Prevalence of latex allergy among operating room employees in the Netherlands

In the present situation, latex hypersensitivity among healthcare workers is a
well-known and acknowledged occupational disease. An IgE mediated allergy to
latex can induce reactions ranging from (work related) urticaria and
rhinoconjunctivitis to asthma and even anaphylactic shock and is therefore a
serious health problem. Health care workers are especially at risk due to their
frequent contact with rubber gloves.

Powder (from maize meal) in powdered NRL gloves plays an important role in the
sensitisation process in glove wearing employees, since latex allergen can bind
to it. When this powder subsequently becomes airborne, employees are exposed to
latex allergen and sensitisation can occur via inhalation.

The use of protective gloves by health care workers has increased since the era
of acquired immunodeficiency syndrome (AIDS). This increase has led to numerous
undesirable cutaneous and mucosal effects, such as IgE mediated reactions. In
the 1990s, the prevalence of NRL allergy in health care workers had been
estimated at up to 40%.
In a systematic review published in 2006, natural latex allergy was found in
4.32% of health care workers. The decrease in new cases has been attributed to
an overall reduction in NRL exposure by introduction of low-allergen (often
powder-free) NRL gloves or allergen free non NRL gloves in health care
facilities.

In 1997 and 1998, two studies on the prevalence of latex allergy among Dutch
health care workers regularly wearing NRL gloves have been performed. Both
studies were carried out in Erasmus Medical Centre, Rotterdam. These studies,
among employees of the immunology department on the one hand and the operating
rooms on the other hand, showed prevalence figures of respectively 8.3% and
14.1%.

In order to reduce the sensitisation prevalence among Erasmus Medical Centre
employees, the board of Directors changed the hospital glove policy: In 1998
powdered research NRL gloves were replaced by non powdered NRL gloves and 1
year after, the same replacement was realized for sterile surgical NRL gloves.

Research questions:
What is the current prevalence of latex allergy among operating room employees
from Erasmus Medical Centre, Rotterdam? Is the sensitisation prevalence
significantly lower compared to the prevalence before introducing non powdered
sterile surgical NRL gloves for operating room employees?

Study design:
Glove wearing operating room employees from Erasmus Medical Centre,
(n = 328) older than 18 years will be asked to participate. Biographic data,
data on job characteristics and (work related) respiratory symptoms will be
gathered by means of a questionnaire. Also skin prick tests with allergen
extracts will be performed including a latex extract from a surgical glove and
commercial available latex (soluprick ALK 960), cross reacting foods such as
kiwi, avocado, banana and common inhalalant allergens. Additionally, blood
samples will be taken for additional recombinant RAST tests.

Burden and risks:
A systemic severe reaction after a skin prick test (an allergic reaction to the
skin test) is rare, because only a minimum amount of allergen is used. Local
itchiness can occur. Apart from the direct skin reaction (after 15 minutes) an
itchy swelling can appear after 6 hours. This swelling will disappear in the
next few days.
The duration of the visit amounts approximately 30 minutes.