University of the West of Scotland: Information and Guidance Note

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1 University of the West of Scotland: Information and Guidance Note Latex and Latex Associated Allergies Introduction In recent years, latex sensitisation has become well recognised and is thought to follow exposure. Attention has been focussed on the use of gloves, as they are the most obvious example of a latex-containing item employed in a variety of environments and in and beyond biomedical sciences. However, latex is present in many medical devices and other products used at work, in the home and everyday life, where its presence may not be immediately obvious. These include for example, elastic plasters and balloons. In consequence, a thorough understanding of personal allergic history is critical in order to manage the risks associated with latex allergy. What is Allergy? An allergic response is one of the body's defence mechanisms against a foreign material. In the general population, many people become allergic or "sensitised" to environmental agents such as grass pollens or animal fur and present typical symptoms of a "runny-nose" - rhinitis - and/or "itchy, watery eyes" - conjunctivitis ("hay-fever"). There is no obvious outward reaction to the first encounter with the sensitising agent generally termed an allergen, but the body may be developing an immune response. Subsequent contact(s) may cause increasingly distressing effects which in the most severe situations can cause Anaphylactic Shock Fortunately this is fairly rare. A significant proportion of the population are atopic, that is they have a history of multiple allergic responses often to environmental allergens encountered in everyday life. What is Latex? Latex is a natural mainly hydrocarbon and proteinaceous liquid harvested from trees. On processing, it forms a strong, flexible and durable material. In gloves, for example, this allows dexterity for the user as well as excellent protection against certain substances. Some products made of synthetic rubber, may be labelled as latex; however, such products do not release the proteins associated with latex sensitivity (but may contain other allergy inducing agents). Allergens - In Particular those Associated with Gloves The allergens inducing sensitisation include extractable latex proteins and/or the residues of chemicals used in the manufacture of the product. These have been shown to be present at higher levels in gloves dusted with powder. Additionally, certain latex proteins readily adhere to the powder of gloves, allowing the latter to act as a carrier resulting in higher levels of contact with the user's skin. The powders tend to form aerosols during glove removal, facilitating inhalation of any powder including latex complexes. This may promote both the immediate and delayed forms of latex sensitivity not only to the wearer but also other people who may be in the vicinity. Reactions to Latex Sensitivity to latex materials was first described as early as 1927, viewed at this time as a rare event. In the last thirty years, latex sensitisation has become well known. In the late 1980s, the United States authorities issued the first medical alerts warning of the dangers of latex allergy following a number of fatalities linked to the material.

2 Three types of response have been reported:- 1. Irritant contact dermatitis 2. Allergic contact dermatitis, also known as delayed type hypersensitivity and 3. Allergic reactions frequently described as immediate hypersensitivity Irritant Contact Dermatitis This is the most common of the reactions and results in the development of dry, itchy areas of skin, most frequently on hands. Episodes of dermatitis may be the result of direct exposure to latex containing materials alone or in conjunction with other factors, such as the powders or chemical agents used during manufacture. However, it should be noted similar reactions might be caused by factors unrelated to latex. For example; washing of the skin, or failure to dry such areas properly, perhaps after using latex gloves, or as a reaction to the detergent agents in the hand wash may cause such reactions. Under such circumstances, symptoms can be exacerbated by latex containing products. Irritant contact dermatitis is not of an immunological nature in contrast to the other types of hypersensitivity. Allergic Contact Dermatitis These responses are caused by exposure to the reagents added to the latex during processing. Typically, symptoms develop several hours after contact, peaking at twenty-four to forty-eight hours post exposure and include an initial rash, which may lead to a leathery skin or ongoing blisters. Further exposure may induce extension of the affected area beyond the contact site. Immediate and Delayed Hypersensitivity Such reactions develop upon exposure to the extractable latex proteins and are the most serious form of allergic response. Reaction often begins within thirty minutes of exposure, but may be delayed a few hours. They may be:- 1. mild - skin redness, itching; 2. moderate to severe respiratory distress - such as running nose, sneezing, asthma and itchy eyes and/or nausea and abdominal pain/dizziness; or rarely: 3. severe - such as anaphylactic shock which may become life threatening. All types of reaction are reversible and disappear in the absence of subsequent contact. However, symptoms may rapidly reappear on any further exposure, frequently with increasing severity and in the presence of much lower levels of the allergen than the initial, sensitising dose. People at Risk Any person in contact with latex containing products may develop a sensitisation to the material. However, atopic individuals, notably but not exclusively persons with allergy to foods such as nuts, vegetables and fruits * appear to be at increased risk of developing latex sensitisation and tend to experience the more severe forms of this condition. It should also be remembered that sensitised persons might be affected by secondary rather than direct exposure, such as via aerosols. Those who have undergone multiple surgeries, especially in childhood, may also be atopic. * e.g. peanuts, chestnuts, avocado, pineapple, potatoes, mangoes and bananas.

3 Detecting Latex Allergy Latex allergy should be suspected in individuals who develop any of the symptoms of skin itchiness, a rash, blistering, respiratory distress, eye or sinus irritation or anaphylactic shock following exposure. Such a reactivity should be investigated as soon as possible by the individual s GP, and Occupational Health department if it is work related, as a more serious, systemic response could follow after a short period. In addition, it would be highly advisable to avoid contact with latex containing products immediately even during any investigative period. Recognised diagnostic methods are available which may enable allergens to be identified. On development of an allergic sensitivity, complete avoidance of latex products is the only fully effective approach. Latex Allergy and the Law Two sets of legislation are particularly relevant to the development of allergy to latex containing products. Under the Control of Substances Hazardous to Health Regulations (COSHH), latex will be defined as a hazardous substance. In consequence, duties under that legislation require where latex containing materials are employed the production of an assessment of the risks presented to human health and safety with prevention or control of exposure as far as reasonably practicable, by:- 1. Ideally, the elimination of contact substitution of alternatives; 2. Monitoring of those exposed and application of health surveillance; 3. Information, instruction and training of (potential) exposees considering the nature of the hazards, the control measures to be applied, the symptoms of allergy and the procedures to follow should sensitisation be suspected or develop. 4. Under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (2013) (RIDDOR), it is a requirement to formally report any development of latex sensitisation arising from work activities to the enforcing authorities. That encompasses occupational dermatitis, asthma or life threatening anaphylactic shock. In addition, symptoms should be detailed to H&SS, using the University Injury or Dangerous Occurrence Report Forms, who in turn will notify the regulator - the Health and Safety Executive. Recommendations A preventative strategy should be promoted in preference to the management of sensitivity. A number of approaches can be taken to reduce (ideally eliminate) exposure to latex and the associated allergens: 1. A Personal Protective Equipment (PPE) Risk Assessment must be undertaken in accordance with the Universities Personal Protective Equipment Procedure. 2. Use products that do not contain latex. In particular, this applies to gloves where there is minimal probability of contact with infectious agents. Question if it is necessary to wear gloves at all. 3. Alternatives to latex containing products are available for most commonly encountered situations. Buyers should adopt a latex avoidance-purchasing regime as far as possible. For example, again with particular reference to gloves, alternatives composed of nitrile, neoprene or other synthetic rubbers are available and easily sourced. 4. Where latex-containing products must be employed, personnel - both direct users and those who could be affected such as co-workers - should be fully informed of the hazards posed, the symptoms of sensitivity and the actions to

4 take if such sensitivity develops

5 4. Persons exposed to high latex levels regularly and known to be atopic, and particularly those with the food allergies often associated with latex sensitisation, need to be most cautious and vigilant. 5. Determine rigorously how exposure of such individuals to latex products can be eliminated. 6. Hazard must be identified on the risk assessment form. Health and Safety Services October 2015