Reduced protein levels in latex gloves: key to lowering sensitization risks among health workers; a cross-sectional analytical study

doi:10.21203/rs.3.rs-4250228/v1

Download PDF

Research Article

Reduced protein levels in latex gloves: key to lowering sensitization risks among health workers; a cross-sectional analytical study

https://doi.org/10.21203/rs.3.rs-4250228/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background

Health workers frequently rely on latex gloves as personal protective equipment protects against biological hazards. However, the use of latex gloves has also given rise to a noteworthy occupational health concern—latex allergy. This issue is particularly associated with powdered, protein, and allergen levels in latex gloves. Recent advancements in latex glove manufacturing have led to reduced levels of extractable proteins, a known factor triggering allergic reactions. This study aimed to compare latex sensitization between nursing staff using low-protein and high-protein latex gloves at a tertiary university hospital in Thailand.

Methods

A cross-sectional analytical design was employed, categorizing participants into two groups based on glove exposure. 1) the low protein group consisted of participants who were only exposed to non-powdered latex gloves with extractable protein levels below 50 µg/g (< 9.9–36.7 µg/g), while 2) the high protein group comprised individuals who were exposed to powdered latex gloves with extractable protein levels above 50 µg/g (53.0–56.9 µg/g). The sample size comprised 163 individuals in the low protein group and 318 in the high protein group (1:2). Latex allergy symptoms and sensitization were assessed using a self-administered questionnaire and latex-specific IgE measurement (ImmunoCAP). Data analysis involved descriptive and inferential statistics, including odds ratios and 95% confidence intervals.

Results

Demographic data was mostly similar in both exposure groups except for age. No significant differences in latex sensitization between the low and high protein groups were found via latex-specific IgE measurement (crude OR 1.90, 95% CI 0.5 to 7.18), potentially attributed to lower extractable protein levels in powdered latex gloves compared to previous studies. In contrast, the low protein group exhibited significantly fewer current latex allergy symptoms in both bivariate (crude OR 0.24; 95%CI 0.06 to 0.74) and multiple variable analysis (adjusted OR 0.18; 95%CI 0.04 to 0.86).

Conclusions

This study underscores the importance of using non-powdered and low-protein latex gloves to reduce latex allergy symptoms while emphasizing the need for further investigation into the relationship between extractable protein levels in addition to the attempt of the major allergen removal and latex sensitization amid evolving glove manufacturing practices.

glove allergy

latex sensitization

latex allergy

nursing staff

latex gloves

Latex gloves are widely used as personal protective equipment in healthcare settings due to their favorable properties, including protection against biological hazards, elasticity, and dexterity [1]. Since the late 1980s, the use of latex gloves in healthcare has increased, leading to a continuous rise in latex sensitization and allergy among health workers, becoming a significant occupational health concern [2]. In 2014, the prevalence of latex sensitization and allergy among health workers was estimated to be 12.4% and 9.7%, respectively [3].

Latex allergen exposure can occur through direct skin contact or inhaling latex aero-allergen generated from powdered latex gloves. Implementation of a non-powdered latex gloves policy has been identified as an effective measure to decrease the incidence of latex sensitization and allergy [4,5]. The rationale behind this lies in the aerosolization of powder from the powdered latex gloves, which creates an environment for latex allergens to become airborne and subsequently inhaled [6]. In contrast, non-powdered gloves do not generate this aero-allergen, leading to a decrease in the risk of inhalation and subsequent sensitization [6,7].

Moreover, extractable protein levels are believed to be a significant contributor to latex sensitization, as they have a reasonable correlation with latex allergen levels [8]. Consequently, many glove standards mandate minimizing extractable protein levels to reduce the risk of latex sensitization. For example, the European standard EN 455-3 stipulates that latex gloves should have leachable protein levels as low as reasonably practicable (less than 50 µg/g) to minimize sensitization and allergy risks [9,10].

Although, many developed countries have successfully implemented policies on the replacement of powdered latex gloves with non-powdered latex or synthetic rubber gloves through laws and regulations, which effectively reduced latex sensitization and allergy cases [9,11], this replacement are not fully implemented in developing countries due to economic constraints. For instance, in Thailand, while the Ministry of Public Health has banned the use of sterile powdered latex gloves, disposable powdered latex gloves remain in use by health workers [12]. This has led to persistent problems of latex sensitization and allergy among health workers in developing countries.

While previous studies have shown the effectiveness of policies banning powdered latex gloves in reducing latex sensitization rates, there remains a gap in understanding the relationship between extractable protein levels and latex sensitization. To address this gap, this study aims to investigate latex sensitization among nursing staff in two distinct exposure groups (low vs high): those regularly using non-powdered latex gloves with lower extractable protein levels (less than 50 µg/g), and those using powdered latex gloves with higher extractable protein levels (more than 50 µg/g). Understanding this association is crucial, as extractable protein levels play a significant role in latex allergy issues, influencing policies aimed at promoting the use of latex gloves with lower extractable protein levels. This not only contributes to a safer workplace for health workers but also leads to cost savings within the healthcare sector, especially in developing countries.

This study was a cross-sectional analytical study conducted in two healthcare facilities in Northeastern Thailand, at Srinagarind Hospital and Queen Sirikit Heart Center of Khon Kaen University, Khon Kaen province. Data collection and participant recruitment occurred within the timeframe of January to April 2022.

Study population

The sample size for this study was determined based on previous research by M. Joan Saary et al. [13], which identified that individuals exposed to powdered latex gloves had a prevalence of latex sensitization of 10%, while those exposed to non-powdered latex gloves (that generally contained lower extractable protein) had a prevalence of 3%. The sample size was calculated using Winpepi version 11.65, with a 1:2 ratio between the low protein latex gloves exposure and high protein latex gloves exposure groups, a significance level of 5%, and a power of 80%. The calculated sample size for the study was 154 in the low protein group and 308 in the high protein group. However, to account for potential losses, the sample size was increased by 20% to 193 participants in the non-powdered group and 386 participants in the powdered group.

The study participants were nursing staff who had worked at one of those two hospitals for at least six months and were divided into two groups based on their exposure to latex gloves with different extractable protein levels. Following EN455-3 recommendation, which suggest extractable protein should be ≤ 50 µg/g for non-powdered latex gloves [10], A threshold of 50 µg/g was used to differentiate between high and low protein levels in latex glove exposure in our study. The "low protein group" comprised 212 operating theatre nurses who exclusively used non-powdered or synthetic rubber gloves. The non-powdered latex gloves in this group exhibited protein levels ranging from < 9.9 to 36.7 µg/g, as determined by the modified Lowry method. The "high protein group" consisted of 1,455 staff spread across 54 units, including inpatient, ICU, and emergency departments. Nursing staff in this group were typically required to use powdered latex gloves with protein levels ranging from 53.0 to 56.9 µg/g, using a minimum of three pairs per day, although they were also allowed exposure to gloves with lower protein levels.

Research tools

The research tools used in this study included self-administered questionnaires and blood samples for serum latex-specific IgE levels analysis. The questionnaires were used to evaluate latex allergy symptoms, including cutaneous and non-cutaneous symptoms, as well as demographic data, underlying atopic diseases, history of fruit allergy, glove exposure characteristics, and other latex product exposure. The questionnaire component was derived and adapted from previous studies conducted by Chaiear et al. [14] and Boonchai et al. [15]. It was reviewed by three experts in dermatology, immunology, and occupational medicine to ensure its validity. The questionnaire's item-objective congruence was found to be 0.92. Additionally, its test-retest reliability was determined by having 30 nursing staff complete the questionnaire twice with a two-week interval, resulting in a stability coefficient of 0.996. Participants who reported symptoms of latex allergy, including both cutaneous (e.g., urticaria, erythema rash, or itching) and non-cutaneous symptoms (e.g., runny nose, dyspnea, wheezing, or conjunctival injection) after exposed to latex gloves within 24 hours were classified as having latex allergy symptoms.

Blood samples were obtained and analyzed to determine serum-specific IgE levels at the Clinical laboratory section of Srinagarind Hospital in Khon Kaen. The ImmunoCAP and the Phadia 250 analyzer were used. This laboratory technique measures the level of IgE specific to natural latex allergen through a fluoroenzyme immunoassay with a sensitivity of 76.3% and a specificity of 96.7%. Latex sensitization was defined as serum latex-specific IgE levels equal to or exceeding 0.35 kAU/L [16].

Data collection

All participants mentioned in the study population section were explained the research process, benefits, and risks of participating in this study. Informed consent was obtained from each participant before administering the questionnaire and collecting blood samples. The self-administered questionnaire, in its online format, was completed by the participants. Following the questionnaire, blood samples were taken on the same working day. These samples were promptly sent to the laboratory unit, where they were centrifuged and stored at a temperature of -20°C until the time of analysis.

Statistical analysis

The statistical analyses were conducted using IBM SPSS version 28.0 and OpenEpi. Categorical data, such as demographic information, exposure characteristics, and latex allergy symptoms, were presented as proportion and percentage, while continuous data, such as age, employment duration, exposure characteristics, and latex-specific IgE level, were presented as mean and standard deviation (SD) or median and interquartile range (IQR). The relationship between latex sensitization and allergy between the two exposure groups was analyzed using the Chi-square or Fisher's exact test, and a p-value of less than 0.05 was considered to be statistically significant. Lastly, multiple logistic regression analysis was used. Factors for latex allergy symptoms, including history of atopic diseases, history of fruit allergy, family history of atopic diseases, surgical history, gloves exposure characteristic, and other latex product exposure, were analyzed to determine an association.

The response rate of this study was 76.8% (163 out of 212) in the low protein group and 77.2% (318 out of 412) in the high protein group. Of the participants in the low protein group, 58.0% (123 out of 212) agreed to the blood collection for latex-specific IgE, while 56.6% (233 out of 412) of participants in the high protein group did so. Unfortunately, two samples from participants in the high protein group were not suitable for analysis due to inadequate specimens. The median age of participants in the low protein group was 30 years (IQR 25–37), and 32 years (IQR 28–42) in the high protein group. Most of the participants were female and registered nurses. Approximately half of the participants reported underlying atopic diseases. The demographic data and underlying diseases related to latex sensitization are presented in Table 1 and showed no significant differences between the two exposure groups, except for age.

Table 1

Demographic data and underlying factors related to latex allergy among two exposure groups
Demographic data	Low protein group N = 163 (%, n)	High protein group N = 318 (%, n)	p-value
Age (years, IQR)	30 (25–37)	32 (28–42)	0.01
Sex			0.33
Female	92.0 (150)	94.3 (300)
Male	8.0% (13)	5.7% (18)
History of atopic diseases	50.3% (82)	47.5% (151)	0.56
History of fruit allergy	0.6% (1)	2.5% (8)	0.13
History of surgery	23.3% (38)	29.9% (95)	0.13
Family history of atopic diseases	20.2% (33)	26.1% (83)	0.16
History of hand dermatitis	24.5% (40)	18.9% (60)	0.15

Several exposure factors, such as job characteristics and glove usage patterns (i.e., duration of glove exposure per day and frequency of glove use), exhibited notable differences between the two groups. Additionally, there was a significant disparity in the duration of initial contact with latex gloves between the two exposure groups. Furthermore, variations were observed in the exposure to different types of latex medical products, including tourniquets, elastic bandages, and stethoscopes. However, despite these differences, there were no significant disparities in overall exposure to latex medical products. Further details on the exposure characteristics of gloves and other latex products can be found in Table 2.

Table 2

Characteristics of latex products and gloves exposure among two exposure groups.
Exposure characteristic	Low protein group N = 163 (%, n)	High protein group N = 318 (%, n)	p-value
1. Job characteristic			0.005
1.1 Registered nurse	76.7 (125)	66.4 (211)
1.2 Nurse assistant	22.7 (37)	29.2 (93)
1.3 Nursing aid	0.6 (1)	2.8 (9)
1.4 Hospital housekeeper	0 (0)	1.6 (5)
2. Intensity of gloves exposure
2.1 Duration since first contact (years, IQR)	8 (3,13.5)	10 (5,15)	0.04
2.2 Duration of contact per day (hours, IQR)	6 (4, 8)	4 (2,4)	< 0.001
2.3 Frequency of contact per day (pairs, IQR)	7 (5, 10)	10 (6,15)	< 0.001
3. Occupational latex medical product exposure and type	68.7 (112)	73.9 (235)	0.22
3.1 Tourniquet	34.4% (56)	59.7% (190)	< 0.001
3.2 Elastic bandage	58.9% (96)	36.2% (115)	< 0.001
3.3 Stethoscope	9.2% (15)	46.5% (148)	< 0.001
3.4 other latex medical products	41.1% (67)	39.6% (126)	0.77
4. Nonoccupational latex exposure by types
4.1 Dipping product exposure	40.5% (66)	33.6% (107)	0.14
4.2 Coagulation product exposure	39.9% (65)	44.7% (142)	0.32
5. Childhood exposure to latex	81.6% (133)	82.1% (261)	0.90

In terms of latex sensitization, the main outcome of this study, a total of 2.8% (10 out of 354) of all participants across both exposure groups tested positive for latex-specific IgE. When examining the findings in detail, 4.1% (5 out of 123) of participants in the low protein group and 2.2% (5 out of 231) of participants in the high protein group exhibited positive results for latex-specific IgE. Notably, our analysis did not identify any statistically significant differences between these two exposure groups with respect to latex sensitization (OR 1.90, 0.5–7.2). Furthermore, while the geometric mean of latex-specific IgE levels in the low protein group was lower, measuring at 0.0029 kUA/L, compared to the high protein group, which recorded a mean level of 0.0037 kUA/L, these variations were not deemed statistically significant. These results collectively indicate that there was no substantial difference in latex sensitization prevalence or mean latex-specific IgE levels between two exposure groups. Table 3 provides a detail of the latex-specific IgE levels in this study. Additionally, it's noteworthy that out of the ten nursing staff members who tested positive for latex sensitization, only two of them reported experiencing current latex allergy symptoms. Importantly, both of these individuals belonged to the high protein group.

Table 3

Specific IgE results categorized according to the exposure intensity
Exposure group	Positive latex-specific IgE case (n, %)	Geometric mean (kUA/L)	Range (kUA/L)
Low protein group	5 (4.1)	0.0029	0–1.94
High protein group	5 (2.2)	0.0037	0–2.44
Total	10 (2.8)	0.0034	0 -2.44s

Based on the findings obtained from a self-administered questionnaire, our study revealed that 1.2% of participants in the low protein group reported experiencing current latex allergy symptoms, compared to 7.2% of participants in the high protein group. This significant difference in current latex allergy symptoms was quantified using an OR of 0.16 (95%CI: 0.03, 0.59), indicating a substantially lower odds ratio of experiencing such symptoms in the low protein group in comparison to the high protein group. Detailed findings on latex allergy symptoms are presented in Table 4.

Table 4

Latex allergy symptoms categorized by exposure groups.
Latex allergy symptoms	Non-powdered exposure group (n, %)	Powdered exposure group (n, %)	OR (95%CI)	P-value
Latex allergy symptoms	2 (1.2)	23 (7.2)	0.16 (0.03, 0.59)	0.002
Cutaneous symptoms	2 (1.2)	21 (6.6)	0.18 (0.03, 0.66)	0.005
Non-cutaneous symptoms	0 (0)	2 (0.6)	1.29 (0.04, 19.92)	0.84
Furthermore, our research identified two significant contributing factors to the occurrence of latex allergy symptoms: a history of hand dermatitis with an OR 2.70 (95%CI: 1.14, 6.24) and the frequency of glove contact per day (p-value = 0.02). Additionally, our result found that the frequency of glove contact for more than eight pairs per day increases the risk of developing latex allergy symptoms with an OR 3.02 (95%CI: 1.22, 8.41)

To establish a more robust understanding of these associations, multiple logistic regression analysis was employed, which confirmed the earlier observations. Even after controlling for associated medical/surgical history, intensity of glove exposure, and exposure to other latex products, our study still demonstrated significantly lower current latex allergy symptoms in the low protein compared to the high protein group, with an adjusted OR of 0.18 (95%CI: 0.04, 0.86). More detailed findings are presented in Table 5.

Table 5

Summary of the association between factors and current latex allergy symptoms
Associated factors	Crude OR (95%CI)	Adjusted OR (95%CI)	P-value
Exposure intensity
Exposure group (low protein, high protein)	0.24 (0.06, 0.74)	0.18 (0.04, 0.86)	0.03
Medical and surgical factors
History of atopic diseases (no, yes)	0.98 (0.43, 2.23)	0.91 (0.36, 2.30)	0.84
History of fruit allergy	2.33 (0.10, 15.42)	3.55 (0.35, 36.1)	0.28
History of surgery	1.25 (0.50, 2.93)	0.92 (0.33, 2.56)	0.87
Family history of atopic diseases	1.83 (0.75, 4.25)	1.68 (0.64, 4.37)	0.29
History of hand dermatitis (no, yes)	2.70 (1.14, 6.24)	2.77 (1.11, 6.96)	0.03
Glove exposure characteristic
Duration since first contact (year)	N/A	0.99 (0.94, 1.04)	0.63
Duration of contact per day (hours)	N/A	0.92 (0.33, 2.56)	0.32
Number of gloves used per day (pairs)	N/A	1.09 (1.01, 1.18)	0.04
Other latex product exposure
Occupational latex medical product exposure (no, yes)	0.33 (0.14, 0.76)	0.26 (0.10, 0.66)	0.004
Nonoccupational exposure to dipping products (no, yes)	1.43 (0.62, 3.23)	1.86 (0.69, 5.00)	0.22
Nonoccupational exposure to coagulation products (no, yes)	1.04 (0.45, 2.37)	0.89 (0.33, 2.37)	0.81
Childhood exposure to latex (no, yes)	1.17 (0.41, 4.07)	1.38 (0.41, 4.60)	0.60

The present study provides updated information on latex allergy and sensitization among health workers. The results indicate that the incidence of current latex allergy symptoms was significantly lower in the low protein group. However, there are no significant differences in latex sensitization between low and high protein groups.

While demographic data did not significantly differ between the low and high protein groups, several exposure factors, including job characteristics and glove usage patterns (such as duration of glove exposure per day and frequency of glove use), exhibited notable disparities. This was attributed to the different working characteristics of the participants in the operating theatre and inpatient department. The non-powdered latex gloves exposure group consists of nursing staff primarily stationed in operating theaters, where the nature of their work requires them to wear gloves for extended durations during surgical procedures. In contrast, the powdered latex gloves exposure group comprises nursing staff stationed in inpatient care or intensive care units, where the use of gloves is more frequent but of shorter duration, as they change gloves regularly while attending to patients on a case-by-case basis.

Latex allergy is an IgE-mediated hypersensitivity reaction that arises from exposure to latex allergens. The higher the levels of latex allergens exposure, the higher the chance of developing latex sensitization. However, our study cannot demonstrate the significant differences in latex sensitization between low and high protein groups (4.1% vs 2.2%, as shown in Table 3). This discrepancy can be attributed to the comparable extractable protein levels in both high (powdered) and low protein (non-powdered) gloves. The lower levels of extractable protein (53.0–56.9 µg/g) observed in powdered latex gloves (classified as high protein gloves in our study) compared to levels reported in previous studies (generally higher than 100 µg/g) [9,17] may account for the lack of significant differences in latex sensitization cases. In recent years, advancements in latex glove production, such as in-line high-temperature processes and post-washing procedures, have led to a significant decrease in extractable protein levels [9]. A striking contrast can be observed when comparing studies published in 2003 and 2016; the extractable protein levels in latex gloves from Germany in 2003 were as high as 917.38 µg/g, and 68.4% of these gloves exceeded the DGUV recommended limit of 30 µg/g (TRGS 540) [17]. In contrast, a study published in 2016 reported that the extractable protein content in latex gloves in Germany had significantly decreased to 92.3 µg/g, with only 27.8% of all gloves in that study exceeding the DGUV recommended limit [18]. Moreover, our study found lower extractable protein levels in currently used latex gloves (lower limit of detection – 33.6 µg/dm²) when compared to the gloves examined in earlier studies in our country (115.1–203.9 µg/dm²) [19]. These earlier studies demonstrated a higher prevalence of latex sensitization among health workers (2.8–6.9%) compared to our research (2.8%) [19]. This serves as evidence of the technological improvements in glove production, which have likely contributed to the reduction in latex allergen levels and, consequently, the absence of significant differences in latex sensitization observed in our study.

In contrast, our study highlights that nursing staff in the low protein group, who were exposed to non-powdered latex gloves with lower extractable protein, had significantly fewer latex allergy symptoms than those in the high protein group (1.2% vs 7.2%, OR 0.16 95%CI: 0.03, 0.59), who were still exposed to powdered latex gloves with higher extractable protein. This difference persisted even after adjusting for various factors, as shown in Table 4 (adjusted OR 0.18; 95% CI: 0.04, 0.86). This phenomenon may be explained by the use of powdered latex gloves elevated the risk of developing latex allergy symptoms [6,20–21]. Not only extractable protein level but also powdered in latex gloves can increase the risk of latex allergy symptoms. Based on a study conducted in the United States, a noteworthy decrease in symptoms associated with latex glove exposure was observed, with a decline from 42–29% following the substitution of powdered latex gloves with non-powdered latex gloves and synthetic rubber gloves [4]. in Canada, the incidence of symptoms also decreased from 20–6% after those policies were implementation. Furthermore, a similar outcome was observed in Sweden, UK, and Germany [6, 22–23]. This is because powdered latex gloves can produce latex-aeroallergen in the workplace, causing higher levels of latex-allergen exposure [20]. In addition, Baur also confirmed a significant correlation between types of latex gloves (powdered/non-powdered) and airborne latex allergens [24]. Therefore, latex allergy was notably more prevalent in the high protein group where powdered latex gloves were still in use, highlighting the potential role of latex aeroallergen inhalation in triggering latex allergy. However, this result could be interpreted cautiously. Participants in our study may have experienced confusion between symptoms of latex allergy and those associated with other forms of contact dermatitis. The irritant properties of the powder present in latex gloves, combined with the additives used in their production may cause itching, burning, or irritating symptoms after exposure to latex gloves [25–27]. These factors may have contributed to a higher reporting rate of symptoms such as itching and redness among participants who were exposed to powdered latex gloves, causing some confusion. Contact dermatitis is the most common occupational skin condition and can affect individuals in various professions, including health workers [28]. A study on latex glove-related skin symptoms showed that nearly all participants (93.2%) who reported glove-related skin symptoms, such as itching, erythema, and dryness, were diagnosed with contact dermatitis, while 2.4% were confirmed to have both contact dermatitis and contact urticaria due to latex, as determined by patch tests and skin prick tests [29]. Similar results were found in a study in India, where 93.2% of participants reporting skin symptoms related to latex glove exposure had contact dermatitis, while only 28.3% were confirmed to have latex allergy, and 21.6% had both contact dermatitis and contact urticaria [30]. These findings provide evidence of potential confusion between the symptoms of latex allergy and contact dermatitis, and in some cases, both conditions may coexist.

However, we acknowledge certain limitations in our study. It is essential to interpret our findings on latex allergy symptoms cautiously and consider the potential for misclassification bias. Future studies may benefit from more comprehensive clinical assessments such as history taking and physical examination by dermatologists or occupational medicine physicians to differentiate between true latex allergy and other dermatological reactions, thus providing a clearer understanding of the relationship between glove type and symptom presentation among health workers.

Unlike clinical settings, the field of occupational health places a strong emphasis on proactive measures aimed at identifying abnormalities and potential health risks before they escalate into full-blown diseases. In the healthcare sector, occupational medicine physicians are pivotal in early identification of latex sensitization. Their aim is to prevent the onset of latex allergy symptoms and minimize the risk of more severe complications among healthcare workers. Implementing personal protective equipment suitable for workers with latex sensitization is crucial to enhance the quality of working life for health workers while simultaneously safeguarding their health. Our study suggests that one promising approach to effectively control and manage latex sensitization among health workers is to focus on reducing extractable protein levels in latex gloves. This approach presents a viable alternative that has the potential to contribute to the broader goal of minimizing latex-related health risks among this workforce. Although extractable protein may provide an indirect measurement of the allergenicity of latex gloves when compared with other techniques, such as determining latex allergen levels, it is more practical and cost-effective, making it feasible for implementation, especially in developing countries where resources may be limited. By addressing the root cause of latex sensitization, we can take proactive steps toward ensuring the well-being and longevity of healthcare professionals in their critical roles within the healthcare industry.

In conclusion, this study provides valuable insights into latex sensitization among health workers. The decreased levels of extractable protein in powdered latex gloves have emerged as a vital factor contributing to the reduction in latex sensitization. Furthermore, the elimination of powdered latex gloves has proven to be a protective measure against the development of latex allergy symptoms. These findings underscore the importance of adopting non-powdered latex gloves and minimizing extractable protein levels to safeguard the health and well-being of healthcare professionals.

Ethical considerations and consent to participate

This study underwent ethical review and received approval from the Khon Kaen University Ethics Committee for Human Research. The approval was granted in accordance with the Declaration of Helsinki and the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) Good Clinical Practice Guidelines. The approval number is HE641367. Participants received an explanation of the study, including its objectives, procedures, potential risks, and benefits, provided through written documents and discussions with the research team. They were informed that participation was entirely voluntary. Written informed consent was obtained from all participants before administering the questionnaire and collecting blood samples. Data presentation and analysis ensured participant anonymity and confidentiality.

Consent for publication:

not applicable

Available of data and materials

Additional data of this study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare that there are no financial or non-financial conflicts of interest related to this research study.

Funding

This research funding was support by National Research Council of Thailand (NRCT) grant number N21A650783 and Faculty of Medicine at Khon Kaen University (IN65206). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors' contributions

CN, NC, and JS contributed to the conception and design. The data were collected by CN, SD, SS, PK and JS. The analysis and interpretation of data were done by CN, NC, and JS. CN written the first draft of the manuscript and it was revised by NC. All authors read and approved the final manuscript.

Acknowledgments

The authors thank all research participants for their support. Special thanks are due to Prof. Surasak Wongratanacheewin, an immunologist, for his invaluable guidance and insights on immunological aspects of the research. The authors also wish to express our appreciation to the National Research Council of Thailand (NRCT) and the Faculty of Medicine at Khon Kaen University for their invaluable support throughout the research process. Their support played a crucial role in advancing our research efforts and promoting the well-being of health workers.

Manuscript preparation

In the process of preparing this article, ChatGPT-3.5, a Large Language Model Al tool, was used to improve and refine the language used in this article. However, it is crucial to emphasize that all the content, ideas, and concepts presented in this study are entirely the original work is the author's own idea, with no instances of potential plagiarism.

Hollins LC, Flamm A. Occupational contact dermatitis: evaluation and management considerations. Dermatol Clin. 2020;38(3): 329–338.
Nucera E, Aruanno A, Rizzi A, Centrone M. Latex Allergy: Current Status and Future Perspectives. J Asthma Allergy. 2020;13: 385–398.
Wu M, McIntosh J, Liu J. Current prevalence rate of latex allergy: Why it remains a problem? J Occup Health. 2016;58(2): 138–144.
Korniewicz DM, Chookaew N, Brown J, Bookhamer N, Mudd K, Bollinger ME. Impact of converting to powder-free gloves: decreasing the symptoms of latex exposure in operating room personnel. AAOHN J. 2005;53(3): 111–116.
Turner S, McNamee R, Agius R, Wilkinson SM, Carder M, Stocks SJ. Evaluating interventions aimed at reducing occupational exposure to latex and rubber glove allergens. Occup Environ Med. 2012;69(12): 925–931.
Edelstam G, Arvanius L, Karlsson G. Glove powder in the hospital environment – consequences for healthcare workers. Int Arch Occup Environ Health. 2002;75(4): 267–271.
Brown RH, Taenkhum K, Buckley TJ, Hamilton RG. Different latex aeroallergen size distributions between powdered surgical and examination gloves: significance for environmental avoidance. J Allergy Clin Immunol. 2004;114(2): 358–363.
Yunginger, JW, Jones RT, Fransway, AF. Extractable latex allergens and proteins in disposable medical gloves and other rubber products. J Allergy Clin Immunol 1994; 93(5): 836–842.
Palosuo T, Antoniadou I, Gottrup F, Phillips P. Latex medical gloves: time for a reappraisal. Int Arch Allergy Immunol. 2011;156(3): 234–246.
European Committee for Standardization. EN455-3: Medical gloves for single use - part 3: requirements and testing for biological evaluation. Brussels:CEN; 2015.
Tarlo SM, Easty A, Eubanks K, Parsons CR, Min F, Juvet S, et al. Outcomes of a natural rubber latex control program in an Ontario teaching hospital. J Allergy Clin Immunol. 2001;108(4): 628–633.
Notification of Ministry of Public Health: Prohibition on the production, import, or sale of powdered gloves for surgical purposes BE 2563 (A.D. 2020). Roy Thai Gov Gaz 2020; 137 (Special Pt 260 ng):8. (in Thai)
Saary MJ, Kanani A, Alghadeer H, Holness DL, Tarlo SM. Changes in rates of natural rubber latex sensitivity among dental school students and staff members after changes in latex gloves. J Allergy Clin Immunol 2002;109(1): 131–135.
Chaiear N, Med M, Jindawong B, Boonsawas W, Kanchanarach T, Sakunkoo P. Glove allergy and sensitization to natural rubber latex among nursing staff at Srinagarind hospital, Khon Kaen, Thailand. J Med Assoc Thai. 2006;89(3): 368–376.
Boonchai W, Sirikudta W, Iamtharachai P, Kasemsarn P. Latex glove–related symptoms among health care workers: a self-report questionnaire-based survey. Dermatitis. 2014;25(3): 135–139.
Ünsel M, Mete N, Ardeniz Ö, Sin A, Gülbahar O, Kokuludağ A. Diagnostic value of specific IgE analysis in latex allergy. Int Arch Allergy Immunol. 2012; 158(3): 281–287
Crippa M, Belleri L, Mistrello G, Carsana T, Neri G, Alessio L. Prevention of latex allergy among health care workers: evaluation of the extractable latex protein content in different types of medical gloves. Am J Ind Med. 2003;44(1): 24–31.
Gathen Y von der, Sander I, Flagge A, Brüning T, Raulf-Heimsoth M. Quantification of protein and latex allergen content of various natural rubber latex products. Allergol Sel 2017;1(2): 109–119.
Supapvanich C, Povey AC, de Vocht F. Evaluation of proteins in natural rubber latex gloves and pulmonary function amongst female nurses in two tertiary hospitals in southern, Thailand. Asian Pac J Allergy Immunol. 2019. Available from: https://apjaijournal.org/wp-content/uploads/2019/11/AP-310319-0530.
Raulf M. Current state of occupational latex allergy. Curr Opin Allergy Clin Immunol. 2020;20(2): 112–116.
Bittner C, Velasco Garrido M, Krach LH, Harth V. Content of asthmagen natural rubber latex allergens in commercial disposable gloves. Adv Exp Med Biol. 2016;921: 37–44.
Clayton TH, Wilkinson SM. Contact dermatoses in healthcare workers: reduction in type I latex allergy in a UK centre. Clin Exp Dermatol. 2005;30(3): 221–225.
Allmers H. Primary prevention of natural rubber latex allergy in the German health care system through education and intervention. J Allergy Clin Immunol. 2002;110(2): 318–323.
Baur X. Measurement of airborne latex allergens. Methods. 2002;27(1): 59–62.
Cleenewerck MB. Update on medical and surgical gloves. Eur J Dermatol. 2010;20(4): 434–442.
Brehler R, Voss W, Müller S. Glove powder affects skin roughness, one parameter of skin irritation. Contact Dermatitis. 1998;39(5): 227–230.
Goodier MC, Ronkainen SD, Hylwa SA. Rubber accelerators in medical examination and surgical gloves. Dermatitis. 2018;29(2): 66–76.
Chern A, Chern CM, Lushniak BD. Chapter 27: occupational skin diseases. In: Kang S, Masayaki A, Bruckner AL, Enk AH, Margolis DJ, McMicheal AJ, et al. Fitzpatrick's Dermatology. 9th ed. New York: McGraw-Hill. 2019 [cited 2023 May 23]. Available from: https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210417622
Nettis E, Assennato G, Ferrannini A, Tursi A. Type I allergy to natural rubber latex and type IV allergy to rubber chemicals in health care workers with glove-related skin symptoms. Clin Exp Allergy. 2002;32(3): 441-7.
Tomy C, Joseph B, Madhukara J. Study of latex glove associated dermatoses among nurses in a tertiary care hospital. Indian Dermatol Online J. 2021;12(6): 841–846.

No competing interests reported.

Download PDF

Editorial decision: Revision requested
08 May, 2024
Reviews received at journal
07 May, 2024
Reviews received at journal
23 Apr, 2024
Reviewers agreed at journal
17 Apr, 2024
Reviewers agreed at journal
16 Apr, 2024
Reviewers invited by journal
16 Apr, 2024
Editor assigned by journal
15 Apr, 2024
Submission checks completed at journal
14 Apr, 2024
First submitted to journal
11 Apr, 2024

You are reading this latest preprint version

Reduced protein levels in latex gloves: key to lowering sensitization risks among health workers; a cross-sectional analytical study

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Introduction

Materials and Methods

Study population

Research tools

Data collection

Statistical analysis

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1