Overview
What is natural rubber latex?
Natural rubber latex (NRL) is a milky fluid obtained from the Hevea brasiliensis tree, which is widely grown in South East Asia, and other countries. NRL is an integral part of thousands of everyday consumer and healthcare items.
As with many other natural products, natural rubber latex contains proteins to which some individuals may develop an allergy.
Latex allergies
Natural rubber latex (NRL) proteins have the potential to cause asthma and dermatitis. More serious allergic reactions, such as anaphylaxis, are also possible.
The proteins naturally present in NRL cause the allergies either through direct contact with the skin, or by inhalation of powder from powdered latex gloves
What is the cause of Natural Rubber Latex Allergy?
The introduction of Universal Precautions in the late 1980s mandated that healthcare workers protect themselves against the risk of cross-infection from blood-borne pathogens, such as HIV and Hepatitis B. This demand led to an unprecedented demand for latex gloves, which was met by changes in some manufacturers' practice (ie, high-protein [allergen] examination gloves coming onto the market place), and is believed to be the primary cause of the increased number of healthcare workers with NRL allergy. At the same time, there has been an unrelated and dramatic rise in incidence of atopic allergic disease in the past 30 years, which is also thought to be a major factor.
Who is most at risk?
Those most at risk from NRL are:
- individuals exposed to NRL on a regular basis in occupations where single-use gloves are frequently used eg, workers in the car mechanics, catering, hairdressing and electronics trades;
- individuals undergoing multiple surgical procedures (some studies have reported that up to 65% of Spina Bifida children are sensitised to NRL);
- individuals with a history of certain food allergies, such as banana, avocado, kiwi and chestnut;
- individuals with atopic allergic disease (estimated at some 30 - 40% of the UK population); and
- individuals exposed to NRL on a regular basis eg, workers in the car mechanics, catering and electronics trades
Around 1-6 per cent of the general population is thought to be potentially sensitised to NRL, although not all sensitised individuals develop symptoms.
Selecting latex gloves
Background
Natural rubber latex (NRL) proteins have the potential to cause asthma and urticaria. More serious allergic reactions, such as anaphylaxis, are also possible. NRL proteins are substances hazardous to health under COSHH (Control of Substances Hazardous to Health Regulations). Therefore, COSHH and the COSHH ACOP (Approved Code of Practice) apply, including the specific requirements for the control of substances that cause occupational asthma.
Specific approach to latex gloves
A very common route of exposure to NRL proteins in the workplace is through the use of single-use latex gloves. These gloves can be supplied 'powdered' (where powder is added to ease putting on and removal) or 'powder-free'. In powdered latex gloves, the NRL proteins can leach out of the glove material and attach to the powder particles. When the gloves are put on or removed, the powder - along with the attached NRL proteins - becomes airborne and can be inhaled. The risk of inhalation and skin exposures to NRL proteins is reduced when non-powdered, 'low-protein' single-use latex gloves are used. 'low-protein' means manufactured to the European Standards indicated by EN420 (This requires extractable latex proteins to meet the European Standards defined by EN455-3).
These evidence-based guidelines address the likely level of risk arising from the use of single-use latex gloves.
HSE Recommends
Employers should carefully consider the risks when selecting gloves in the workplace, because of the importance of latex gloves as a source of exposure to NRL proteins.
When considering glove use in the workplace (latex or otherwise), HSE's glove selection guidance should be followed.
In summary, this means:
- Decide whether or not protective gloves are required at all to perform the task (the law requires that other means to prevent exposure should be considered in preference to gloves). There may be reasons other than worker protection that require the use of gloves eg, patient protection in healthcare. When deciding on glove selection, employers need to take account of all factors.
- If protective gloves are needed, they must be suitable. This means they provide adequate protection against the hazard and are suited to the wearer, the work and the environment in which they are used. To ensure suitability, consider the work (substances handled, other hazards, type and duration of contact), the wearer (comfort and fit) and the task (eg, need for dexterity; sterility issues). This is required to decide on the most suitable glove type, eg, single-use or reusable, and the material they are manufactured from.
If the employer's assessment leads to latex as the most suitable glove type for protection against the hazard, then:
- Single-use latex gloves should be low-protein, powder-free.
- Individuals with existing allergy to NRL proteins should take latex avoidance measures and should not use single use or reusable latex gloves. Employers may therefore need to provide gloves of an alternative material.
- Where the use of gloves may result in direct or indirect exposure to members of the public (eg, single-use latex gloves used in patient care; food handling; hairdressing; motor vehicle maintenance), the employer must undertake an assessment of the risks of such exposure and adopt suitable control measures to ensure the health of others is protected.
Where low-protein, powder-free, single-use latex gloves are used in the workplace, the employer must carry out a risk assessment to determine if health surveillance for occupational asthma should be in place. Given that the risks of developing occupational asthma are considered to be low, where health surveillance is appropriate, a low level of health surveillance is likely to be sufficient. Examples of typical health surveillance approaches are given in the article which was coordinated by HSE.
Employers must be able to demonstrate that they have carried out an assessment (as set out above) to select which (if any) type of gloves they should provide. They must also be able to demonstrate that they have an effective glove use policy in place that, for example, takes account of those employees or others (such as members of the public), who may have a latex allergy.
Whenever protective gloves are used (regardless of the material), employers should provide information, instruction and training to employees on how to use them to properly protect themselves. This should include the provision of information on latex allergy, if this is appropriate.
Whenever protective gloves are used (regardless of material), employers must consider the need for, and, if appropriate, implement suitable health surveillance for work-related dermatitis ie, regular skin checks.