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.
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.
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:
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).
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 evidence and conclusions from the NHS Plus Occupational Health Clinical Effectiveness Unit report provide reassurance that:
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),
This section provides useful links to sources of guidance, research and information on the management of dermatitis in the health and social care sector.