A hospital-based screening program for natural rubber latex allergy.
BACKGROUND
Natural rubber latex (NRL) allergy has become an important occupational health problem for health care workers, of whom approximately 10% are reportedly sensitized. Some medical facilities have chosen to convert entirely to NRL-free gloves, but others have found this to be financially or logistically unfeasible.


OBJECTIVE
The goals of this study were 1) to devise a NRL allergy screening program that could identify sensitized (at-risk) employees for the purpose of providing them with a safe working environment; and 2) to develop a glove conversion plan that would lead to the removal of all NRL gloves from the institution.


METHODS
A multidisciplinary University of Maryland Medical System NRL risk team developed a mandatory NRL screening program for all newly hired employees and any existing employees transferring into or within patient care positions. Employees were screened with a clinical questionnaire and a serology for immunoglobulin (Ig)E anti-NRL. Some employees voluntarily received an experimental NRL skin test to evaluate their skin reactivity to NRL. Each employee reporting respiratory or systemic symptoms associated with NRL exposure was evaluated by an allergist.


RESULTS
During the 15-month study period from April 1998 to July 1999, 1,795 employees were screened for NRL allergy. Of the whole group, 8% (144 of 1,795) were NRL-specific IgE antibody-positive by CAP radioallergosorbent test (Pharmacia-Upjohn Diagnostics, Kalamazoo, MI) and/or NRL skin test, 57.3% of whom reported symptoms with powdered NRL glove exposure. The NRL IgE-positive rates of nonpatient-care employees (who did not use NRL gloves on a regular basis) and direct patient-care employees was 5.9% and 8.6%, respectively. Most NRL-sensitized employees were successfully accommodated with the use of synthetic gloves and continued to work in the positions for which they were hired.


CONCLUSIONS
The University of Maryland Medical System NRL screening program has been successful in identifying at-risk employees and ensuring them a safe working environment during a progressive conversion of the hospital to a NRL-safe environment.
Bollinger
Mary E
ME
Division of Pediatric Pulmonology/Allergy, University of Maryland School of Medicine, Baltimore, USA. mbolling@peds.umaryland.edu
Mudd
Kim
K
Keible
Lynn A
LA
Hess
Becky L
BL
Bascom
Rebecca
R
Hamilton
Robert G
RG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis; D005260:Female; D017575:Gloves, Protective; D006282:Health Personnel; D006801:Humans; D020315:Latex Hypersensitivity / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000517:prevention & control*; D016273:Occupational Exposure; D012307:Risk Factors; D012882:Skin Tests; D011795:Surveys and Questionnaires
D000888:Antibodies, Anti-Idiotypic; C026408:anti-IgE antibodies