Knowledge Base
Learn about infection control practices and considerations.
Glove-Associated Reactions
What causes glove reactions?
Powder, surface chemical residues, bacterial endotoxin contamination, ethylene oxide sterilization residuals, fit and length of use are several factors associated with irritant contact dermatitis; glove manufacturing chemicals such as accelerators and antioxidants have been associated with Type IV allergic contact dermatitis, and natural rubber latex proteins have been associated with Type I hypersensitivity. Choosing gloves processed to reduce chemicals and natural rubber latex protein content reduces the risk of allergic reactions. For further information, kindly contact the glove manufacturer.
What are the types of glove-associated reactions?
There are three known glove-associated reactions:
- Type I immediate type hypersensitivity is an allergic reaction associated with proteins found in natural rubber latex (NRL). This allergic response usually manifests from minutes to an hour after exposure and is associated only with genetically predisposed individuals.
- Type IV hypersensitivity (also known as delayed type hypersensitivity, allergic contact dermatitis or chemical allergy) is an allergic reaction associated with specific chemicals called chemical contact sensitizers, potentially present in both latex and synthetic gloves. This reaction is a delayed reaction that typically takes from 6 to 48 hours for maximum expression of physical symptoms. An individual must be genetically predisposed to have allergic reactions.
- Irritation (also known as dermatitis, irritant dermatitis or irritant contact dermatitis) can be caused by chemicals, endotoxin and/or powder potentially present in both latex and synthetic gloves. Irritation is a non-allergic reaction that can affect anyone.
How can the possibility of acquiring a glove-associated reaction be reduced?
In order to reduce the potential for glove associated reactions, wear gloves that are low in residual chemicals generally and chemical contact sensitisers specifically, and low in NRL allergens (if gloves are natural rubber latex). Select powder-free gloves to reduce reactions that can be associated with the powder such as irritant dermatitis. Some published reports have suggested that if NRL allergen laden powder comes into contact with a latex allergic individual, an allergic reaction might be initiated. For further information, kindly contact the glove manufacturer.
Is there a glove which is 100% free from any latex protein or chemical residues that may cause some sort of reaction?
There is no perfect glove. Latex proteins are inherent to natural rubber latex. Chemicals are necessary to manufacture both synthetic and natural rubber latex gloves. Latex proteins and glove manufacturing chemicals are removed during production steps that include, but are not limited to, multiple rinses, leaching and chlorination. While each of these steps, if used, remove substantial amounts, some protein and chemical residue may remain. Since natural rubber latex proteins cannot be completely removed, latex allergic individuals should not wear natural rubber latex gloves.
Is there a limit to the protein content of latex gloves?
Powder-free gloves undergo an intensive leaching and washing process in order to ensure that the leachable protein level is as low as possible. However, when using natural rubber latex (NR) gloves it is not possible to eliminate the exposure to allergenic proteins completely and there is no defined safe limit. Consequently, as part of risk control measures for any glove made from NR it must be clearly indicated on the primary packaging that the glove contains natural rubber latex plus an additional warning that the product may lead to allergic reactions needs to be included. Any labelling claims suggesting a protein level lower than the process limit of the producer are not allowed. The lowest allowable protein level that a manufacturer is allowed to claim for single use medical gloves is 50 ”g/g and such claim is only applicable for the U.S. market.
What foods and plants are cross-reactive with latex allergens?
A Type I reaction to latex gloves is caused by the naturally occurring protein allergens found in raw latex. Proteins that are very similar to latex allergens can be recognised by latex specific IgE antibodies. An allergy to the cross-reactive (similar) allergens in the items listed below may trigger an allergic reaction to latex proteins and vice versa. While an allergy to these foods and plants is a risk indicator for potential latex sensitisation, having these allergies does not mean an individual is or will necessarily become latex allergic.
| Almond | Apple | Apricot | Avocado | Banana |
| Bell Pepper | Beet | Buckwheat | Carrot | Celery |
| Cherry | Chestnut | Crab | Date | Dill |
| Ficus (benjamina tree) | Figs | Grape | Grapefruit | Hazelnut |
| Kiwi | Lettuce | Lobster | Mango | Melon |
| Mugwort | Mushroom | Nectarine | Orange | Oregano |
| Papaya | Passion fruit | Peach | Peanut | Pear |
| Pineapple | Plum | Potato | Prawn | Ragweed |
| Rye grass | Sage | Scallop | Shrimp | Soy |
| Spinach | Squid | Star fruit | Strawberry | Timothy grass |
| Tomato | Turnip | Walnut | Wheat |
Why is a reduced level of total allergenic protein important?
Scientific studies provide evidence that the greater the overall exposure to an allergy-causing substance, the greater the risk of sensitisation in genetically predisposed individuals. Reduced exposure to natural rubber latex allergenic proteins has been reported to be associated with decreased allergenic response. Therefore, in the healthcare profession, it is important to select natural rubber latex gloves with reduced allergenic protein levels.
Is there a specific natural rubber latex protein level that can cause an allergy?
As with most allergies, researchers have not been able to determine the exact level of natural rubber latex protein exposure, or how many exposures, will cause a genetically capable individual to become allergic and to begin expressing symptoms. There is scientific consensus that reduced allergenic protein levels will lower the potential for both sensitisation of non-sensitised genetically susceptible individuals and allergic reactions in sensitised individuals.
Can natural rubber latex allergies be treated or cured?
There are no treatments commercially available to cure a latex allergy. Topical steroids and oral antihistamines may temporarily reduce some latex allergy symptoms. Bronchodilators or steroids may be prescribed to treat symptoms. Individuals who suspect they are allergic to natural rubber latex (Type I) need to be diagnosed and treated by their physician, and are usually referred to an allergist. In the most severe cases, such as anaphylactic shock, immediate emergency treatment is necessary.
Who is at risk for developing a Type I hypersensitivity to natural rubber latex?
Currently, there is no way to predict who will, or will not, develop an allergy to natural rubber latex. Some population groups may have an increased risk for latex sensitisation. These groups include, but are not limited to:
- Atopic individuals.
- Individuals with a family history of atopy.
- Individuals with occupational exposure.
- Individuals requiring repeated surgical interventions, especially those beginning such procedures as newborns (e.g. spina bifida, congenital abnormalities, multiple surgeries).
- Individuals with frequent mucosal exposure to natural rubber latex products (e.g. urinary catheterisation).
- Individuals allergic to cross-reactive foods and plants.
- Presence of multiple risk factors.
What causes a Type IV hypersensitivity to gloves?
Type IV hypersensitivity to natural rubber latex or synthetic glove chemical additives can occur when chemical contact sensitisers come in contact with and penetrate the skin surface of genetically predisposed individuals. The genetically predisposed or capable individual develops sensitised T-cells each time he/she is exposed to the chemical. They are not yet allergic and no symptoms are visible while the body âdevelopsâ the allergy. After repeated contact over weeks, months or years, the body may reach a critical exposure level referred to as a symptom threshold level. Subsequent exposure after the threshold level is reached elicits clinical symptoms. The individual is then considered allergic to the chemical. On the other hand, if the level of chemical contact sensitisers is low enough, the threshold level may never be reached and thus even the genetically prone individual would never have symptoms.
What are chemical accelerators and why are they used in medical gloves?
Chemical accelerators are chemicals used as part of the manufacturing process for traditional latex and synthetic materials used in the manufacturing of medical gloves. These chemicals help to stabilize the raw material during the curing process in order to form a strong and elastic medical glove offering barrier protection and comfort.
There are four types of chemical accelerators typically used:
- Thiurams
- Dithiocarbamates/Carbamates
- Mercaptobenzothiazoles (MBTs)
- Diphenylguanidine (DPG)
Of these chemical accelerators, Thiurams are the most frequent glove accelerators causing Type IV hypersensitivity.
Can powdered gloves contribute to Type IV hypersensitivity?
Powder may contribute to the development of a Type IV hypersensitivity. Powder can act as a vehicle transporting bound chemicals from the glove to the wearerâs skin. Perspiration can dissolve or extract the chemicals, while the glove keeps them pressed against the skin.
What causes non-glove related irritation?
Non-glove related irritation may be caused by soaps, detergents, disinfectants, solvents, degreasing agents, ethylene oxide, alcohol, cold, dry weather and hundreds of other irritants. Glove-associated irritation may be caused by glove powder, manufacturing chemicals and endotoxins found in both latex and synthetic gloves. Other irritation factors that are often overlooked are skin occlusion, sweat and friction experienced most often when gloves are worn too long.
What should you do if you are experiencing skin sensitivities?
If you are experiencing skin irritation, itâs important to respond accurately to the cause â not base it on a hunch. Focus first on common non-immunologic reactions, such as soaps and vulnerability from damaged skin. Approved moisturisers, rehydrating products and glove liners may help. Detergents, fragrances and products used at work or outside are more common irritants than synthetic gloves.
If Type IV hypersensitivity is suspected, this may include an evaluation by a dermatologist or allergist for patch testing for specific agents. Patch tests exist for all chemical accelerators.
Switching to accelerator-free gloves should be done if it is determined that the chemical accelerator has caused an immune response. However, âglove hoppingâ â frequently switching gloves in response to dermatitis â is counterproductive because itâs important to allow enough time for the wearer to adapt to a different glove or develop an understanding of delayed allergic reactions.
