Log in Register

Login to your account

Username *
Password *
Remember Me

Create an account

Fields marked with an asterisk (*) are required.
Name *
Username *
Password *
Verify password *
Email *
Verify email *
Captcha *

Captcha Image Reload image challenge


Periodontics

Authors: Dr. Tanay V. Chaubal,Dr. Arvind Shetty,Dr. Devanand Shetty.

Irritant contact dermatitis due to the use of latex gloves is a well-known condition seen commonly in health care professionals and particularly dental clinicians. Professionals should not overlook the fact it is our duty report such cases and encourage the development of new materials which act as effective barriers and virtually free of irritant and allergic reactions. This case report presents a unique case of irritant contact dermatitis due to the use of latex gloves, its manifestations, diagnosis, treatment and prevention.

Introduction
More than 4000 environmental chemicals have been identified as contact allergens.1 Of these, rubber glove chemicals are among the most frequent causes of allergic contact dermatitis (ACD) in health care workers, usually as a result of frequent glove use.2,3Contact allergy should be suspected in any patient who wears rubber gloves and presents with a diffuse or patchy dermatitis on the dorsal surface of the hands (skin over the metacarpal phalangeal joints, thenar, and hypothenar), wrists, and distal forearms.4

Case presentation
The following case is of a 26 year old dental student who gradually developed irritation which later developed into blisters and cracking on dorsal surface of the hand, consistent with the use of pre-powdered latex examination gloves. (Figure 1) There was no previous report of such type of reaction with the use of the same type of gloves. The clinical features were suggestive of irritant contact dermatitis. The student was told to immediately stop donning these gloves and the skin lesions were treated by local application of flucinolone (0.0025% w/w) ointment for a period of 3 months after consulting a dermatologist. (Figure 2), (Figure3).The skin lesions ceased to exist after discontinuation of the gloves and application of flucinolone. (Figure 4). He was advised to wear powder free latex free gloves. (Figure 5).

Discussion
In a latex allergy the immune system identifies latex as a harmful substance. Your immune system triggers certain cells to produce immunoglobulin E (IgE) antibodies to fight the latex component (the allergen). The next time body or the host comes in contact with latex; the IgE antibodies sense it and signals the immune system to release histamine and other chemicals into the bloodstream. These chemicals cause a range of allergic signs and symptoms. Histamine is partly responsible for most allergic responses, including runny nose, itchy eyes, dry throat, rashes and hives, nausea, diarrhea, labored breathing, and even anaphylactic shock.5

 

   
figure 1_baseline figure 2_after 7 days

Latex sensitivity can occur in two ways viz direct contact or inhalation. Most common cause of latex allergy is direct contact, such as by wearing latex gloves or by contact with latex-containing products. Once the body has direct contact with latex, it becomes sensitized. Sensitization is the process in which the immune system learns to recognize and attack allergens, causing an allergic reaction. Latex allergy can also be developed by inhaling latex particles. Latex products, especially gloves, shed large amounts of latex particles, which can become airborne. Cornstarch is sometimes used on the inside of gloves to make them easier to put on and take off. The cornstarch absorbs latex proteins, but when the gloves are snapped during application or removal, the latex-laden particles fly into the air. The amount of airborne latex from gloves differs greatly depending on the brand of glove used.6People who are allergic to latex often have a reaction after being in contact with the latex in rubber gloves. Three types of reactions can occur with latex gloves. Firstly, irritant contact dermatitis which is the most common reaction to protective gloves. It isn't an actual allergy but most likely due to sweating or rubbing under the gloves or from detergents left on the hands before wearing them. This rash occurs most often in people who wear protective gloves, such as dental and health care workers. Irritant contact dermatitis usually makes your skin appear red, dry and cracked.Secondly, allergic contact dermatitis which is a reaction to the latex or chemical additives [Thiuram, Carbamates, MBT] used during the manufacturing process. The chemicals added to latex can cause a skin rash 24 to 48 hours after contact. The rash usually starts on the parts of your skin that have come in contact with latex, and then may spread to other areas.

 

     
figure 3_after 1 month  figure 4_after 2 years figure 5_powder free latex free gloves

You may also have oozing blisters.Thirdly, Hypersensitivity immune system response which is an actual latex allergy. It occurs when the immune system reacts to proteins found in natural rubber latex. In a latex allergy, exposure to latex may cause immediate reactions, such as itching, redness, swelling, sneezing and wheezing.7 Screening and diagnosis – along with proper history, following tests confirm the diagnosis. Skin test in which small amounts of latex are placed on the skin of the forearm or back and then it is pricked with a needle, to allow a tiny amount of the substance beneath the skin surface. Allergy to a particular substance being tested is diagnosed when a raised bump is observed and a blood test can measure the immune system's response to latex by assessing the amount of allergy-type antibodies in the bloodstream, known as immunoglobulin E (IgE) antibodies. The blood sample is sent to a medical laboratory, where it can be tested for sensitivity to latex.8In treatment although medications are available to reduce the symptoms of latex allergy, there is no cure for latex allergy. Treatment is based on prevention. The only way to prevent an allergic reaction is to avoid products that contain latex.8 However, despite best efforts, contact with latex that causes a severe reaction. In this case, an emergency injection of adrenaline (epinephrine) and a trip to the emergency room is needed. For less severe allergies, use of corticosteroids, antihistamines can be taken after exposure to an allergen to control the reaction and help relieve discomfort. Creams may relieve skin reactions brought on by a latex allergy. The best way to prevent an allergic reaction is to avoid latex viz. reduce your exposure, choose alternative gloves. If wearing gloves at work are mandatory, choose gloves made without latex. Vinyl gloves work in many situations, but aren't as effective at protecting you from hepatitis or HIV transmission. Many other types of synthetic gloves work just as well as latex gloves for stopping disease transmission, but they can be more expensive. Use nonlatex gloves for activities that are not likely to involve contact with infectious materials (food preparation, routine housekeeping, maintenance, etc.). Appropriate barrier protection is necessary when handling infectious materials. If latex gloves are chosen, usage powder-free gloves with reduced protein content is advised.6

Brand Name
1]  Dermaprene
2]  Neolon
3]  Elastyren
4]  Tactylite
5]  Pure advantage
6]  Allegard


Conclusion: Clearly, we need gloves that provide excellent barrier protection, surgeon comfort, and acceptable cost. Ideally if glove of latex is used it should be powder free with very low in extractable latex protein, and have the smallest concentration and the fewest number of residual chemicals from manufacturer.
References:

  1. De Groot ACedPatch Testing: Test Concentrations and Vehicles for 4350 Chemicals. Wapserveen, the Netherlands Acdegroot Publishing 2008.
  2. Estlander TJolanki RKanerva LDermatitis and urticaria from rubber and plastic gloves.Contact Dermat 1986; 14 (1) 20-25.
  3. Von Hintzenstern JHeese AKoch HUPeters KPHornstein OPFrequency, spectrum and occupational relevance of type IV allergies to rubber chemicals.Contact Dermat 1991; 24 (4) 244-252.
  4. Taylor JS, Wattanakrai P, Charous BL, Ownby DRYearbook focus: latex allergy.Thiers BHLang PGeds.1999 Yearbook of Dermatology and Dermatologic Surgery. St Louis, MO Mosby1999;1-44.
  5. Miri S Pourpak, Zarinara A et al.Prevalence of type I allergy to natural rubber latex and type IV allergy to latex and rubber additives in operating room staff with glove-related symptoms [published correction appears in Allergy Asthma Proc. 2008; 29(2):224].Allergy Asthma Proc 2007;28 (5) 557-563
  6. Lundberg M, Wrangso K, Johansson S G O. Latex allergy from glove powder – an unintended risk with the switch from talc to cornstarch. Allergy 1997; 52;1222-1228.
  7. Nettis E, Assennato G, Ferrannini A, Tursi A.Type I allergy to natural rubber latex and type IV allergy to rubber chemicals in health care workers with glove-related skin symptoms.Clin Exp Allergy 2002;32 (3) 441-44.
  8. Taylor JSErkek ELatex allergy: diagnosis and management.Dermatol Ther 2004;17 (4) 289-301.