Long-term outcome of 160 adult patients with natural rubber latex allergy☆,☆☆,★

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Abstract

Allergy to natural rubber latex is a major occupational problem in the health care sector and a problem even in other occupations in which protective gloves are used. There is little information available about the long-term outcome at work in large patient populations. To study the occupational outcome when all gloves in the working environment were changed either to low-allergen latex or non-latex gloves, in 1995 to 1996 we re-examined 160 of 174 adult subjects who were diagnosed with natural rubber latex allergy between 1982 and 1994 after a median of 3 years (range, 0.5 to 24 years) after the diagnosis. The outcome in daily work or as a patient in health care was investigated with the use of a questionnaire. Special attention was paid to the assessment of the occurrence of hand eczema. Glove selection policy as an intervention in the treatment of natural rubber latex allergy is described. Of 71 health care workers and 89 non-health care workers, 72% and 83% were atopic; 54% and 65% had hand eczema at the time of diagnosis, and 89% and 19% had work-related allergy to natural rubber latex, respectively. On re-examination, none of the health care workers had changed work because of natural rubber latex allergy, and only 38% had hand eczema (significant decrease). Ninety-eight percent of the non-health care workers, of which 58% had hand eczema, continued with their previous jobs. The use of low-allergen latex or non-latex gloves throughout the health care sector seems to be an adequate step for health care workers who have natural rubber latex allergy; nonhealth care workers get along with personal avoidance of latex gloves if they are not working directly with natural rubber latexcontaining materials in production. (J Allergy Clin Immunol 2002;110:S70-4.)

Section snippets

Patients and methods

Between 1982 and 1994, 213 patients were diagnosed with allergy to NRL at the Department of Dermatology, Tampere University Hospital (TUH). Thirty-nine patients were children, who have been discussed elsewhere.5 One hundred sixty of 174 adult patients (health care workers [HCWs], 71 [44%]; nonhealth care workers [non-HCWs], 89 [56%]) were followed. The median duration of symptoms before the diagnosis was 3 years (range, 0.5 to 30 years). The mean age at diagnosis was 36 years (range, 23 to 56

SPT, RAST, challenge tests

The SPT results were positive in all but 3 patients who were challenge-positive but negative to latex-RAST. In the 157 patients whose SPT results were positive, latex-RAST was positive in 62% (observed agreement, 63%; 95% CI, 55 to 71). SPT results were also positive to NRL in 13 of 71 HCWs (18%) and 33 of 89 non-HCWs (37%) who did not recall any symptoms from NRL products, although they could be diagnosed with NRL allergy in our further studies. This happened significantly more often in

Discussion

The general outcome of the re-examination was very good. Only 2 workers at a rubber band plant had to change their tasks or to retire; the rest of the patients continued with their old jobs. This may be due to the fact that NRL allergy has been exceptionally well recognized within the TUH since the mid 1980s.

In the present study, we paid special attention to the occurrence of hand eczema, which diminished significantly in HCWs during the follow-up, but not in non-HCWs. This may be due to better

References (17)

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Supported by a grant from Tampere University Hospital and a grant from Ansell Healthcare.

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Drs Turjanmaa, Kanto, Reunala, and Palosuo and Mr Kautiainen have no significant financial interest in the commercial sponsors of this publication. They attest that there is no commercial or personal conflict of interest.

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Reprint requests: Kristiina Turjanmaa, MD, Department of Dermatology, Tampere University Hospital, PO Box 2000, FIN-33521 Tampere, Finland.

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