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Comparison of latex-specific IgE binding among nonammoniated latex, ammoniated latex, and latex glove allergenic extracts by ELISA and immunoblot inhibition.

BACKGROUND: Nonammoniated latex, ammoniated latex, and latex glove extracts have been used as source materials for the preparation of allergenic extracts for the diagnosis of latex allergy. These materials showed different patterns of protein bands and immunoreactive bands. However, their IgE-reactive repertoires were not compared. OBJECTIVE: The goals of this study were to compare the IgE reactivity and to define the common IgE-reactive epitopes among three latex allergenic extracts. METHODS: Two serum pools were obtained from adults and children with latex allergy to evaluate the IgE reactivity among three latex extracts. IgE reactivity and IgE-reactive proteins were compared by inhibition ELISA and inhibition immunoblot methods, respectively. RESULTS: In this study inhibition curves were similar for nonammoniated latex and ammoniated latex but were different when the latex glove extracts were used. Several protein bands of ammoniated latex and latex glove extracts could not be inhibited by the nonammoniated latex. The ammoniated latex and latex glove extracts were able to remove all the latex-specific IgE from the serum. CONCLUSION: The IgE-reactive proteins differ among different latex extracts. Ammoniated latex and latex glove extracts contain more complete immunoreactive repertoires for detecting IgE antibodies. Our study provides useful information for selecting the latex extract.

Adult↗

[Allergy to latex gloves among healthcare workers in Dakar].

BACKGROUND: The prevalence of latex allergy is high (to 17%) among groups at risk such healthcare workers. Our aim was to determine the prevalence and severity of allergy to latex gloves among health workers in Dakar. PATIENTS AND METHODS: The study was conducted in three of the five hospitals in Dakar (Senegal). A randomized sample was constituted. All healthcare workers required to use latex gloves in their work were included. A questionnaire was administered. The analysis was performed using the Epi-info software package (6.0). RESULTS: One hundred and forty cases were included. The median age was 39 years and the sex-ratio was 0.57. Sixty-six (47%) cases had familial atopic dermatitis, 13 (9.6%) had atopic dermatitis, and 4 (2.9%) indicated food allergy (banana, avocado). Irritant dermatitis was found in 40.7% of cases, 112 healthcare workers (81.2%) used bleach and water to clean their hands. Antiseptics were used frequently: 75.5% of those interviewed used them more than three times a day. None of the healthcare workers indicated any allergy to latex condoms. Otherwise surgical procedures and bladder/rectal catheters were noted respectively in 24% and 18% cases. Fifteen healthcare workers (10.7%), of whom 12 were women, indicated appearance of clinical signs when using latex gloves. The clinical manifestations were: contact urticaria or immediate pruritus (8 cases), combined contact dermatitis and contact urticaria (2 cases), allergic conjunctivitis (1 case), allergic rhinitis (2 cases) and asthma (2 cases). We also noted 6 cases of contact dermatitis. Rechallenge tests were performed in 7 cases and were positive, 2/3 prick-tests and 1/4 patch-tests (standard European battery). The statistical analysis shows that allergy to latex gloves was significantly associated with atopy and irritant dermatitis (p<0.03). DISCUSSION: We found a prevalence of allergy to latex gloves of 11% among healthcare workers in Dakar, reflecting reports in the literature. The classical risk factors such atopic dermatitis and irritant dermatitis were found. The correlation between irritant dermatitis and frequent use of bleach and water mean that these practices should be eradicated since they play an important role in the development of contact urticaria and anaphylactic reactions.

Adult↗

Surgical glove powders differentially modulate macrophage and lymphocyte-derived cytokines and eicosanoids production in vitro.

The objective of the present study was to determine the effect of surgical glove powders Biosorb, Keoflo, and CaCO(3) and Hydrocote (a powder-free film; Biogel) on cytokine and eicosanoid production by lipopolysaccharide/phorbol 12-myristate 13-acetate activated and unactivated HL60, U937, and RPMI 1788 cells, human monocyte/macrophage, and B lymphocyte cell lines. The unactivated cell culture-conditioned media contained a low level of interleukin-1alpha and -1beta, granulocyte macrophage colony stimulating factor, and tumor necrosis factor-alpha, which significantly increased after activation (p < 0.05). Exposure of unactivated cells to glove powders or Hydrocote (100 microg/ml) had little effect. However, these compounds appeared to have multiple inhibitory and stimulatory action on the production of these cytokines and eicosanoids in lipopolysaccharide/phorbol 12-myristate 13-acetate activated cells. For instance, granulocyte macrophage colony stimulating factor production was inhibited only in U937 cells by Keoflo and CaCO(3), whereas, tumor necrosis factor-alpha production was stimulated by Biosorb and Keoflo in HL-60, and CaCO(3) was found to be predominantly inhibitory on tumor necrosis factor-alpha production by these cells (p < 0.05). Total transforming growth factor-beta(1) production was stimulated by Biosorb and Hydrocote in U937 and HL-60 cells, respectively, but inhibited by Keoflo in U937 cells. However, Biosorb and Keoflo inhibited transforming growth factor-beta(1) production in both HL-60 and RPMI 1788 cells, without any effect on active transforming growth factor-beta(1). With regard to eicosanoids, Biosorb and Keoflo stimulated prostaglandin E(2) production by RPMI 1788 cells, whereas it was inhibited by all glove powders in HL-60 cells. Thromboxane B(2) production was stimulated by Keoflo and inhibited by CaCO(3) and Hydrocote in U937 cells. Finally, Leukotriene B(4) synthesis was found to become stimulated by Keoflo, CaCO(3), and Hydrocote in both HL60 and RPMI 1788 cells (p < 0.05). These data indicate that exposure of activated, but not unactivated, macrophages and lymphocyte to surgical glove powders and Hydrocote differentially effects the release of cytokines and eicosanoids by these cells. Considering that cytokines and eicosanoids play an important role in mediating the inflammatory and immune responses of wound healing, complications arising from glove powder exposure in vivo may involve mechanisms which alter the type and level of cytokine and eicosanoid production.

Journal Article↗

Skin absorption and protective gloves in dynamite work.

Serious health hazards have been reported from dynamite manufacturing during the last hundred years but many problems are still unsolved concerning biological monitoring and protective clothing. In this study, experiments are reported where ethylene glycol dinitrate (EGDN) has been measured in blood from subjects whose hands were exposed to dynamite vapors only or to the combination of vapors and the solid phase, with an without gloves. Strong indications were found that skin absorption is a major route of entry for EGDN into the body. Rubber gloves were found to absorb considerable amounts of EGDN and also to let it pass thorugh to the skin and the blood. However, rubber gloves with inner cotton gloves seem to constitute some protection if they are changed as frequently as once or twice an hour compared with only using cotton gloves or working bare-handed. Blood samples from cubital veins primarily were found to reflect the local skin absorption of EGDN and not the total uptake. Exhaled air was analyzed at moments of high skin exposure but no EGDN could be detected. Further studies of biological monitoring and protective materials are suggested.

Air Pollutants↗

Occupational exposure to asbestos fibers resulting from use of asbestos gloves.

To assess the magnitude of fiber emission from asbestos gloves, 10 pairs were compared in an isolation chamber during simulation of a sterilization procedure; 176 air samples were collected. Means of time weighted average (TWA) concentrations ranged from 0.95 to 11.74 fibers (greater than 5 micrometers)/cm3 of air. Well-worn/clean gloves emitted significantly more fibers than did brand-new gloves, but fiber emission decreased with increased surface soiling. Eighty air samples were collected during simulation of the sterilization procedure in a well-ventilated room. The range of mean TWA concentrations was 0.07-0.99 fiber/cm3 for breathing zone samples and 0.06 to 0.60 fiber/cm3 for area samples. Thirteen samples were collected at actual workplaces; the range of TWA concentrations was 0.07-2.93 fibers/cm3 for breathing zone samples and 0.04-0.74 fiber/cm3 for area samples. Five of seven breathing zone samples from workplaces exceeded the proposed TWA concentration limit of 0.1 asbestos fiber/cm3. Hand contamination also was assessed. Four samples collected after touching the worktable ranged from 9953 to 13 108 fibers (greater than 5 micrometers)/cm2 of hand surface area; seven samples collected immediately after taking off gloves ranged from 741 to 3860 fibers/cm2. Available substitutes for asbestos gloves are discussed, and adoption of these substitutes is recommended strongly.

Air Pollutants↗

Permeation of chlorinated aromatic compounds through Viton and nitrile glove materials.

The ASTM cell was utilized to study permeation of chloro-, o-dichloro-, and m-dichloro-benzenes and o- and p-chlorotoluenes through Viton (unsupported) and nitrile (supported and unsupported) glove materials using isopropanol as collecting solvent, and FID/gas chromatography for quantitation. Adequate mixing in the collection chamber was accomplished by externally agitating the ASTM cell at the required speed in a moving-tray water bath at 25 degrees C. The Viton glove did not show permeation even after 4 hours. The nitrile gloves showed breakthrough times of less than 1 hour. The steady state molar flux rates for unsupported or supported nitrile gloves, or for the different challenge solvents were not statistically different. Thus, breakthrough times were better indicators of permeation than steady state molar flux rates. A "mixed" permeation mechanism was proposed, depending on swelling of the glove material.

Chlorobenzenes↗

A test method for the evaluation of protective glove materials used in agricultural pesticide operations.

The ASTM Standard Test Method for Resistance of Protective Clothing Materials to Permeation by Liquids and Gases (F 739-85) and the recommended permeation cell have been modified to permit the testing of protective clothing materials for permeation by the low volatility, low water solubility active ingredients present in many pesticide formulations. The modification makes use of solid collection medium, a thin (0.02-in. thick) sheet of silicone rubber, to collect permeants. Those compounds permeating the protective material can then be desorbed into an appropriate solvent and analyzed using conventional methods and instruments. A series of permeation tests have been conducted using samples of 10 common, commercially available protective glove materials and the modified cell. Permeation of the active ingredient as well as carrier solvent components of several concentrated pesticide formulations containing low volatility, low water solubility active ingredients and aromatic hydrocarbon carrier solvents has been monitored. The relative breakthrough and the total mass of material permeating the glove materials appears to be strongly related to the concentration of the aromatic carrier solvent present in the formulations studied to date. The collection method was found to be less useful for monitoring the permeation of active ingredients, which have reasonably high water solubilities. The results obtained by using this method with samples of protective glove materials challenged by several concentrated pesticide formulations are described. For these formulations containing xylene boiling range aromatic solvents, gloves made of nitrile rubber, butyl rubber, and Silver Shield were most resistant to permeation; natural rubber and polyethylene glove materials were least resistant.

1-Propanol↗

Latex allergen elimination in natural latex sap and latex gloves by treatment with alkaline potassium hydroxide solution.

Antigenic proteins in latex products can cause type I allergy. We investigated the effects of potassium hydroxide (KOH) solution on the allergenicity of proteins in natural latex sap and latex gloves by using an EAST competitive inhibition immunoassay and skin prick test. Latex sap was mixed with KOH solution at different concentrations and incubated over various periods of time at room temperature. Latex gloves were washed in KOH solution for different times at 30 degrees C and 90 degrees C. Our immunoassay results for the subsequently extracted latex proteins demonstrated a KOH concentration-, temperature-, and time-dependent decrease in allergenicity, finally resulting in complete loss of IgE-binding activity. In the skin prick test, we found only four weakly positive reactions to proteins extracted from KOH-washed gloves in 30 latex-sensitized patients. In addition, up to 97% of the aqueous extractable protein content could be removed from latex gloves by washing in KOH solution under certain conditions. These results suggest that antigenic proteins in natural latex sap and latex gloves can be changed by treatment with KOH solution, which is followed by a loss of their capability to bind specific IgE antibodies from most latex-sensitized patients.

Allergens↗

Evaluation of a fiber optic glove for semi-automated goniometric measurements.

Normal subjects were used to evaluate a fiber optic instrumented glove for semi-automated goniometric measurement. The glove electronically records and transmits hand and finger position to a host computer by measuring the amount of joint flexion. The glove was put through a series of range-of-motion (ROM) tests with five subjects. Metacarpal (MP) and proximal interphalangeal (PIP) joint angles of the five digits were compared during repetitive standardized motions to evaluate the glove's repeatability. The results showed an overall error of 5.6 degrees, as compared to an error of between 5 and 8 degrees with manual measurement. Additional tests were done to determine factors such as fit, grip force, and wrist motion that may contribute to the overall error. The glove should have applicability to some aspects of hand evaluation as a semi-automated goniometric measurement device.

Adolescent↗

Glove retractor for left circumflex coronary artery bypass grafting.

BACKGROUND: During off-pump coronary artery bypass grafting (OPCAB), displacing the heart to expose the left circumflex artery (LCX) results in hemodynamic disturbance. The objective of this study was to evaluate, in a canine model, the hemodynamic impact on the beating heart of using a glove retractor instead of conventional retraction to expose the LCX. METHODS: Six mongrel dogs ranging in weight from 19.7 to 25 kg were used. Hemodynamic parameters were continuously monitored at a fixed rate of 80 beats/min. After the baseline data had been obtained, the LCX was exposed by applying an Octopus system. Each dog was then placed in the Trendelenburg position. Subsequently, the glove retractor was applied and its effects were examined both with and without the Trendelenburg position. RESULTS: LCX exposure decreased aortic flow to 35.2 +/- 12.8% of the baseline value (p< 0.001 vs. baseline), and this decrease was not fully reversed even by the Trendelenburg position (67.6 +/- 14.3%). Glove retractors tend not to interfere with right ventricular expansion so that hemodynamic disturbance is mild, and in the Trendelenburg position aortic flow (88.9 +/- 9.9%) and mean aortic pressure (95.0 +/- 5.1%) during LCX exposure were completely maintained with the glove retractor in place. CONCLUSION: Glove retractors can be used to displace the canine heart to expose the LCX, minimizing hemodynamic impairment, with normalization of hemodynamic parameters by the Trendelenburg position. This technique may offer an alternative hemodynamic support method in some patients undergoing OPCAB.

Animals↗

Efficacy of compression gloves in rheumatoid arthritis.

Twenty-three patients with rheumatoid arthritis whose disease had become stabilized while receiving non-steroidal, anti-inflammatory drugs and/or gold salt injections entered an 8 week crossover study in which the effect of a compression glove worn during sleep was compared to a loosely fitting glove made of the same material. Improvement in hand symptoms was greater with the compression glove than with the control glove as regards morning stiffness, pain, night time throbbing, numbness or heaviness and a subjective assessment of swelling (p = 0.01). In addition, swelling of the proximal interphalangeal joints was slightly reduced (p = 0.05). These data suggest that the night time use of compression gloves in patients with rheumatoid arthritis can improve hand symptoms and exert a mild, transiently beneficial effect upon the degree of hand swelling.

Adult↗

The permeability of laboratory gloves to selected nitrosamines.

Samples of laboratory gloves of various composition and thicknesses were used as barriers between 0.136 M solutions of nitrosamines (dimethyl-, ethylmethyl-, diethyl-8 n-butylmethyl-, di-n-propyl-, di-iso-propyl- and di-sec-butyl- in dichloromethane, acetone, ethanol and double-distilled, deionized water) and water. The concentration of permeated nitrosamine was measured periodically. Nearly all gloves tested were permeable to the nitrosamine solutions. The results indicate that: (1) gloves should not be assumed to provide full protection, (2) gloves should be discarded immeidately following overt contamination and (3) gloves should not be reused.

Hand↗

Diffusion of nitrosamines through protective gloves.

A simple experimental demonstration of the permeability of protective gloves to volatile nitrosamines has been carried out. Rubber and polyvinyl chloride (PVC) gloves were turned inside out and the fingers filled with dilute solutions of nitrosamines in hexane. The outer faces of the fingers were washed with water at various times and the nitrosamine content of these washings determined. From these measurements the proportions of the various nitrosamines passing through the gloves were calculated. For both types of gloves N-nitrosopyrrolidine (NPYR) permeated the fingers most rapidly and to the greatest extent. Only a relatively small amount of N-nitrosodibutylamine (NDBA) was transmitted. It was also established that the rubber gloves themselves did not contain any of the common volatile nitrosamines; N-nitrosomethylphenylamine and N-nitrosodiphenylamine were also absent.

Chromatography, Gas↗

Limitations in protection afforded by gloves in laboratory handling of aflatoxins.

The permeability of latex and vinyl laboratory gloves by aflatoxins in chloroform or dimethyl sulfoxide (DMSO) has been investigated. Latex gloves provide good protection against permeation by aflatoxins in DMSO, but aflatoxins in chloroform permeate all types of laboratory gloves. If gloves are contaminated when aflatoxins in chloroform are handled, an immediate change of gloves is recommended.

Aflatoxins↗

Reducing the hazards of exposure to cornstarch glove powder.

Latex allergy has received considerable attention during the past decade. The occurrence of latex allergy in health care workers is higher than in the general population. Latex gloves are the most frequent form of exposure that health care workers have to natural rubber latex; therefore, the relationship between gloves and latex allergies, has been well studied. Scientific evidence supports the link between glove powder and the occurrence of latex allergies, as well as the development of postoperative complications in surgical patients. This article describes how a multihospital system, which is the seventh largest not-for-profit health care corporation in the nation and includes 35 ORs, successfully eliminated powdered gloves from the environment.

Gloves, Protective↗

Latex: a cause of allergic contact eczema in users of natural rubber gloves.

BACKGROUND: Latex is a common cause of contact urticaria in glove users. We recently found that 1.2% of patients attending a contact dermatitis investigation unit had delayed type hypersensitivity to latex as a cause of eczema. OBJECTIVE: We reassessed the relevant contact allergens in users of natural rubber gloves with hand dermatitis. Particular emphasis was placed on allergens not included in the standard patch test series. METHODS: Consecutive natural rubber glove users with hand dermatitis were investigated for the presence of contact dermatitis and urticaria. RESULTS: One hundred seventeen consecutive patients were tested. The American standard series missed 34% and the European 40% of patients with positive patch test reactions to rubber related chemicals. Six percent of patients (20% of those with a positive reaction) demonstrated delayed type hypersensitivity to latex, often in the absence of other relevant contact allergens and contact urticaria to latex. CONCLUSION: Latex is a relatively common cause of allergic contact eczema in the absence of contact urticaria. Latex should be included in a rubber series for screening patients with hand dermatitis who are glove users.

Adolescent↗

Surface powders on surgical gloves.

Four different instrumental techniques were used to analyze the microscopic particles on the patient-contact surfaces of a variety of surgical gloves. The presence of talc was confirmed on most, but not all, gloves tested. The presence of talc, when it occurred, seemed to be due to design by the manufacturer rather than by accident, and it was predominantly on the patient-contact surfaces. The intentional inclusion of talc on modern surgical gloves has been unexpected up to now. A washing and wiping procedure showed that talc was more difficult to remove than starch-based powder. A powder-stripping procedure showed that powder that resisted removal by washing could be mechanically dislodged. Thus, a shedding hazard might exist during a surgical procedure even if the glove surfaces have been washed and wiped.

Gloves, Surgical↗

Latex glove allergy. A survey of the US Army Dental Corps.

OBJECTIVE: To assess the prevalence of latex glove allergy in a population of health care providers (dentists) with a high occupational exposure to latex gloves. DESIGN: A survey instrument was distributed to all active-duty dental officers in the US Army (n = 1628). The survey was designed to identify those individuals who had symptoms of allergy to latex gloves. SETTING: US Army dental facilities worldwide. RESULTS: The response rate to the survey was 64% (n = 1043). There were 143 (13.7%) responses indicating latex glove allergy. If nonrespondents were assumed to be allergy-free, the prevalence rate would be 8.8%. CONCLUSION: Latex allergy, as ascertained by self-report in this survey, appears to have a substantial prevalence in this health care provider population.

Dermatitis, Allergic Contact↗