Hi Chris
On the point of bio availability, perhaps you can clear up (or not) a
perception of mine. My understanding is that prior to the 1980s there were
few producers of latex gloves who all manufactured to a high standard. Even
with powder in the glove, the level of free latex proteins was low.
Following aids, glove manufacture increased hugely, supply went up but
quality came down and allergic reactions started to rise.
Now latex glove manufacture is back to a high standard again but with
everyone concerned about latex, is the manufacture of nitrile and other
alternatives rather less stringent, hence increasing bio availability of the
allergens?
Thanks
Lindsey
Lindsey Hall
Independent Occupational Health Adviser
Split Dimension Ltd
07771 596111
Phone/Fax 01454 852715
www.splitdimension.co.uk
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-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf
Of Chris Packham
Sent: 10 February 2012 12:34
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Latex gloves
Just a couple more thoughts on this contentious issue.
Those confronted with the HSE approach to latex should take a look at the
HSE's website and try to see where it requires a 'ban' on latex. Better
still, point out the information on latex on this site and ask the local HSE
inspector to show where it supports their policy!
It also refers to the evidence based study by the Royal College of
Physicians/NHS Plus, in which appears the following statement:-
"The evidence does not therefore support a complete ban on the use of latex
gloves. Institutions should judge whether their needs would be met better by
the use of latex-free or powder-free latex gloves, or use of both in
different settings, while taking into account the desirable and undesirable
properties of both materials."
(This document can also be downloaded, either direct or via the HSE website
on latex.)
Since the primary purpose of providing gloves for the healthcare employee is
for protection against biohazards and natural rubber latex is the optimum
glove for this purpose, and since the risk of latex allergy from unpowdered,
low free protein latex gloves is miniscule, where is the justification for
eliminating the use of latex?
One additional thought: For an allergen to elicit a reaction it must be
bioavailable, i.e. it must be able to be absorbed into the skin at a
sufficient concentration to elicit a reaction in the immune system. If the
amount of bioavailable molecules of the sensitiser can be reduced to below
the threshold that will elicit a reaction in a sensitised person, then the
fact that the sensitiser is present is irrelevant. If this were not the
case, then we would have to ban stainless steel (technically
chrome-nickel-steel) as this contains two of our most common sensitisers.
However, chrome and nickel sensitive persons can handle stainless steel
without a problem, since neither sensitiser is bioavailable. It was
different with jewellery and other items that contained nickel. Here there
was significant release of nickel, such that the EU introduced a Directive
limiting the amount of free nickel to below the threshold needed to elicit
such a result. (Interestingly not with coins as a simple test - see below -
will demonstrate)
The same will be true of gloves manufactured from natural rubber latex. If
the manufacturing process is such that there is insufficient free protein to
elicit a reaction - as several studies have shown to be possible - then
where is the hazard? Where is the justification for insisting on the
elimination of latex gloves?
As an illustration of this principle some years ago I was asked to assist a
client who had a case of occupational allergic contact dermatitis to nickel.
This was a young lady who, in the course of her work, handled nickel plated
metal components. She developed a hand dermatitis. This cleared when she
went on holiday, returned after a few days back at work. She was diagnosed
as allergic to nickel. Assumption was, as said, that this was due to her
exposure to nickel at work. I was asked to advise on precautions needed to
avoid a similar problem in others. However, a check using a simple test
(Dimethylglyoxime test) showed that none of the materials this lady handled
at work were releasing nickel. Further investigation revealed that her
problem was actually an irritant contact dermatitis due to contact with
hairdressing chemicals in her secondary occupation as a hair stylist!
Chris
Chris Packham
FRSPH, FInstSMM, MCMI, MIIRSM, MBICSc
EnviroDerm Services
Unit 10, Building 11, The Mews, Mitcheldean, GL17 0SN
Tel: +44 1386 832 311 (office), Mobile: +44 7818 035 898
www.enviroderm.co.uk
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