Identification and practical management of latex allergy in occupational settings

Abstract

Allergy to natural rubber latex (NRL) from Hevea brasiliensis is a relevant occupational health hazard. The use of gloves and products manufactured with latex and environmental allergen exposure in the work environment are risks factors for the development of occupational allergy among different job categories. Healthcare workers have been the most commonly affected, but other professions with exposure to latex products such as hairdressers, cleaners, food handlers and those making natural rubber latex (NRL) products are also at risk of developing occupational allergy. Clinical manifestations of IgE-mediated latex allergy can range from troublesome skin disorders to life-threatening systemic reactions. It is very important to identify the occupational allergic diseases in their early stages in order to implement avoidance strategies. For this purpose, the interventions for prevention should emphasize the importance of latex allergy awareness and surveillance among exposed workforces.

Keywords:

• component-resolved diagnosis
• immunotherapy
• latex allergens
• latex allergy
• natural rubber latex
• occupational allergy
• occupational asthma
• specific IgE antibodies

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The use of gloves and objects manufactured with NRL and the indoor allergen exposure in the work environment are risk factors for development occupational allergy among different job categories. HCWs have been the most commonly affected, likely from their greater exposure, but other workers, such as hairdressers and employees in latex product manufacturing industries, can develop NRL allergy.

• It is extremely important to identify the occupational allergic diseases in their early stages and to take appropriate preventive measurements to avoid persistent workplace exposure, in order to improve the clinical outcomes of sensitized subjects and to prevent future cases of disease among the exposed workforce.

• To date, there are 15 allergens identified from Hevea brasiliensis that had been included in the allergen database.

• The most relevant latex allergens from the point of view of occupational allergy are Hev b 5, 6 and 13, as major allergens in HCWs, and Hev b 1, 4, and 7, as minor allergens in HCWs.

• The difference in latex allergen sensitization profiles described between HCWs and patients subjected to repetitive surgeries could be partly due to differences in the allergen levels observed between internal and external surfaces of the surgical and examination gloves. Concentrations of Hev b 1 and Hev b 3 are significantly higher on external surfaces, whereas internal surfaces had higher allergen levels of Hev b 5 and Hev b 6.02.

• The lack of standardization of the SPT extracts used for diagnosis of NRL allergy leads to wide differences in terms of total protein content between manufacturers, broad differences in protein profiles between the extracts and a marked variability in the amount of the relevant latex allergens. These facts are reflected in the variation in sensitivity and test efficiency.

• Interventions for prevention of occupational latex allergy should emphasize the importance of the knowledge of latex allergy, not only for HCWs also for other workers exposed to latex as hairdressers, cleaners, food handlers and those making NRL products, by means of health education campaigns regarding the appropriate use of gloves.