Occupational latex exposure: characteristics of contact and systemic reactions in 47 workers

Background: Recent reports have noted an apparent increase in the prevalence of natural rubber latex (NRL) allergy among workers with occupational latex exposure (OLE). The risk factors for and the natural history of NRL allergy in this population are not well delineated, and the utility and comparability of immunoassays as confirmatory testing are unclear. Methods: Serum samples and medical histories were obtained from 47 symptomatic workers with OLE, from nine other individuals with a history consistent with NRL allergy, and from 10 atopic asymptomatic NRL-exposed control subjects. Sera were coded and analyzed in a blinded manner for latex-specific IgE, using a variety of antigen sources, including ammoniated and nonammoniated raw latex preparations and three finished glove preparations. Results: Risk factors for the latex allergy in workers with OLE appear to include a history of atopy or preexisting dermatitis involving the hands. In this population, NRL allergy is commonly preceded by latex glove-associated contact dermatitis. Serologic testing confirmed the suspected diagnosis in 62% of workers (15 of 24) with systemic symptoms but was only positive in 27% of workers (4 of 15) with symptoms limited to contact urticaria. Conclusions: The appearance of a latex glove-associated contact rash may precede the development of NRL allergy, particularly in atopic persons. Workers at risk should be advised to use alternate types and brands of latex gloves or to switch to nonlatex gloves entirely.