title: Natural rubber latex-related occupational asthma: association with interventions and glove changes over time.
abstract: BACKGROUND
  Exposure to natural rubber latex (NRL) has been recognized as a cause of occupational asthma (OA), especially among health care workers (HCWs) associated with use of gloves. Little or no population-based data are available which chart the changes over time in the number of cases of OA as this problem was increasingly recognized and then interventions instituted.
  
  
  METHODS
  We obtained the numbers of allowed asthma claims with exposure to latex by year in the province of Ontario, Canada from the Ontario Workplace Safety and Insurance Board; details of the cases from the largest teaching hospital were reviewed. Interventions included: (1) in 1996, the Board recommended in its focus for accommodation of sensitized workers, the reduction of aerosols of latex proteins and that hospital facilities use powder-free, low-protein or nonlatex gloves; and (2) hospitals instituted latex policies and glove changes at various dates. For example, at the largest teaching hospital, interventions included education and voluntary medical surveillance in 1994; substitution of low protein, "powder-free" NRL gloves for non-sterile powdered gloves in 1995; and replacement of powdered sterile NRL gloves by lower protein, "powder-free" NRL gloves in 1997.
  
  
  RESULTS
  Through 1999, there were 60 allowed claims for asthma in Ontario with exposure to latex; of these 49 (82%) were among HCWs. The number of claims among HCWs changed from 0 to 2 per year up to 1990; increased to 7 to 11 per year between 1991-1994; and declined to 3 per year in 1995-1996 and 1 to 2 per year in 1997-1999. Of the ten institutions having two or more OA latex claims, all claims occurred in 1996 or earlier at 8 (80%). At the largest hospital, there were five accepted claims with year of diagnosis in 1993 (1 case), 1994 (3 cases), and 1995 (1 case).
  
  
  CONCLUSIONS
  These findings suggest that, despite the effect of increasing recognition, the introduction of gloves with reduced powder and/or protein, as well as other interventions have been associated temporally with declines in the number of cases of latex OA.
authors.affiliation: Gage Occupational and Environmental Health Unit, University of Toronto, 400 University Ave. Toronto, Ontario, Canada M7A 1T7. gary.liss@utoronto.ca
authors.forename: G M
authors.initials: GM
authors.lastname: Liss
authors.forename: S M
authors.initials: SM
authors.lastname: Tarlo
mesh_terms: D000328:Adult; D001249:Asthma / Q000139:chemically induced*; D005260:Female; D005932:Gloves, Surgical / Q000009:adverse effects*; D006293:Health Promotion; D006784:Hospitals, Teaching; D006801:Humans; D007345:Insurance Claim Review; D020315:Latex Hypersensitivity / Q000150:complications* / Q000517:prevention & control; D008297:Male; D008499:Medical Records; D009784:Occupational Diseases / Q000139:chemically induced* / Q000150:complications / Q000191:economics; D016273:Occupational Exposure / Q000191:economics / Q000517:prevention & control* / Q000592:standards; D009864:Ontario; D015397:Program Evaluation