related to the increased use of rubber gloves for protection against infectious diseases such as hepatitis and AIDS.

Workers in emergency services, janitorial work, housekeeping, hairdressing, and food services -- and other workers who wear rubber gloves or other rubber products -- may also be at risk of developing these health problems.

This document has three parts. The first part explains the health problems that may be caused by using such products. The second part focuses on the natural rubber latex protein allergy, which may cause severe health problems -- it is essential to understand the risk factors for this allergy, how to prevent it from developing and what to do if it does develop. The third part lists other sources of information on "latex allergies".

The information in this document applies to a wide range of jobs with exposure to rubber products.

To order copies of this booklet in print, or other safety and health information, call the WCB Films and Posters section at 276-3068 in the Lower Mainland, or toll-free in B.C. at 1 800 661-2112 (local 3068).

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What is rubber?

"Rubber" is a flexible, elastic substance made from either:

• Sap collected from rubber trees (natural rubber latex)
• Various artificial mixtures (synthetic rubber)

Natural rubber latex contains complex compounds (proteins) that may cause specific health problems. Chemicals added to the natural rubber latex during processing may also cause a particular skin condition. Health problems caused by the proteins and chemicals are covered later.

Synthetic (artificial) rubber does not contain any natural rubber latex proteins. Common synthetic rubbers are butyl (isobutylene), neoprene (polychloroprene) and nitrile (acrylonitrile butadiene) rubber. Synthetic rubber does, however, contain some of the same chemicals that are added to natural rubber latex during processing. Therefore, workers using synthetic rubber may develop a particular skin condition due to these chemicals.

The words "latex" and "rubber" are often used interchangeably and do not always mean natural rubber latex. For example, latex paints and caulkings are usually synthetic products that do not contain natural rubber latex and its proteins. It is impossible to tell by looking at a rubber product if it is made from natural rubber latex or synthetic rubber. A list of products found at work and home that may contain natural rubber latex is provided below.

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What health problems are associated with rubber products?

Not everyone who uses rubber products will develop health problems. Health problems that do occur are grouped into two types of reactions -- irritant (non-allergic) reactions and allergic reactions (it is possible to have more than one of these health problems).

Irritant reactions

Irritant contact dermatitis is a skin rash that results from direct damage to the skin -- it is not an allergic reaction. It is the most common health problem associated with products like gloves made of either natural rubber latex or synthetic rubber. Factors that may lead to this type of dermatitis include:

• Irritants such as residual soaps, detergents, hand creams, cleaning materials, disinfectants, and other chemical agents left on the skin are trapped under the gloves, causing skin irritation.
• Prolonged dampness from sweating in gloves softens the skin, making skin vulnerable to chafing and rubbing by the gloves.
• Powders inside some gloves (used to make them easier to put on and remove) may adsorb skin oils, drying the skin and causing irritation.

Repetitive hand washing may also cause the skin to become dry and irritated, as can using alcohol-based solutions and rough paper towels.

Allergic reactions

Rubber products may cause over-reactions by the body's defence (immune) system, called hypersensitivity or allergic reactions. These reactions are much less common than the irritant reaction mentioned previously, and are caused by substances called antigens. Animal dander, house dust, and pollens are examples of well-known antigens that cause allergic conditions. A common allergic condition is hay fever.

Two types of hypersensitivity reactions are associated with rubber products:

• Rubber chemical allergy.
  Allergic contact dermatitis is a skin rash caused by the body's immune response to the chemicals added during the processing and manufacturing of BOTH natural rubber latex and synthetic rubber. This condition is more common than the natural rubber latex protein allergy discussed as follows.
  
• Natural rubber latex protein allergy.
  This allergic reaction is associated ONLY with natural rubber latex products. It is caused by the body's immune response to protein(s) in the natural rubber latex itself. Several symptoms may occur including:
  • Hives
  • Red, watery, itchy eyes
  • Runny nose, sneezing
  • Asthma (wheezing and shortness of breath)

In extreme cases, some people may suffer a potentially severe allergic reaction known as anaphylaxis. This reaction occurs within minutes of exposure to proteins in natural rubber latex, and is recognized by the appearance of severe breathing difficulties and falling blood pressure. Left untreated, this reaction may result in death. Anaphylaxis is a medical emergency that requires immediate treatment by a qualified person. Those who are susceptible to this reaction may be advised by their doctors to wear a Medic-Alert bracelet and carry an allergy kit (e.g., Epipen®, Ana-kit®) with them at all times. The kit contains medication that will ease their condition during anaphylaxis until they can be treated by emergency medical personnel.

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Summary of allergic reactions

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What should I do if I have a health problem that may be related to rubber products?

If you suspect you suffer from symptoms (for example, skin problems or hives) that may be related to rubber products, seek medical attention for assessment, diagnosis, and treatment. Your doctor may refer you to a skin specialist (dermatologist) or an allergy specialist who may conduct tests to determine if a rubber chemical or natural rubber latex protein allergy exists.

If you and your doctor think the problem is work-related, report your condition to your supervisor or employer as soon as possible. The person receiving your report must investigate your concerns and ensure any necessary corrective action is taken immediately.

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Because the natural rubber latex protein allergy may be life-threatening, it is covered here in more detail.

How am I exposed to natural rubber latex proteins?

You may be exposed to natural rubber latex proteins at or away from work by:

Direct contact with a natural rubber latex product

• If you wear gloves containing natural rubber latex, your skin is in direct contact.
• If your dentist uses a natural rubber latex dental dam in your mouth, your mucous membranes are in direct contact with the dam.
• If you use contraceptive barriers such as condoms, diaphragms and cervical caps that may contain natural rubber latex, you are in direct contact.

Contact with airborne natural rubber latex proteins

Natural rubber latex proteins can bind onto the powder used inside some natural rubber latex gloves. When the gloves are put on and removed, the powder can become airborne. Airborne powder carrying the proteins may be a major cause of natural rubber latex sensitization. The powder may also cause allergic symptoms if it contacts the eyes and other mucous membranes. In addition, airborne powder can be inhaled not only by the glove wearer, but also by others in the area, and cause respiratory symptoms such as wheezing or shortness of breath.

Glove powder may stay airborne for a while, or it may settle and contaminate clothing and work surfaces.

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Who may be at risk of developing a natural rubber latex protein allergy?

People who have, or have had, repeated exposure to natural rubber latex products may be at higher risk of developing a natural rubber latex protein allergy than those who don't have repeated exposures. Workers who are regularly exposed to natural rubber latex products and in whom health problems have been reported, include:

• Health care workers such as doctors, nurses, dentists, dental hygienists, lab technicians, etc. (mostly through the use of natural rubber latex gloves)
• Workers who process and manufacture natural rubber latex products

Recently, workers in many other occupations have increased their use of natural rubber latex products (particularly gloves) including:

• Ambulance attendants, firefighters, police officers, and first aid attendants
• Housecleaning, janitorial, hairdressing, and food service workers
• Other workers who wear natural rubber latex gloves for protection

• People who have had multiple surgeries, childbirths or medical procedures, or frequent exposure to natural rubber latex medical products
• People who have active skin problems (such as irritant or allergic contact dermatitis)
• People with allergic conditions (like eczema, hay fever, and asthma)
• People with certain food allergies (for example, bananas, avocados, chestnuts, kiwi fruits)

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How can the risk of developing a natural rubber latex protein allergy be minimized?

If you are considered at risk of developing a natural rubber latex protein allergy, minimize your exposure to natural rubber latex products as much as possible. Since many medical and consumer products contain components made of natural rubber latex, completely avoiding these products is difficult. Minimizing exposure to powder from natural rubber latex gloves is also thought to reduce the risk of developing this allergy.

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What MAY contain natural rubber latex?

Strategies for minimizing exposure to natural rubber latex include:

Elimination

The most effective method to minimize exposure is to eliminate unnecessary use of natural rubber latex products. For example, some workers use natural rubber latex gloves when there is currently no need to even wear gloves.

This may be the case in the food service industry where workers may wear gloves due to concerns about contaminating food. Practicing good personal hygiene -- that includes appropriate hand washing -- will help prevent food contamination by workers. (In the future, food service workers may not be allowed to contact "ready-to-eat" foods -- i.e., foods that do not need further cooking before being eaten -- with their bare hands. In this case, utensils and trays can be used to directly handle food and eliminate the need to wear gloves.)

Substitution

Where it is impossible to eliminate the use of a particular item, substitute the natural rubber latex product with another appropriate one that does not contain natural rubber latex. If there is no such suitable or available substitute, use a product (i.e., gloves) that contains as little natural rubber latex (i.e., low protein) as possible. Also choose low-protein natural rubber latex gloves that are powderless. For more information on substitution products, contact product manufacturers and suppliers.

Minimizing exposure

If natural rubber latex products must be used, only use them when absolutely necessary and for as short a time as possible. Always wash your hands as soon as possible after wearing natural rubber latex gloves, to remove the natural rubber latex proteins. It may also be possible to wear an underglove that is free of natural rubber latex. This will minimize exposure by direct skin contact.

Engineering controls

Install effective ventilation in work areas to decrease airborne natural rubber latex proteins. This may be feasible in some industrial applications such as natural rubber latex manufacturing.

Administrative controls

These may include:

• Purchasing policies. Where possible, avoid purchasing natural rubber latex products. If natural rubber latex products are necessary, obtain information from manufacturers on the protein content of their products and choose one (i.e., gloves) with a low protein content. Powderless natural rubber latex gloves are also available. Consult the resource list at the end of this document.
  
• Work procedures. Develop and follow work procedures that eliminate or minimize the use of natural rubber latex products. If powdered natural rubber latex gloves are worn, workers should remove them from their hands without flicking or snapping them. Snapping gloves releases glove powder carrying natural rubber latex proteins into the air.
  
• Education and training. Workers exposed to natural rubber latex products need to know which products contain natural rubber latex and what health problems are associated with the products, especially the natural rubber latex protein allergy. To reduce the risk of developing this allergy, workers should be trained in work procedures that reduce their exposure to natural rubber latex. Workers should be instructed to report any health problems that may be related to natural rubber latex to their employer.

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What if I must wear personal protective equipment like gloves?

Personal protective equipment (such as gloves) may be required to be used to protect workers from biological or chemical hazards. Many gloves are made of natural rubber latex. Other protective equipment such as respirators, aprons, and boots may also contain natural rubber latex. If possible, choose personal protective equipment, like gloves, that is free of natural rubber latex.

In some cases, however, it may not be possible to use a product that is not made from natural rubber latex and still obtain the same degree of protection from the hazard. When natural rubber latex products must be used, obtain information from manufacturers on the protein content of their products, and choose a product with a low protein content.

Powderless, low-protein natural rubber latex gloves are available, but are not suitable for workers with a confirmed natural rubber latex protein allergy. These workers should only use gloves that are not made from natural rubber latex. The use of powderless, low protein natural rubber latex gloves by co-workers, however, may reduce airborne protein levels enough to allow a sensitized worker to continue working in the same area. It may also help prevent other workers from developing the natural rubber latex protein allergy.

Some gloves may be marketed as "hypoallergenic" (i.e., less likely to cause allergy) -- this term was originally used to indicate that gloves may contain less chemical additives. Such gloves may therefore be suitable for workers with allergic contact dermatitis caused by the chemical additives. However, "hypoallergenic" does not necessarily mean that the gloves are free of natural rubber latex. As such, these gloves may not be suitable for those with a natural rubber latex protein allergy.

If gloves are labelled "non-latex" or "latex-free" they should not contain natural rubber latex proteins, but may contain chemical additives.

Manufacturers or suppliers of the gloves should be contacted to answer any questions on rubber chemical additives and natural rubber latex protein content.

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How do I know if I am allergic to natural rubber latex proteins?

You should describe to your doctor in detail any adverse reactions you have had to rubber products. Your doctor may then refer you to an allergist. The allergist may test your sensitivity to natural rubber latex and make a diagnosis.

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Is there a cure for natural rubber latex protein allergy?

Currently, there is no "cure" for a natural rubber latex protein allergy. Once you develop this condition, the concern is that the reactions may become more severe after each exposure, or that you may react to lower and lower exposures. It is also possible to have a severe reaction the very first time you are re-exposed, even to a very small amount.

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What can I do if I have a natural rubber latex protein allergy?

If you do develop a natural rubber latex protein allergy, you must avoid natural rubber latex as much as possible, both at work and away from work. Seek advice and information from your allergist and family doctor. Controlling symptoms with medications while continuing to be exposed may increase sensitivity and severity of reactions. The following are ways to cope with this allergy:

• Inform your employer (with a note from your doctor) that you must avoid exposure to natural rubber latex. Work with your employer to achieve this -- ask for assistance in identifying and modifying your risk. Your employer must investigate the situation, and take corrective action.
  
• Contact your company's occupational health and safety department or health nurse, if there is one. Work with purchasing personnel to determine if natural rubber latex products can be eliminated or substituted with products that do not contain natural rubber latex.
  
• Consider informing the workplace first aid attendants about your natural rubber latex protein allergy. While your exact medical diagnosis is your personal information, you may choose to tell them that you have this allergy, as this will help them provide you with appropriate first aid if you have an allergic reaction at work. This is particularly important it you suffer from anaphylaxis.
  
• Avoid exposure to natural rubber latex products at all times. Directly contact only products free of natural rubber latex and work in an area free of airborne glove powder from natural rubber latex gloves. Low-protein, powderless natural rubber latex gloves are not suitable for workers with a natural rubber latex protein allergy. However, if co-workers use such gloves, it may reduce the airborne protein levels enough to allow the sensitized worker to continue working in the same area. General use of these gloves may also help prevent others from developing this condition. A list of products containing natural rubber latex and their alternatives should be made available to workers by their employer.
  
• If you have been diagnosed by your doctor as having a natural rubber latex protein allergy, inform other medical practitioners (including dentists) of your allergy before you are examined or treated. This will help ensure that they use products that do not contain -- or have a minimum amount of -- natural rubber latex. Scheduling your appointments first thing in the day may minimize exposure to airborne protein from natural rubber latex glove powder. Further precautions may be necessary if you require surgery or hospitalization.
  
• Wear a Medic-Alert bracelet that identifies the natural rubber latex protein allergy, and discuss with your doctor the need to carry an allergy kit (e.g. Epipen®, Ana-kit®) for use in case of an emergency. Learn how to use the kit.
  
• When travelling to areas where medical supplies are limited, carry with you a variety of sizes of gloves that are not made from natural rubber latex, in case you need emergency medical or dental work.
  
• Avoid certain foods to which people with natural rubber latex protein allergy also tend to be allergic (for example, bananas, avocados, chestnuts, and kiwi).

Research on "latex allergies" is ongoing. At the time of publication, this document reflected generally accepted findings on "latex allergies".

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For more information on the natural rubber latex allergy, consult the following resources:

A.L.E.R.T.

Allergy to Latex Education and Resource Team
P.O. Box 23722
Milwaukee, WI, USA, 53223
Phone 414 677-9707 Fax 414 677-2808

Ansell Medical

Publication: Source to Surgery
Free newsletter dealing with latex allergy and glove safety issues for health care professionals.
105 Lauder Street
Cowansville, PQ J2K 2K8
Phone 1 888 267-3555 (ext. 237)

Canadian Healthcare Association

Publication: Guidelines for the Management of Latex Allergies and Safe Latex Use in Healthcare Facilities
#100 - 17 York Street
Ottawa, ON K1N 9J6
Phone 613 241-8005

Canadian Latex Allergy Association

96 Cavan St.
Port Hope, ON L1A 3B7
Phone 905 885-5270 Fax 905 885-2839
email address This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Health Canada Medical Devices Bureau

Publication: Health Canada Latex Allergy Compendium of Non-Latex Gloves
Phone 1 800 267-9675

Ontario Ministry of Labour Professional and Specialized Services

Publication: Guidelines for Latex Glove Users
Phone 416 326-7744 and ask for Publications

Spina Bifida Association

220 - 388 Donald Street
Winnipeg, MB R3B 2J4

Workers' Compensation Board of B.C.

Phone 276-3100 in Vancouver
1 888 621-SAFE toll-free within B.C. (24 hours)

Contact Occupational Disease Services for compensation-related questions on skin problems or allergies.
Phone 276-3007 in Vancouver
1 800 661-2112 toll-free within B.C.

Information via the Internet

http://www.cdc.gov/niosh/latexalt.html

NIOSH Alert, June 1997
"Preventing Allergic Reactions to Natural Rubber Latex in the Workplace"

Latex Allergy Information Service (LAIS)

Allergy Internet Resources (AIR)

The above information can also be obtained as a printed booklet (reference number BK2) by contacting the Films and Posters Section of the WCB.

© Copyright Workers' Compensation Board of British Columbia
Richmond, B.C., Canada.  1996.  All rights reserved.  http://www.wcb.bc.ca
This information may be freely distributed but cannot be altered in any way.
 

This page last modified: February 5, 1998.