Lise C. Borel, now 42, had been happily practicing dentistry for 10 years when she began noticing welts on her neck whenever she touched herself after removing her latex gloves.
Several weeks later, she suddenly found she couldn’t breathe within three minutes of donning her gloves.”I turned incredibly red. I was feeling very odd,” she recalls. A partner recognized that she was having a severe allergic reaction, gave her oxygen and a shot of antihistamine.
She revived and went to an allergist, who told her to use an inhaler and antihistamines and to keep an “EpiPen” handy to give herself adrenalin shots if it happened again.
It did, repeatedly, until even minimal contact with latex would send Borel into potentially fatal anaphylactic shock.
Her troubles are severe, but even less dramatic reactions to latex have become a growing problem, and not just among health care workers.
Natural rubber latex, made from the rubber tree Hevea brasiliensis, is used in 40,000 products – including 300 medical items – from anesthesia masks to automobile tires, balloons to blood pressure cuffs, condoms to catheters to diaphragms.
Although latex has been around for 50 years, concern about allergic reactions to the plant proteins in this natural, milky substance didn’t surface until 1979, with the first published report of a reaction to latex gloves in England.
Then in 1987, with fear of AIDS soaring, the US Centers for Disease Control recommended “universal precautions” for all health workers – using masks and gloves all the time to lessen the risk of infection. In 1992, the Occupational Safety and Health Administration stepped in, requiring employers to provide gloves and take other measures to protect employees against blood-borne organisms.
Although no one said latex was the only way to protect against disease, it quickly became the top choice. Before 1987, Americans used two billion pairs of gloves a year for medical purposes, says Thomas Tillotson, a New Hampshire glove manufacturer. Today, the figure is up to nine billion pairs,says Tillotson, who heads the latex task force of the Health Industry Manufacturers Association.
In addition to greater use of latex, some manufacturers may have changed the way they process the natural rubber, leaving more allergy-producing proteins in the finished goods, says Dr. Edward Petsonk, chief of the clinical section at the National Institute for Occupational Safety and Health.
And many of the gloves are now made overseas, where it’s tougher for American customers to monitor manufacturing, although gloves labelled for surgical or patient exam use are spot checked by the Food and Drug Administration.
Latex products have undoubtedly saved some lives, but they began threatening others. In 1989, the FDA investigated reports of patients going into shock during barium enemas. In all, 16 people died from allergies to latex in enema tips, which were taken off the market seven years ago.
Suspicions deepened in the early 1990s when nine children at a Milwaukee hospital went into shock after anesthesia had begun but before the first surgical incision was made. The culprit was the latex in anesthesia equipment and intravenous catheters.
Today, the FDA has tallied at least 1,700 cases of latex allergic reactions and 17 deaths. But Borel, who quit dentistry to run a support group called Elastic, Inc., says this understates the problem, based on data she obtained through a Freedom of Information Act request.
Indeed, half of people with spina bifida, a congential defect of the spinal canal, or with congenital urinary problems, have allergies attributed to the numerous medical procedures they must undergo that involve latex products, according to the American Academy of Allergy, Asthma & Immunology.
There are also more than 100 latex lawsuits in state and federal courts. The federal cases are now consolidated into a multi-district litigation in Philadelphia, says Jami Oliver, a lawyer with Clark, Perdue, Roberts & Scott in Columbus, Ohio.
Other studies estimate that 1-to-6 six percent of the general population and 8-to-12 percent of health care workers have been “sensitized” to latex, says Dr. Marshall Plout, chief of the allergic mechanisms section at the National Institute of Allergy and Infectious Diseases.
Sensitization means the body has antibodies to latex proteins, notes Dr. B. Lauren Charous, chairman of the latex allergy committee of the American College of Allergy, Asthma and Immunology.A fullblown allergic response often affects the skin and other organs, producing hives, swelling, asthma and, in extreme cases, anaphylatic shock.
Prompted by the growing concern, the occupational safety institute last month issued an alert urging employers and workers to switch to non-latex gloves for activities, like food handling, that do not involve contact with infectious materials.
When latex is a must, NIOSH recommended powder-free, lower-protein latex products. The powder, used to make gloves easier to put on, can latch onto latex proteins and aerosolize them.
Some hospitals, including Brigham and Women’s in Boston, have now gone latex-safe. But avoiding latex completely – the only real protection for people who are allergic – requires enormous commitment and vigilance, for both institutions and individuals.
If you are allergic, you have to avoid not only the latex in everything from balloons to condoms, but often bananas, kiwis, avocados and chestnuts as well, because proteins in these fruits and vegetables are similar to those in latex.
But it’s avoiding the products themselves that is hardest.
When one 39-year old banker from a Boston suburb discovered she was allergic to the condoms she and her husband used, she felt “overwhelmed, because of the extent of lifestyle changes.
“Many things are not labelled,” she adds, although the FDA is now considering requiring a warning on all latex products.
“It’s a nightmare,” says Rosemarie Pinheiro, a 33-year old Norton manicurist who got hives from her son’s toys. “I have to avoid everything with latex – that’s basically everything.”
And some health care workers, like Borel and Taunton nurse Maureen Iannoni, 41, have had to give up their jobs to survive.
Iannoni can no longer work in a hospital and uses non-latex products when she sees patients in their homes. The prospect of surgery was terrifying, because the hospital had to use a special protocol so she would not come in contact with latex.
Borel’s war with latex has been even tougher, she recalled recently from a hospital bed near her home in West Chester, Penn., where she was being treated for heart damage caused by asthma, which has plagued her since her first allergy attack.
After that first reaction, she went on vacation, she says. “I just felt wonderful. I felt my problems were done.” But on her first day back at work, she went into shock. Her office mates called 911 and the paramedics rushed to her aid, whipping on latex gloves and spewing powder everywhere.
She wound up in the hospital, but then went back to work and avoided using latex. But she went into shock again because her co-workers were still using powdered gloves.
While she stayed home, her partners then “de-latexed” the office, deep-cleaning carpets and scouring the ventilation system. Borel returned, went into shock again and spent a week in intensive care. That was the end of her dentistry career.
Today, things are changing, slowly. Tillotson, of the industry task force, estimates that non-powdered, reduced-latex gloves now comprise 25 to 30 percent of the market.
And although some medical centers like the Mayo Clinic in Minnesota have found that switching to latex-safe alternatives can save money, others find that costs go up. When allergist Dr. Donald Accetta of Taunton, head of the Massachusetts Allergy Society, made the switch, “the price doubled,” he says.
Still, there is a growing array of nonlatex products available. Some gloves for patient exams are now made of vinyl or PVC (polyvinyl chloride), nitrile or other synthetics, including synthetic rubber.
For surgical gloves, which must stretch, synthetic neoprene is also an option, as are some synthetic rubber gloves. The US Department of Agriculture is also exploring natural latex from a plant called guayule (pronounced “why-YOU-lee”) that grows in the southwest and seems not to trigger the same allergies as the traditional latex.
The FDA says that for protecting intact skin, both natural rubber latex and non-latex gloves are effective.
For condoms, which must protect more delicate mucous membranes, the CDC still recommends latex, noting that the AIDS virus can get through the pores of animal skin condoms.
For people allergic to latex, the FDA has approved condoms made from synthetics like polyurethane and Tactylon. Lab studies show these materials block viruses, but studies in people have not yet been completed.
Says Borel: “Don’t use latex if something else will do. If and when you do need latex gloves, use the kind that’s powder-free, with low latex proteins.”
LATEX REACTIONS CAN VARY
Latex allergy sometimes causes only a poison-ivy like rash 12-to-36 hours after contact. This reaction is not life-threatening.
Life-threatening reactions usually occur in people who are already sensitized to latex proteins. With the next exposure, these people may develop itching, redness, swelling, sneezing and wheezing, trouble breathing and anaphylactic shock, a marked drop in blood pressure.
The greatest danger often occurs when latex proteins are inhaled or come in contact with mucous membranes in the lips, nose, rectum or vagina, or during surgery.
For more information on latex allergies, you may call:
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Allergy and Asthma Foundation of America, New England Chapter, 617-965-7771 begin_of_the_skype_highlighting 617-965-7771 end_of_the_skype_highlighting or 800-7-ASTHMA begin_of_the_skype_highlighting 800-7-ASTHMA end_of_the_skype_highlighting (1-800-727-8462 begin_of_the_skype_highlighting 1-800-727-8462 end_of_the_skype_highlighting).
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Latex Allergy News, 860-482-6869 begin_of_the_skype_highlighting 860-482-6869 end_of_the_skype_highlighting.
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Elastic, Inc. 610-436-4801 begin_of_the_skype_highlighting 610-436-4801 end_of_the_skype_highlighting. (In Massachusetts, 508-824-4094 begin_of_the_skype_highlighting 508-824-4094 end_of_the_skype_highlighting.) Elastic (Education for Latex Allergy Support Team and Information Coalition – a independent nonprofit group.
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Alert (Allergy to Latex Education and Resource Team), 888-97-ALERT begin_of_the_skype_highlighting 888-97-ALERT end_of_the_skype_highlighting or 888-972-5378 begin_of_the_skype_highlighting 888-972-5378 end_of_the_skype_highlighting. Alert accepts funding from manufacturers of low allergen, non-powdered latex products.
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For a copy of the latex alert by the National Institute for Occupational Safety and Health, call 800-35-NIOSH begin_of_the_skype_highlighting 800-35-NIOSH end_of_the_skype_highlighting.