Abstract

About a quarter of the world’s demand for elastic products is supplied by natural rubber derived from the Hevea brasiliensis tree. Natural rubber latex (NRL) from this tree is used in the production of numerous rubber products found at home and at work including gloves, balloons, adhesive tape and bandages, condoms and catheters, rubber bands, dental dams, tourniquets and resuscitation equipment.
Allergy to certain latex proteins emerged as an occupational disease in the 1980s and continues to be an important occupational health problem as natural rubber products are used increasingly worldwide, particularly in healthcare. Symptoms of the immediate type of allergy produced range from rash, itchy or runny eyes or nose, sneezing, and coughing to chest tightness, shortness of breath and anaphylactic shock. The symptoms experienced depend in part on the route of exposure, which can be by direct contact with skin or mucosa, or by inhalation. Although there is a large body of research on latex allergy, few studies have examined occupational health interventions. This systematic review summarises current evidence and is intended to assist occupational health professionals, managers and other interested parties in providing advice on occupational health interventions to address the problem of latex allergy from both individual and institutional perspectives. The review is concerned particularly with issues relating to gloves, as these represent by far the main occupational use of latex. Latex allergy of the immediate type is distinguished in this review from contact dermatitis caused by delayed hypersensitivity (type IV allergy) to chemicals that are added to latex during processing. The main focus of this review is on type I or immediate-type allergy to latex proteins, which has a reported prevalence of up to 17% in certain occupational groups.

Key findings and recommendations
• 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 nonlatex 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 the use of non-latex gloves by colleagues.

Latex allergy: occupational aspects of management
• 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 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.

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