|<< Back to Safety and Health Information Bulletins - Table of Contents by Year
||U. S. Department of Labor
Occupational Safety and Health Administration
Directorate of Technical Support and Emergency Management
(formerly Directorate of Science, Technology and Medicine)
Office of Occupational Medicine
Safety and Health Information Bulletin
| This Safety and Health Information Bulletin is not a standard or regulation, and it creates no new legal obligations. The Bulletin is advisory in nature, informational in content, and is intended to assist employers in providing a safe and healthful workplace. Pursuant to the Occupational Safety and Health Act, employers must comply with hazard-specific safety and health standards promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, pursuant to Section 5(a)(1), the General Duty Clause of the Act, employers must provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. Employers can be cited for violating the General Duty Clause if there is a recognized hazard and they do not take
reasonable steps to prevent or abate the hazard. However, failure to implement any recommendations in this Safety and Health Information Bulletin is not, in
itself, a violation of the General Duty Clause. Citations can only be based on standards, regulations, and the General Duty Clause.
This safety and health information bulletin updates TIB 99-04-12 and informs
field personnel, employees and employers about issues regarding sensitization
and allergic reactions that have occurred in some individuals using natural
rubber latex (NRL) products, particularly gloves, in the workplace setting. This
bulletin can also provide information to personnel, especially health care staff, who use gloves as
personal protective equipment or use other NRL products in their workplace.
Natural rubber is utilized in a variety of products, including gloves, airways
(e.g., for intubation), airway masks, medication vial tops, anesthesia bags,
various catheters, supplies for intravenous use, dental dams, balloons, and
other items.1,2,3 NRL glove use in the health care setting has risen
dramatically since about 1987 due to increased awareness about the risk of contracting HIV, hepatitis B and C, and other
infectious agents in the course of delivering health care to patients.1,4 Thus,
the frequency of exposure to NRL among health care and other employees has
NRL products are also used to provide barrier protection from disinfectants and
other chemicals and agents in health care and other environments. (NOTE: While
NRL gloves provide an effective barrier for certain purposes, they are not
universally suitable. The material properties and construction of a glove
suitable for barrier protection must be determined in advance of use. Gloves
appropriate for protection from the particular chemical or agent must be used).
In some workplaces (e.g., electronics, drug manufacturing, and food
preparation), gloves are used to prevent contamination of products. NRL gloves
have also appeared in some workplaces where there is a perceived need to protect
employees from an exposure such as toll booths, post offices, and day care
settings. Natural rubber-containing articles are manufactured in a variety of
workplaces (e.g., manufacturers of medical gloves, industrial gloves, balloons,
rubber bands, boots and shoes, and many other products).
With more widespread use of NRL gloves after 1987
there was an increase in reported NRL sensitization and allergic reactions among
patients and among employees, notably health care employees. In rare cases,
these allergic reactions can be fatal. In addition to reports from the
dermatology, allergy, and pulmonary literature of severe skin and respiratory
symptoms, life threatening reactions associated with use of NRL products have
been noted in pediatric patients with spina bifida who had repeated NRL exposure
from numerous surgical procedures.5,6,7
In addition, the U.S. Food and Drug
Administration (FDA) received reports of numerous severe allergic reactions
among NRL-allergic patients, including some deaths, associated with the use of
NRL enema cuffs and gloves.8
NRL is found in a variety of plants but is mainly harvested from the rubber
tree, Hevea brasiliensis. The tree's milky fluid (latex) contains variable
amounts of proteins. These proteins, when present on a glove or adsorbed to
glove powder, may be absorbed through the skin or inhaled. Many of these
proteins have been characterized, with a number of them designated as allergens
by the International Allergen Nomenclature Committee.9 Studies regarding these
allergens are ongoing; some researchers have noted that up to 60 protein
variations in NRL may be allergenic, or capable of causing sensitization in some
Some of these proteins, including some that are allergenic for some individuals,
can be eliminated through the use of various processing techniques. A number of
studies indicate that corn starch powder, often added to gloves to facilitate
removal, serves as a carrier for the allergenic proteins from the NRL.2,3,13,14
In this document, "sensitization" or "sensitized" refers to the presence of an
immunoglobulin (IgE) response to allergenic protein exposure. An individual may
or may not show any symptoms of allergy, even though they are sensitized.
"Allergic response" refers to a skin reaction in response to a skin prick test.
"Allergic reaction" refers to (1) local reactions such as a skin reaction in the
area of exposure in response to wearing gloves or a glove challenge test, and
(2) systemic reactions, which occur beyond the body areas of exposure and lead
to various symptoms. This document refers to local or systemic allergic
reactions that cause symptoms as "symptomatic."
In addition to the above concerns, gloves, including those made from NRL as well
as some other materials, may contain chemical accelerators such as thiurams,
carbamates, and benzothiazoles to which an employee may develop an allergic
dermatitis. Antioxidants, biocides, soaps, and other chemicals used in the
processing of NRL products may also contribute to this type of reaction.
Occupational Exposure Routes
The two major routes of occupational exposure are dermal contact and inhalation. Inhalational exposure can occur particularly when glove powder acts as a
carrier for NRL protein, which becomes airborne when the gloves are donned, or removed.2,3,13
Allergenic proteins appear to be only a portion of
the total protein content of NRL gloves. It has been noted that gloves with lower protein concentration caused fewer positive responses to skin prick tests
than gloves with higher protein concentration;15 also, higher total protein levels found on a glove generally have included high levels of NRL allergenic
proteins.16 However, several investigators have reported that glove NRL total protein content may not necessarily correlate with allergenic protein
content, especially at lower protein levels.16,17,18,19 A number of workplace interventions have indicated that powder-free gloves with either lower total
protein or lower allergenic protein content reduced risk of sensitization to allergenic NRL proteins or allergic reactions in persons already
sensitized.20,21,22,23,24 Importantly, most interventions have included the provision, and most investigators recommend, that only non-NRL gloves be used by
those employees who are sensitized to or have exhibited allergic reactions to NRL proteins.
The majority of health care employees are able to use
NRL products to care for most patients. However, some employees may develop
sensitivity to NRL upon repeated exposure. Variations exist in the reported
prevalence of NRL allergy. This variation is probably due to different levels of
exposure and methods of estimating NRL sensitization or allergy, as well as
different study populations and sampling methods. The prevalence statistics in
the studies mentioned below are based on seroprevalence, skin prick test
positivity and/or allergic manifestations, and do not refer to the more serious
anaphylactic response, which is rare but potentially life threatening in some
individuals. In one example of an investigation of health care employees, a
survey of active duty dental officers in the U.S. Army reported that the
prevalence of allergic symptoms correlated with NRL use was 13.7%.27
An investigation of dental employees using NRL
skin prick testing at two consecutive American Dental Association meetings
in 1994 and 1995 revealed
allergic responses in 9.1-9.7% of dental hygienists and assistants, although
dentists showed a lower rate of 5.1-6.7%.28
A 2000 - 2002 study of dental
hygienists using NRL skin prick testing found allergic response in 4.8% of those
A study of 247 nurses recruited at a
nurses' association meeting revealed that 6.9% responded to a natural rubber
latex extract skin prick test, although the rate for positive skin prick test
together with a history of symptoms associated with latex was somewhat less
Another article concluded that 8.9% of 741 inpatient
nurses were seropositive for anti-latex antibodies, an indication of
sensitization.31 A study of 168 anesthesiologists and nurse
anesthetists determined that 12.5% were sensitized (anti-latex IgE antibody
positive), but only 2.4% had experienced allergic symptoms.32
Several papers have also addressed sensitization or allergic response prevalence
rates in the general population or in populations perceived to be surrogates for
the general population. Examples include: (1) a study of volunteer blood donors
which determined that 6.4% were seropositive for antilatex IgE antibodies,
indicating sensitization to NRL;33 and (2) a report that 6.7% of 996 ambulatory
surgery patients were sensitized to NRL (IgE anti-latex antibodies).34 In a
review of a large number of prevalence studies in occupationally exposed groups,
as well as in general populations in North America and Europe, 2.9% -12.1% of
occupationally exposed groups, and under 2% of general population groups,
reacted to skin prick testing, indicating allergic response to NRL.35 A later
analysis of prevalence studies found 6.9% to 7.8% of health care employees and
2.1% to 2.7% of the general population reactive to skin prick testing.36
Health care employees particularly affected include operating room personnel,
dental patient care staff, special-procedure and general-medical nurses,
laboratory technicians, and hospital housekeeping personnel consistently exposed
to NRL.1,37 NRL
sensitization or allergic response or reaction has also been reported in
greenhouse employees,38 hairdressers,39 doll manufacturing employees,40 and
employees in a glove manufacturing plant.41
Types of Reactions
Use of natural rubber products may result in reactions that fall into the
following three categories (See also Types of Reactions table):
- irritant contact dermatitis;
- type IV delayed hypersensitivity (also called
allergic contact dermatitis); and
- type I immediate hypersensitivity (also called
IgE/histamine mediated allergy).
These categories include reactions that vary from
localized redness and rash; to nasal, sinus, and eye
symptoms; to asthmatic manifestations, including
cough, wheeze, shortness of breath, and chest
tightness; to in some cases, severe systemic
reactions with swelling of the face, lips, and airways
that may progress rapidly to shock and, potentially,
When gloves are associated with skin lesions, the most common reaction is
irritant contact dermatitis. Irritant contact dermatitis may be due to direct irritation from gloves or glove powder or may be due to other causes, such as
irritation from soaps or
detergents, other chemicals, or incomplete hand drying. Irritant contact
dermatitis presents as dried, cracked, split skin. Although irritant contact
dermatitis is not an allergic reaction, the breaking of the intact skin barrier
due to these lesions may afford a pathway for NRL proteins to gain access, and
thus promote development of sensitization.42,43,44 In addition, irritant contact
dermatitis lesions disrupt the barrier function that intact skin provides to
inhibit passage of various chemicals and pathogens.
The second type of reaction that may be associated with glove use is allergic
contact dermatitis (also known as type IV delayed hypersensitivity or allergic
contact sensitivity). When glove use has been associated with this reaction, the
majority of cases
appear to be due to the chemicals used in processing NRL or other glove
materials; a small percentage of these reactions have been reported to be due to
NRL.45,46 The allergic contact dermatitis has an appearance similar to the
typical poison ivy reaction, with blistering, itching, crusting, oozing lesions.
Also, like poison ivy, this dermatitis appears 24-72 hours after the use of
gloves or exposure to other sources of chemical sensitizers.
The third and potentially most serious type of reaction sometimes associated
with glove use is a true IgE/histamine-mediated allergy (also called immediate
or type I hypersensitivity) to allergenic glove protein [in the case of NRL
allergy, to allergenic NRL protein(s)]. This type of reaction can involve local
or systemic symptoms. Localized reactions occur at the site of exposure. For
example, contact urticaria (hives), appearing in the area where contact
occurred, is a localized reaction.
Allergic rhino conjunctivitis and asthma following exposure to airborne allergen
are localized reactions. Generalized reactions are those occurring at sites in
the body distant from the site of exposure. For example, rhinitis or asthma
after a skin exposure (or
hives at a site other than where the exposure occurred) is a generalized
reaction. The presence of allergic manifestations to allergenic NRL protein
indicates an increased risk for anaphylaxis, a rare but severe reaction
experienced by some individuals
who have developed an allergy to certain allergenic proteins (e.g., those
present in NRL, some foods). A type I reaction can occur within seconds to
minutes of exposure to the allergen (in the case of NRL, to allergenic natural
rubber proteins), either
by touching a product with the allergen (e.g., gloves) or by inhaling the
allergen (e.g., powder to which natural rubber proteins from gloves have
adsorbed). When such a reaction begins in highly sensitive individuals, it can
progress rapidly from
swelling of the lips and airways to shortness of breath, and may progress to
shock and death, sometimes within minutes.
Any of these allergic signs and symptoms may be the first indication of
development of sensitization. Sensitized employees with exposure to allergenic
NRL proteins can develop allergic reactions such as skin (contact urticaria)
and/or respiratory symptoms. A number of studies indicate that individuals with
NRL allergy are more likely than NRL non-allergic persons to be atopic
(individuals with an increased susceptibility for IgE response to common
allergens, with symptoms such as asthma, eczema, or allergic rhinitis),30,47,48
or that atopic individuals have an increased risk for developing sensitization
to allergenic NRL proteins.48 Once symptomatic NRL allergic responses occur,
allergic individuals have continued to experience symptoms on exposure to
allergenic NRL proteins. These symptoms have included life-threatening
reactions, not only on exposure to allergenic NRL proteins in the workplace, but
also upon receiving or accompanying a family member receiving health care
services at inpatient as well as office-based settings. In addition, such
reactions have occurred on exposure to consumer goods such as balloons, condoms,
and other products. Symptoms have also occurred in some persons from exposure to
plants or foods (e.g., bananas, kiwi, avocados, and chestnuts) with proteins
that are cross-reactive with NRL allergenic proteins, and allergic symptoms have
been reported by NRL allergic persons from eating foods handled by food service
employees wearing NRL gloves. Moreover, some affected individuals continue to
experience asthmatic symptoms even without known contact with NRL; long-term
treatment with steroids or other medications may be necessary for managing
symptoms in these cases. Therefore, development of symptomatic allergic
responses to allergenic NRL proteins in an individual may have lifestyle
implications beyond the workplace.
|Types of Reaction
|(1) Irritant Contact Dermatitis
||Itchy, red, inflamed, scaling, dry and cracked skin
||Direct skin irritation by gloves, powder, soaps/detergents,
incomplete hand drying
||Obtain medical diagnosis,
dermatology consultation, avoid irritant product, assure glove material
provides proper barrier; consider alternative gloves/products, cotton/liners
|(2) Allergic Contact
Dermatitis (Type IV delayed hypersensitivity or allergic contact
Itchy, red, inflamed, scaling, dry and cracked blistering (similar to poison ivy
reaction); 24-72 hrs. after contact
||Accelerators (e.g. thiurams,
carbamates, benzothiazoles) processing chemicals (e.g., biocides,
Consider penetration of glove barrier by chemicals
Obtain medical diagnosis, dermatology consultation; identify chemical. Consider
use of glove liners such as cotton. Use alternative glove material without
chemical. Assure glove material is suitable for intended use (proper barrier)
|(3) NRL Allergy - IgE
mediated (Type 1 immediate hypersensitivity)
||NRL proteins; direct
contact/breathing NRL proteins including glove powder containing NRL
proteins, from powdered NRL gloves/environment
(3)(b), and (3)(c):
Obtain medical diagnosis, allergy consultation; substitute non-NRL gloves
and other non-NRL products for affected worker
Eliminate exposure to glove powder - use of reduced allergen, powder free
gloves or non-NRL gloves for coworkers (assure glove material provides a
Clean NRL-containing powder from environment
Consider NRL safe environment
|(3)(a) Localized contact
||Hives in area of contact with
||Wearing NRL gloves or other
direct contact with NRL allergenic proteins
|(3)(b) Other Allergic
||Allergic rhinitis, allergic
||Exposure to aerosolized NRL
allergenic protein. Key role - glove powder
|(3)(c) Generalized Reaction
||Manifesting as: generalized
urticaria, asthma, upper respiratory symptoms, and/or flushing, rapid pulse,
falling blood pressure, weakness. Can progress to anaphylactic shock
||Exposure to NRL allergenic
proteins by any one of several routes
Recommended Strategies - Risk Reduction
It is of primary importance that barrier protection be used when hands would
otherwise contact infectious materials or hazardous chemicals. OSHA's Bloodborne
Pathogens Standard (29 CFR 1910.1030) requires that gloves be worn when it is
reasonably anticipated that hand contact may occur with blood, other potentially
infectious materials, mucous membranes, non-intact skin, or contaminated items
or surfaces, as well as when performing vascular access procedures [except as
specified in paragraph (d)(3)(ix)(D)]. When gloves are being worn to protect
against bloodborne pathogens, the standard requires that employers
provide readily accessible alternatives (e.g., glove liners) for employees who
are allergic to the gloves normally provided. NRL is a glove material that has
been used in the health care environment for barrier protection for a number of
years. In response to reported NRL allergy in some patients and health care
employees, measures have been recommended to reduce the risk of reactions to
allergenic NRL proteins in employees.
Primary prevention involves reducing potential development of allergy by
reducing exposure to NRL allergenic proteins for all employees. Food service
employees, for example, use gloves as a
barrier to infectious agents that may be present on
their hands, and alternative gloves are available for
food handler use. Alternative materials are
appropriate for employees engaged in tasks such as gardening activities. Gloves
made of NRL as well as alternative materials have been cleared for marketing as
medical gloves by the FDA and can be used effectively for barrier protection
against bloodborne pathogens.49,50 General administrative procedures* that a
facility can follow to reduce employee exposure to NRL proteins include:
- If selecting NRL gloves for employee use,
designating NRL as a choice only in those
situations requiring protection from infectious agents;
- If selecting NRL gloves, choosing those that
have lower allergenic protein content. Selecting
powder-free gloves affords the additional benefit of
reducing response to environmental exposure; and
- Providing alternative suitable non-NRL gloves as
choices for employee use (and as required by
OSHA's bloodborne pathogens standard [29 CFR
1910.1030, paragraph (d)(3)(iii)] for employees
who are allergic to NRL gloves).
Use of powder-free gloves has been shown to
reduce the dissemination of NRL proteins into the
environment and decrease the likelihood of reactions
by both the inhalation and dermal routes.2,14,23,51
Appropriate work practices when wearing hand protective
equipment, including NRL gloves, include
avoidance of contact with other body areas such as
the eyes or face. Handwashing after glove removal
is required by OSHA's Bloodborne Pathogens
Standard [paragraph (d)(2)(v)] and helps to
minimize powder and/or NRL remaining in contact
with the skin. Thorough clean-up of any residual
powder in the workplace using HEPA vacuums for
porous surfaces and either HEPA vacuums or wet
methods for nonporous surfaces will decrease
employees' exposure as well.
Since the reason for wearing gloves is to provide
barrier protection from hazardous substances,
substitute materials must maintain an adequate
barrier protection and be appropriate for the hazard.
At a minimum, gloves made from NRL or other
materials and used for a medical purpose should be
labeled as medical gloves. Such gloves must meet
the FDA criteria for marketing, manufacturing, and
testing of medical gloves.
One institution has reported that a coordinated effort to identify NRL
sensitized individuals and reduce the use of "high allergenic" natural rubber
latex gloves substantially reduced aeroallergen levels and costs.4 Another study
reported that some NRL allergic employees have been able to work wearing
nonlatex gloves when their coworkers wore powderfree latex gloves.52 Several
publications have reported on the benefits of a facility-wide use of only lower
protein, powder-free gloves (with already sensitized employees using non-latex
gloves). These benefits include a decrease in cases of occupational asthma
and other clinical latex allergy symptoms,54 and a decrease in latex allergic
response confirmed by skin-prick test.22,55 The Department of Veterans Affairs
mandated a restricted use of latex gloves by hospital employees in July of 1998,
and a prevalence study done during
1999-2001 found sensitization documented by IgE response in only 36 of 1,959
hospital employees (1.8%).56 A teaching hospital, which converted to
low-protein, powder-free gloves, reported that costs related to missed workdays
and workers compensation claims were reduced. This reduction suggested an
overall financial benefit from this approach.22 Another institution studied
several facilities, demonstrating that regardless of size, reduced disability
and costs could be obtained by replacing NRL exam gloves with gloves of
FDA requires labeling
statements for medical devices that contain natural rubber and prohibits the use
of the word "hypoallergenic" to describe such products.8 NRL gloves with a
reduced level of chemical accelerators were once called "hypoallergenic";
however, they must now be labeled to eliminate confusion associated with the
former "hypoallergenic" claim and to provide more specific information to the
user. Some NRL gloves and other devices produced before the effective date of
the FDA regulation (September 30, 1998) may not carry the NRL labeling or may be
labeled "hypoallergenic". If such products are found in a facility, these items
should not be presumed to be
NRL-free; these gloves may still contain the NRL allergenic proteins to which
NRL sensitized employees can react. It is important to note that these FDA
regulations do not apply to non-medical devices, including utility gloves or
food handling gloves.
Recommended Employee Evaluation and Management
The procedures outlined above may not be sufficient to protect all individuals
who have already developed allergic symptoms on exposure to NRL allergenic
proteins. Health care facilities should develop policies and procedures for
reducing the risk of allergic reactions to NRL allergenic proteins in the
workplace. The American College of Allergy, Asthma, and Immunology has suggested
that "safe zones" (areas in which non-NRL products are used and NRL allergenic
proteins have been removed from the environment) may be needed to protect those
employees who are already sensitized to NRL allergenic proteins.5
Prudent risk reduction strategy involves an initial survey and assessment, with
a coordinated effort to identify and catalogue all NRL products used in the
workplace. An ongoing program, involving close coordination with resource and
materials management staff, should be established to monitor the NRL content of
incoming products so that management staff can be prepared to choose appropriate
products for offering non-NRL alternatives/low allergen content products to
control NRL allergenic protein exposure, as well as for creating NRL safe
zones.2 The contribution of glove powder to allergenic protein levels in the
workplace environment should also be considered and use of non-powdered gloves
should be in place for reporting, evaluating, and managing cases of employees
who experience allergic symptoms related to exposure to NRL allergenic proteins.
It is not possible, at present, to determine which employees will become
sensitized or symptomatic on exposure to NRL allergenic proteins. Moreover,
the extent of an individual employee's reaction, or
the length of time required for such allergic reactions
to develop in a sensitized employee, cannot be
ascertained.3 Finally, it is not possible, at present, to
predict which individuals will progress from
sensitization or from local contact urticaria to more
dangerous allergic reactions, nor when this
progression may occur.2,3 Laboratory and clinical
evidence indicates that an association exists between
allergy to some natural rubber proteins and allergy
to some proteins in certain foods and plants (e.g.,
avocado, banana, kiwi, chestnut)58,59 and some
aeroallergens (e.g., pollens, grasses).60,
61 A history
of multiple surgeries has also been reported to be a
risk factor for NRL allergy.2,5 In some institutions,
periodic screening questionnaires for NRL allergic
symptoms in employees with current or past history
of significant NRL exposure (e.g., surgical
personnel) have been useful for ascertaining reaction
rates and managing those individuals experiencing
reactions.3,5 Questionnaires and diagnostic testing
have been determined to provide useful information
as part of exposure control in a hospital
occupational health program.22 A medical evaluation
of hand dermatitis by a physician experienced in
dermatologic diagnoses is essential for taking
preventive steps and assuring effective therapeutic
measures. Evaluation of signs/symptoms consistent
with allergic responses to some NRL proteins
should be accomplished under the direction of a
physician with expertise in NRL allergy, with
additional medical testing and treatment made
available if indicated.
Provision of NRL-free procedure trays and crash carts for treatment of natural
rubber allergic individuals has been recommended.62 Although the fundamentals of
emergency response (i.e., assuring an open airway, breathing, and circulation)
remain of primary importance should an employee develop symptoms (including
those caused by allergy to some NRL proteins) requiring resuscitation, the
emergency needs of NRL-allergic individuals should be anticipated in the
workplace, including provision of immediate access to non-natural rubber latex
containing equipment needed for successful treatment.
Investigation continues into various aspects of NRL sensitization and allergic
response; our understanding of these issues continues to evolve. Meanwhile,
employers and employees need to be aware of the present state of knowledge
regarding sensitization and allergic reaction to some NRL proteins and how to
address these issues.
Employees should be advised of symptoms that are consistent with allergic
reactions as well as primary and secondary preventive measures for decreasing
the risk of (1) development of sensitization to NRL
proteins and (2) symptomatic responses in
employees who are sensitized.
NIOSH published a 1997 Alert titled Preventing Allergic Reactions to Natural
Rubber Latex in the Workplace (NIOSH publication number 97-135). NIOSH can be
reached by calling 1-800-35-NIOSH (800-356-4674), or through the Internet.
OSHA field staff and consultation
be aware of the potential for sensitization and possible allergic reaction to
some NRL proteins among some individuals in workplaces where NRL products such
as gloves are used.
Edwin G. Foulke, Jr.
Occupational Safety and Health Administration
- Hunt LW, Fransway AF, Reed CE, et al. An
epidemic of occupational allergy to latex involving health care workers. J Occup
Environ Med. 1995 Oct; 37(10):1204-9.
- McCormack B, Cameron M, Biel L. Latex
sensitivity: an occupational health strategic
plan. AAOHN J. 1995 Apr; 43(4):190-6.
- Korniewicz DM, Kelly KJ. Barrier
protection and latex allergy associated with
surgical gloves. AORN J. 1995 June; 61(6):1037-44.
- Hunt LW, Boone-Orke JL, Fransway AF,
et al. A medical-center-wide,
multidisciplinary approach to the problem
of natural rubber latex allergy. J Occup
Environ Med. 1996 Aug;38(8):765-70.
- American College of Allergy, Asthma, and
Immunology position statement. Latex
allergy - an emerging healthcare problem.
Ann Allergy Asthma Immunol. 1995 Jul;75(1):19-21.
- Kelly KJ, Setlock M, Davis JP. Anaphylactic
reactions during general anesthesia among
pediatric patients - United States. MMWR
- Cawley M, Shah S, Gleeson R, et al. Latex
hypersensitivity in children with
myelodysplasia. J Allergy Clin Immunol.
- US Food and
Drug Administration. Federal Register Notice. Final Rule: Natural Rubber-
Containing Medical Devices; User Labeling. 1997 Sept 30;62(189):51021-51030.
- Sussman G, Beezhold D, Kurup V.
- Kurup V, Alenius H, Kelly K, et al. A two-dimensional
electrophoretic analysis of latex
peptides reacting with IgE and IgG
antibodies from patients with latex allergy.
Int Arch Allergy Immunol 109(1):58-67,
- Posch A, Chen Z, Wheeler C, et al.
Characterization and identification of latex
allergens by two-dimensional
electrophoresis and protein
microsequencing. J Allergy Clin Immunol
- Alenius H, Kurup V, Kelly K, et al Latex
allergy: frequent occurrence of IgE
antibodies to a cluster of 11 latex proteins in
patients with spina bifida and histories of
anaphylaxis. J Lab Clin Med 1994;123:712-20.
- Tomazic VJ, Shampaine EL, Lamanna A, et
al. Cornstarch powder on latex products is
an allergen carrier. J Allergy Clin Immunol.
- Charous B, Schuenemann P, Swanson M.
Passive dispersion of latex aeroallergens in
a healthcare facility. Ann Allergy Asthma
- Turjanmaa K, Laurila K, Makinen-Kiljunen
S, Reunala T. Rubber contact
urticaria. Allergenic properties of 19 brands
of latex gloves. Contact Dermatitis 1988;19:362-7.
- Petsonk, E. Couriers of asthma: antigenic
proteins in natural rubber latex.
Occupational Medicine: State of the Art
Reviews. Philadelphia. Hanley & Belfus,
Inc. 2000 Apr-June;15(2):421-9.
- Mahler V, Fischer S, Fuchs T, et al.
Prevention of latex allergy by selection of
low-allergen gloves. Clin Exp Allergy 2000;30:509-20.
- Tomazic-Jezic V, Lucas A. Protein and
allergen assays for natural rubber latex
products. J Allergy Clin Immunol
- Brehler R, Rutter A, Kutting B. Allergenicity
of natural rubber latex gloves. Contact
- Levy D, Allouache S, Brion M, et al. Effect
of powdered vs. nonpowdered latex gloves
on the prevalence of latex allergy in dental
students. J Allergy Clin Immunol. 1998;
- Sary M, Kanani A, Alghadeer H, et al.
Changes in rates of natural rubber latex
sensitivity among dental school students and
staff members after changes in latex gloves.
J Allergy Clin Immunol 2002;109:131-5.
- Tarlo S, Easty A, Eubanks K, et al.
Outcomes of a natural rubber latex control
program in an Ontario teaching hospital. J
Allergy Clin Immunol 2001;108:628-33.
- Allmers H, Schmengler J, Skudlik C.
Primary prevention of natural rubber latex
allergy in the German health care system
through education and intervention. J
Allergy Clin Immunol 2002;110:318-23.
- Elliott B. Latex allergy: the perspective from
the surgical suite. J Allergy Clin Immunol
- Hunt L, Kelkar P, Reed C, Yunginger J.Management of occupational allergy to
natural rubber latex in a medical center: the
importance of quantitative latex allergen
measurement and objective follow-up. J
Allergy Clin Immunol 2002;110:S96-106.
- American College of Allergy, Asthma, and
About latex allergies. posted Dec 9, 1998, revised March
2006, accessed October 27, 2006.
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*The American Academy of Allergy, Asthma, and Immunology and the American
College of Allergy, Asthma, and Immunology (ACAAI) issued a joint statement on July 21, 1997, which advises that
latex glove purchase and use should consist of only low-allergen, powder-free latex gloves. The National Institute
for Occupational Safety and Health (NIOSH) also recommends that if latex gloves are chosen, provide and use reduced
protein, powder-free gloves.37 A 1998 Guideline for infection control in health care personnel, consisting of
consensus recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC) to the CDC, included
several recommendations regarding latex hypersensitivity, but did not include advice about use of powder-free
gloves throughout an institution and made no recommendation for institution-wide substitution of non-latex products in
health care facilities to prevent sensitization
to latex (Am J Infection Control 1998;26:339).