Correspondence

Anaphylactic Reaction to Latex Gloves

N Engl J Med 1993; 329:279-280July 22, 1993

Article

To the Editor:

A 40-year-old cardiac-catheterization nurse reported that she had marked scleral edema and throat irritation after being exposed to latex. In order to work, she put vinyl liners inside latex gloves. When vinyl gloves were not available, she was given sterile surgical gloves (Ultraderm, Baxter Healthcare, Valencia, Calif.), “specially formulated for hands allergic to latex.” Ninety minutes after she put on the gloves, scleral edema developed, requiring treatment with epinephrine and intravenous steroids.

When questioned, the manufacturer stated that the gloves were latex powdered with cornstarch. The phrase “specially formulated” referred to the removal of antioxidants thought to contribute to “allergic” contact dermatitis due to latex1. There is no reason to believe that the removal of antioxidants mitigates the potentially far more serious problem of an anaphylactic reaction to latex.

The patient underwent skin-prick testing with an extract of an Ultraderm latex glove soaked in normal saline for 20 minutes. A 5-mm wheal and a 20-mm flare appeared, and marked conjunctivitis developed 75 minutes after testing, requiring epinephrine to be controlled. Skin-prick testing with cornstarch was negative.

Latex is known to induce contact dermatitis in certain people. The use of the word “allergic” to describe this dermatitis can be confusing, since contact dermatitis is mediated through a type IV immunologic pathway. In contrast, immediate hypersensitivity to latex has been increasingly recognized, especially in health care workers2. This hypersensitivity is a true allergic (i.e., IgE mediated) condition. It may lead to life-threatening anaphylaxis in some people.

This case illustrates that increasing caution must be taken in labeling health care products. Gloves containing latex should not be marketed as though they were especially designed for those at risk for anaphylaxis to latex.

Bruce L. Wolf, M.D.
4230 Harding Rd., Nashville, TN 37205

2 References

1. 1

   Fay MF. Hand dermatitis. AORN J 1991;54:451-467
   CrossRef | Medline

2. 2

   Lagier F, Vervloet D, Lhermet I, Poyen D, Charpin D. Prevalence of latex allergy in operating room nurses. J Allergy Clin Immunol 1992;90:319-322
   CrossRef | Web of Science | Medline

Author/Editor Response

Baxter Healthcare Corporation, manufacturer of the Ultraderm Surgeons' Glove, replies:

To the Editor: Baxter shares the concern of Dr. Wolf and our customers regarding the increased incidence and reporting of type I hypersensitivity to natural-rubber latex products. Baxter has been very active in educating manufacturers and health care workers about this fairly recently identified latex allergy. We are working with several government agencies, hospitals, and academicians to evaluate and understand these allergens. Using this information, we are continually reducing levels of type I allergens in our products.

Until recently, irritant dermatitis and allergic contact dermatitis (type IV hypersensitivity) were reactions associated with rubber products. In the early 1900s, “rubber allergies” were primarily associated with accelerators and antioxidants used in latex formulations. Accelerators are catalysts that speed the formation of the rubber matrix.

In 1981, after eight years of collaboration with a consulting dermatologist, the Ultraderm Surgeons' Glove was introduced; the gloves contained only carbamates as primary accelerators. They were patch-tested in subjects known to be allergic to carbamates, and no reactions occurred. These gloves were developed to meet the needs of those allergic to accelerators and other chemicals often found in gloves.

It was not until 1987 that anaphylactoid reactions to natural-rubber latex products were determined to be IgE mediated (type I hypersensitivity). In contrast to the type IV allergic contact dermatitis, a type I reaction may include urticaria, respiratory distress, abdominal cramping, wheezing, rhinitis, angioedema, or even potentially fatal anaphylaxis. To clarify wording that earlier had been acceptable on the basis of known reactions, we are in the process of revising the labeling information for the product.

Currently, 99 percent of all surgeons' gloves used in the United States are made from rubber latex. To be prudent, one should assume that any gloves not specifically referred to as synthetic are indeed latex. The labeling information for all Baxter latex gloves, including the Ultraderm glove, is being changed to include the statement, “Contains natural rubber latex.” We recommend that anyone with type I sensitivity to natural-rubber allergens wear only synthetic gloves or, alternatively, vinyl gloves underneath latex gloves. Further research may allow manufacturers to reduce antigenic levels of allergens below the levels that may elicit a response in sensitized persons. Then, latex gloves may again be recommended.

Dr. Wolf is entirely correct in his efforts to inform readers of both the potential for anaphylactic reactions to natural-rubber latex gloves in sensitized persons and the importance of discriminating between the types of allergies to these products. It is Baxter's hope that the efforts already initiated in labeling, education, and research will help to reassure our customers of our continuing commitment to quality and innovation.

Wava Truscott, Ph.D.
Baxter Healthcare Corporation, McGaw Park, IL 60085