Latex allergies in health and social care

Natural rubber latex (NRL) is a milky fluid obtained from the Hevea brasiliensis tree, which is widely grown in south-east Asia. As with many other natural products, NRL contains proteins to which some individuals may develop an allergy.

HSE has a specific Skin at work website - providing information on how to prevent work-related skin diseases in your workplace – where you can get further help if you need it. The microsite contains further guidance on latex allergies and specific guidance on selecting latex gloves.

Latex in health and social care

NRL can be found in many products used in health and social care. It has been extensively used in the manufacture of medical gloves (non-sterile examination gloves, surgical gloves) because it is a very durable and flexible material giving wearers a high degree of dexterity, sensitivity and microbiological protection. It is also used in a range of medical devices.

As the use of such products has increased, particularly of single-use latex gloves in infection control, NRL allergy and sensitisation has been identified as a problem.

What is the problem?

Natural rubber latex proteins have the potential to cause asthma and dermatitis. Although rare, more serious allergic reactions such as anaphylaxis are also possible. The amount of latex exposure needed to induce sensitisation is unknown. A substance which causes sensitisation can also cause an allergic reaction in certain people. Once sensitisation has taken place, further exposure to the substance, even to low levels, may cause a reaction. Increasing the exposure to latex proteins increases the risk of inducing a sensitised state and triggering allergic symptoms.

NRL proteins can cause type I (immediate) hypersensitivity. In addition, the products manufactured using NRL proteins contain other chemicals that can cause irritant reactions and/or type IV (delayed) hypersensitivity reactions. Typical skin and respiratory problems associated with the use of NRL single-use gloves are:

Irritation. This is known as irritant contact dermatitis. NRL proteins are primarily associated with allergy, rather than irritation, so if irritant contact dermatitis develops in association with NRL glove use, the cause may be something other than NRL proteins – eg chemical additives in the gloves, sweating/occlusive effects of the gloves, or skin contamination caused by incorrect glove use. The signs and symptoms of irritant contact dermatitis can include redness, soreness, dryness or cracking of the skin. This type of reaction is not an allergic response. Once the irritant agent has been identified and its use discontinued, the symptoms will disappear and not recur.
Type lV allergic reactions or allergic contact dermatitis. This is an allergic response to the chemical additives, known as accelerators, used in the manufacture of NRL gloves. The signs and symptoms may be indistinguishable from those of irritant contact dermatitis, and so diagnosis will require clinical assessment. Sensitisation can take months or years but, once sensitised, a type IV allergic response occurs between 10–24 hours after exposure and can get worse over the subsequent 72 hours.
Type l allergic reaction. An immediate allergic reaction to NRL proteins. In rare cases can result in anaphylactic shock. Clinical reactions can involve the skin, eyes, mucous membranes and respiratory system, including localised or generalised rash (urticaria), inflammation of the mucous membranes in the nose (rhinitis), red and swollen eyes with discharge (conjunctivitis) and asthma.

Natural rubber latex in healthcare products

Single-use disposable gloves. The use of gloves as part of infection control within healthcare rose exponentially during the 1990s. There are a number of different types of gloves available. All single-use latex gloves may present a particular risk of latex allergies but the risk is reduced in gloves with lower levels of latex proteins.
Powdered gloves pose an additional risk, not only to the user but also to sensitised people in the area. This is because the proteins in the NRL glove leach into the powder, which becomes airborne when the gloves are removed, leading to the potential for inhalation exposure to the NRL proteins.

Other medical products. NRL is not only contained within single-use disposable gloves, but can also be found in a number of medical products, such as catheters, elasticised bandages, wound dressings etc. It is also in the packaging for a number of medical products. While these may pose a low risk of sensitisation, they can pose a significant risk (eg anaphylactic shock) to sensitised individuals, either patients or healthcare workers.

The majority of healthcare products containing NRL are 'medical devices' as defined by the Medical Devices Regulations 1999. Therefore, their manufacture and provision are regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA).

Recent research

In 2008, the NHS Plus Occupational Health Clinical Effectiveness Unit, in association with the Royal College of Physicians, produced evidence based guidelines for the occupational aspects of latex allergy management.

These guidelines address the likely level of risk from single-use latex gloves and have made a number of 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 non-latex gloves
In employees who are latex allergic/sensitised, taking latex avoidance measures results in symptoms reducing or disappearing
In employees with latex-induced asthma or rhinitis, the use of powder-free, low-protein gloves by colleagues reduces symptoms and indices of severity in the affected employee to a similar degree as the use of non-latex gloves by colleagues
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 sensitised to latex (without symptoms), with those with clinical latex allergy

The evidence and conclusions from the NHS Plus Occupational Health Clinical Effectiveness Unit report provide reassurance that:

using low-protein, powder-free, single-use latex gloves in the workplace is unlikely to lead to new cases of latex allergy
individuals with an existing latex allergy should take latex-avoidance measures
the health of individuals with existing latex allergy is not put at significant risk if colleagues use either low protein, powder free latex gloves or latex-free gloves. An exception might be if the affected employee has anaphylaxis. However, in all cases where employees have work-related medical conditions, competent medical advice should have been sought

Latex glove use

Employers should carefully consider the risks when selecting gloves for use in the health and social care sector. HSE has provided specific guidance on selecting latex gloves and recommends following HSE's glove selection guidance when considering glove use in the workplace (latex or otherwise),

Further information

This section provides useful links to sources of guidance, research and information on the management of dermatitis in the health and social care sector.