Adverse Reactions to Latex Gloves Among Dentists in Bhubaneswar, Odisha

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1 Research Article J Res Adv Dent 2014; 3:1: Adverse Reactions to Latex Gloves Among Dentists in Bhubaneswar, Odisha Gunjan Kumar 1* Md Jalaluddin 2 Dhirendra K Singh 3 CL Dileep 4 Purnendu Rout 5 Ankur Chaudhary 6 1 Senior Lecturer, Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India. 2 Reader, Department of Periodontics, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India. 3 Senior Lecturer, Department of Periodontics, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India. 4 Professor and Head, Department of Public Health Dentistry, Surendra Dental college, Sri Ganganagar, Rajasthan, India. 5 Senior Lecturer, Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India. 6 Private Consultant, Department of Public Health Dentistry, Kanpur, Uttar Pradesh, India. ABSTRACT Background: Adverse reactions to natural rubber latex (NRL) are very commonly seen in dental practice and needs to be addressed on an emergent basis. Aim & objective: The aim of this study was to assess the prevalence of latex glove related symptoms in a sample of 50 dentists who had a high exposure in the dental setting. Material & Method: A questionnaire containing 30 questions was administered to 50 dentists practicing in the city of Bhubaneswar, Odisha, during the month of August and September 2012 for eliciting self-reported information on the prevalence of latex glove related symptoms. Results: From among the dentists surveyed, 12 subjects (24%) had glove related problems; 2 subjects (16%) gave a history of symptoms correlating to atopy, while 5 subjects (41.6%) had symptoms consistent with glove dermatitis and 5 subjects (41.6%) presented with a history suggestive of type 1 hypersensitivity to latex gloves. The most commonly seen manifestation was itching (20%) and dryness (18%). Food allergy was most commonly related to the consumption of bananas, watermelons and grapes. Conclusion: Latex related manifestations were found among 50% of the dentists residing in Kanpur although a true latex sensitization was detected only in a minority of cases. Counseling the dental personnel about ways of avoiding and/or modifying the work environment needs to be considered. Keywords: Latex, hypersensitivity, gloves. INTRODUCTION The use of natural rubber latex (NRL) is seen from historical times and was widely used in the dental profession since the mid-twentieth century with the rising awareness for infection control measures 1. NRL is extracted from the sap of Hevea brasiliensis trees, which contains as many as 256 proteins 2, including 11 potential allergens 3. Surgical NRL gloves were introduced by William Halstead in Latex allergy was first reported by Nutter 4 in In 1987 Axelsson 5 reported a case of NRL anaphylaxis in the dental profession. It is suggested that around 10% of health care workers Copyright 2013

2 and around 5% of the lay population experience latex allergy 6. The prevalence of IgE mediated reaction to NRL is estimated as up to 6% in the general population 7. The introduction of Universal Precautions 8 has increased the exposure of health care team to latex products. Since then, latex allergy has become a grave problem that has implications for both the health care providers and the beneficiaries. Adverse reactions to NRL are multifaceted. Irritant contact dermatitis arises with incompletely dried hands after use of detergents. Allergic contact dermatitis is caused by one or more low molecular weight chemical compounds added in the rubber making process. True latex allergy is marked in atopic individuals who are more likely to develop IgE antibodies to the latex protein with increased exposure. Dental workers form an excellent group for studying the labyrinth of latex glove related symptoms as they routinely wear gloves for 8-10 hours daily for a larger part of the week contributing to a much greater extent of exposure to latex, than most other health care workers. MATERIAL & METHOD Fifty registered dentists in Bhubaneswar, Odisha, were administered a questionnaire during the months of August and September Necessary permission from the Institutional Ethics Committee was taken for the survey. The questionnaire was further divided into 4 sections: Section A: dealt with the practice set-up of the dentists and contained questions on demographic characteristics including age, gender and years in the present occupation. Section B: sought information about hand glove type used and working habits, including the number of patients seen per day, duration for which each pair of gloves was worn, information about hand washing before and after wearing gloves. Section C: sought information about the symptoms or problems upon contact with latex gloves. The respondents who acknowledged gloverelated problems thereupon answered detailed questions about the symptoms, the time, course of symptom development, non-hand related symptoms such as rhino conjunctivitis, asthma, angioedema and hypotension. Section D: dealt with history of other allergies including hay fever, food allergies and drug allergies. Statistical Analysis: The raw data data from the completed questionnaires were entered into a database, and SPSS Ver for Windows was used for the analysis RESULTS A total of 50 registered dental practitioners participated in the study. All the subjects were using non-sterile latex examination gloves. Age- and gender-wise prevalence of adverse reactions to latex are given in Tables 1 and 2, respectively; and pictorially depicted in Figures 1 and 2, respectively. The gamut of symptoms related to adverse reactions to latex, observed among the study group is shown in Table 3. A total of 10 respondents (20%) had adverse reactions to latex. Out of these 10 subjects, 2 subjects (20%) presented with a history of symptoms correlating to atopy, while 5 subjects (50%) had symptoms consistent with glove dermatitis and 3 subjects (30%) gave a history suggesting of latex hypersensitivity (Fig. 3). Out of the 10 subjects who gave a history consistent with latex glove related symptoms, 2 subjects (4%) had a history of drug allergy while 2 other respondents (4%) had a history of food allergy. Table 1: Age-wise prevalence of adverse reactions to latex Age Present Absent Total 56

51-60 2 50 2 50 4 61-70 2 100 0 0 2 71-80 0 0 1 100 1 Table 2: Gender-wise prevalence of adverse reactions to

Gender Present Absent Total Fig 1: Latex gloves hypersensitivity Present/ Absent (Age Wise) Male 20 50 20 50 40

Total Itch 10 20 40 80 50 Redness 3 6 47 94 50 Hives 2 4 48 96 50 Rashes 2 4 48 96 50 Dryness 9 18 41 82 50

48 96 50 Angioedema 0 0 50 100 50 Hypotension 1 2 49 98 50 Cough 4 8 46 92 50 Facial Swelling 0 0 50 100 50

edema 0 0 50 100 50 Fig 2: Latex gloves hypersensitivity Present/ Absent (Sex Wise) Fig 3: Prevalence of latex

21-30 years followed by the age group of 31-40 years (Table 1).

3 Table 2: Gender-wise prevalence of adverse reactions to latex. Gender Present Absent Total Fig 1: Latex gloves hypersensitivity Present/ Absent (Age Wise) Male Female Table 3: Spectrum of symptoms related to adverse reactions to latex Symptoms Present Absent Total Itch Redness Hives Rashes Dryness Fissuring Chapping Vesicles Rhino conjunctivitis Asthma Angioedema Hypotension Cough Facial Swelling Dizziness Laryngeal edema Dyspnoea Food allergy Generalized edema Fig 2: Latex gloves hypersensitivity Present/ Absent (Sex Wise) Fig 3: Prevalence of latex glove related symptoms DISCUSSION A majority of the latex glove related symptoms was found in the age group of years followed by the age group of years (Table 1). It may be pointed out that atopy includes a history of asthma, allergic rhinitis, hay fever, food allergy and/or drug allergy. In our survey we found that 4% each of the dentists suffered from asthma, food allergy, hay fever and drug allergy. This was in agreement with the findings of the study conducted 57

4 by Tarlo SM et.al 9, where 5% subjects tested positive to these symptoms. However, to be classified as atopy positive a person must have at least a minimum of two of the above mentioned features. Thus, in the present study around 20% of the dentists suffered from atopy which was in disagreement with the findings of the study conducted by Gopi Krishna and Parmeshwaran A 10, and in the study conducted by Clarke A 11, where 14.2% and 33.9% of the subjects, respectively, were atopy positive. Glove dermatitis presents with itching, redness, rashes, dryness, fissuring, chapping and vesicles 12. In the present study, it was found that 20% of the dentists suffered from itching, 6% suffered from redness, 4% suffered from rashes, 18% suffered from dryness, 8% suffered from fissuring and none suffered from vesicles. To label a subject to have had glove dermatitis there should be the presence of two or more of the above symptoms. Thus, in the present study 50% of the dentists suffered from glove dermatitis and this finding was in accordance with the findings of the study conducted by Gopi Krishna and Parmeshwaran A 10, where 46.4% of the subjects presented with glove dermatitis. Latex hypersensitivity is a condition whose manifestations includes allergic rhino conjunctivitis, lower respiratory tract symptoms such as cough, wheeze, hypotension, dizziness and generalized edema. It was found that none suffered from rhino conjunctivitis and generalized edema, 8% suffered from cough and 2% each suffered from hypotension and dizziness. Thus, in the present study 30% of the dentists suffered from latex hypersensitivity. This observation was in disagreement with the findings of the study by Gopi Krishna and Parmeshwaran A 10, where only 3.57% subjects had latex hypersensitivity. The most common symptoms of latex glove reaction were itching in 20% subjects and dryness in 18% subjects. Four percent of the subjects reported food allergy, although none reported symptoms with food such as avocado, nuts, apricot, plum, peach, potato and tomato. The present study relied totally on the self reported responses to the questionnaire to quantitate the adverse reactions to glove latex. The results imply that there is a high prevalence of glove related symptoms; particularly of glove dermatitis and latex hypersensitivity. This indicates a need to educate this occupational group about proper hand care as repeated washing, scrubbing and multiple glove changes contribute to hand irritation. The realm of latex allergy has many implications for the dentists which extend beyond the workplace. In treating latex-sensitive patients the best strategy is to minimize exposure to latex 13. Subjects suffering from any gloves related symptoms need to be familiar with ways of avoiding and/or modifying the work environment 14. Mucosal contact with latex appears to be a far more potent trigger for anaphylactic reactions than cutaneous contacts. Atopic individuals appear to be especially at risk of sensitization to the latex protein 15. Adequate counseling about occupational exposure and methods of minimizing the risk needs to be considered. CONCLUSION In summary, latex protein allergy, as well as other reactions associated with frequent wearing of gloves, can have potentially serious consequences for the dental team. Latex products should be replaced with latex-free alternatives for people who have hypersensitivity to NRL. The use of lowprotein, powder-free latex gloves prevents the aerosolization of the protein-powder complex and prevents sensitization to the latex protein. Frequent cleaning of latex dust contaminated work areas and educating the dental personnel about the remedial measures will go a long way in bringing down latex related adverse reactions. CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported. REFERENCES 1. Williams PB, Hays SM, Finley BL. Latex Allergy: epidemic or epiphenomenon. Ansell Professional Healthcare Source to Surgery, URL: http//www. ansellhealthcare.com/ Europe/france/source/jaan00-2.htm. 2. Hamann CP, Turjanmaa K, Rietschel R, Siew C, Owensby D, Gruninger SE, and other. Natural rubber latex hypersensitivity: incidence and 58

5 prevalence of type I allergy in the dental professional. J Am Dent Assoc 1998; 129(1): Hamann CP, Rodgers PA, Sullivan K. Management of dental patients with allergies to natural rubber latex. Gen Dent 2002; 50(6): McNally and Kean T. Latex Hypersensitivity: A closer look at considerations for dentistry. JCDA 2009; 75 (4): Nutter AF. Contact urticaria to rubber. Br J Dermatol 1979; 101: Axelsson JG, Johansson SG, Wrangsjo. K. IgEmediated anaphylactoid reaction to rubber. Allergy 1987; 42 (1) National Institute for Occupational Safety and Health (NIOSH).Latex Allergy June URL: September Ownby D R, Ownby H E, McCulloch J, Shafer AW. The prevalence of anti-latex IgE antibodies in 1000 volunteer blood donors. J Allergy Clin Immunol 1996; 97: Spina A, Levine HJ. Latex allergy: a review for the dental professional. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87(1): Tarlo SM, Sussman GL, Holness DL. Latex sensitivity in dental students and staff: a crosssectional study. J Allergy Clin Immunol 1997; 99(3): Gopi Krishna and Parmeshwaran A. Latex Glove Hypersensitivity. JIDA 2001; 72(1): Clarke A. The provision of dental care for patients with natural rubber latex allergy: are patients able to obtain safe care? Br Dent J 2004; 197(12): Hill JG, Goamwood RD, Hermesch CB, Marks JG. Prevalence of occupationally related hand dermatitis in dental workers. J Am Dent Assoc. 1998; 129: Nainar SM. Dental management of children with latex allergy. Int J Paediatr Dent 2001; 11(5): Field EA, Longman LP, Al-Sharkawi M, Perrin L, Davies M. The dental management of patients with natural rubber latex allergy. Br Dent J 1998; 185:

Dental surgeons with natural rubber latex allergy: a report of 20 cases

Occup. od. Vol. 49,. 2, pp. 103-107, 1999 Copyright C 1999 LJpptncott Williams 4 WilkJns for SO Printed In Great Britain. AH rights reserved 0962-7480/99 Dental surgeons with natural rubber latex allergy: