Index

1. INTRODUCTION

Natural rubber latex (NRL) allergy is a common occupational disease among healthcare workers who use latex gloves [1-3 ]. Diagnosis of latex allergy is based on personal history, physical examination, skin prick, patch and challenge tests, or specific IgE determination, while self-administrated questionnaires are largely used to assess data about natural history, risk factors, etc [4-7 ].

The role of exposure duration to NRL gloves is demonstrated in a few studies, but there is lack of data with concern to this factor among the dental care students in Albania [8 , 9 ]. The aim of the present study was to determine the allergy prevalence to NRL gloves among dental students in the Albanian University of Tirana, and the correlation between questionnaire and diagnostic items to latex exposure duration.

2. METHOD

A total of 240 students (mean age 22.8±3.4 years) were prospectively surveyed using a self-administered questionnaire that gave information about the participants in regards to working habits, glove use, concentration on work, signs and symptoms related to NRL glove usage, any other type of allergy, familiar atopy, precautions taken to minimize the latex allergy, etc. The calculation of the exposure time to latex gloves was estimated based on practice program according to study semesters in addition to student’s statement about the dental work or assistance outside school practice. Beside questionnaire items, prevalence of latex-related symptoms and sensitization was determined in a randomized students’ sample by commercial skin prick tests (Stallergenes, France), patch tests with NRL, as well as through challenge test with dermal and airborne NRL exposure. Similarly to questionnaire, the challenge test was performed on all students.

The suspected cases for adverse reactions during latex exposure were further classified as irritant or allergic skin reactions, and internal organs allergic reactions. Correlation between exposure time to latex and other variables is conducted according to Kendall´s tau correlation coefficient and logistic regression analysis. Statistical significance was considered when p < 0.05.

3. RESULTS

A NRL allergy or hand erythema during work procedures was reported in 10% of subjects. About 14% of subjects reported irritant dermatitis after hand wash or washout procedures and about 10% of subjects complained of irritant symptoms after application of disinfectants. Hand eczema, within two days after NRL gloves use, was reported by 14% of subjects. Immediate facial allergic symptoms, rhino-conjuctival symptoms, lower respiratory symptoms, and visit to the emergency room after latex exposure were reported by 5%, 5.4%, 2.5% and 7.1% of subjects, respectively. The frequency of the rest of admitted questionnaire items is shown in table 1. Additional allergic pathologies and familiar history for such diseases were reported in 17% and 26% of subjects respectively. In addition, 15% of subjects reported food allergies.

With regards to diagnostic procedures, the patch test to latex resulted positive in about 15% of subjects. Skin prick test revealed a latex sensitization on 20% and airborne challenge with NRL gloves confirmed the allergic sensitization on 7.5% of subjects. In total, 25% of subjects were suspected for adverse reactions during NRL exposure, 19.2% were diagnosed with irritant contact dermatitis, 14.6% with allergic skin reactions, and 3.8% with internal allergic symptoms (for more information, see Table 1).

Average latex exposure (in hours) is estimated to be about 214±71 (SE), with a maximum of 11500 hours. The correlation between studied variables and the time exposure to NRL gloves revealed weak to moderate links with respect to reported latex allergy, eczematous reactions, hand erythema after glove wearing, irritant reactions during wash/washout procedures, concentration oscillations during usage of latex gloves, or dyspnea attack during latex exposure. Both suspected and confirmed diagnoses of latex hypersensitivity showed also a weak correlation to time of latex exposure (see Table 1).

Table-1.  Correlation between latex exposure duration and study variables

4. DISCUSSION

The obtained data by self-reported questionnaires and diagnostic procedures agree with literature reports, which emphasize the role of latex allergy as major occupational health problem in health care workers, affecting 0.5 to 18% of subgroups at risk [1 , 2 , 9-13 ]. Additionally, our study revealed concentration changes during the work practice. A skin allergy is confirmed on about 15% and non-cutaneous allergy in about 4% of subjects, indicating that, apart from contact to the skin, the respiratory exposure plays an important role on the latex sensitization [5 , 14 , 15 ].

Average latex exposure in our students is estimated to be about 215 hours, with a maximum of 11500 hours. The moderate correlation between some study items and exposure duration puts forth the argument that latex concentration, frequency and duration of glove use are important factors associated to latex sensitization, and to occurrence of different allergic symptoms [8 , 9 , 14 , 16 , 17 ]. It is estimated that duration of glove use more than 18 hours per week, more than 3 pairs of gloves used per day, NRL glove exposure, during medical practice longer than 3 years with a total exposure time of 9000 hours should be considered additional risk factors on the increased prevalence for latex-related allergic diseases [2 , 16-18 ]. Additional surveys demonstrated that high prevalence of symptoms is much strongly related to the use of latex gloves as compared to years of exposure or number of surgical procedures [19 , 20 ]. These findings demonstrate that latex allergy is an important health problem for health care workers, especially for those working in places where more NRL gloves are used [2 , 18 ]. The determination of latex glove exposure as risk factor for latex sensitization after a lower exposure duration among Albanian students may lead to the conclusion that gloves quality (stratified according to the protection level against biological materials, and concentration level for the NRL), plays a decisive role [6 , 11 , 21 , 22 ].

This study reinforces the conclusion that it is essential to recognize which professionals are sensitized to latex in order to provide appropriate treatment and to establish adequate prevention. Due to the relationship between allergic reactions to latex gloves and development of some medical histories during school practice, it seems necessary to undergo pre-matriculation and pre-employment evaluation, as well as periodic health surveillance of dental students.

REFERENCES

[1]        S. M. Risenga, G. P. Shivambu, M. P. Rakgole, M. L. Makwela, S. Nthuli, T. A. Malatji, N. J. Maligavhada, and R. J. Green, "Latex allergy and its clinical features among healthcare workers at Mankweng Hospital, Limpopo Province, South Africa," South African Medical Journal, vol. 103, pp. 390-394, 2013. View at Google Scholar | View at Publisher

[2]        M. Vangveeravong, J. Sirikul, and T. Daengsuwan, "Latex allergy in dental students: A cross-sectional study," Journal of the Medical Association of Thailand, vol. 94, pp. S1-8, 2011. View at Google Scholar 

[3]        Z. S. Buss and T. S. Fröde, "Latex allergen sensitization and risk factors due to glove use by health care workers at public health units in Florianopolis, Brazil.," Journal of Investigational Allergology and Clinical Immunology, vol. 17, pp. 27-33, 2007 View at Google Scholar 

[4]        M. Lamberti, R. Buonanno, C. Ritonnaro, G. Giovane, V. Crispino, A. Feola, N. Medici, N. Sannolo, A. Di Carlo, and M. Di Domenico, "Molecular profile of sensitization in subjects with short occupational exposure to latex," International Journal of Occupational Medicine and Environmental Health, vol. 28, pp. 841-8, 2015.View at Google Scholar | View at Publisher

[5]        S. Köse, A. Mandiracioğlu, B. Tatar, S. Gül, and M. Erdem, "Prevalence of latex allergy among healthcare workers in Izmir (Turkey)," Central European Journal of Public Health, vol. 22, pp. 262-265, 2014. View at Google Scholar | View at Publisher

[6]        Q. L. Liu, X. Z. He, K. Liang, R. Xie, H. P. Fang, K. J. Zhu, and Y. M. Fan, "Prevalence and risk factors for latex glove allergy among female clinical nurses: A multicenter questionnaire study in China," International Journal of Occupational and Environmental Health, vol. 19, pp. 29-34, 2013. View at Google Scholar | View at Publisher

[7]        S. H. Nabavizadeh, A. Anushiravani, and R. Amin, "Natural rubber latex hypersensitivity with skin prick test in operating room personnel," Iranian Journal of Allergy, Asthma and Immunology, vol. 8, pp. 219-20, 2009. View at Google Scholar 

[8]        C. Supapvanich, A. C. Povey, and F. De Vocht, "Latex sensitization and risk factors in female nurses in Thai governmental hospitals," International Journal of Occupational Medicine and Environmental Health, vol. 27, pp. 93-103, 2014.View at Google Scholar | View at Publisher

[9]        C. R. Zeiss, A. Gomaa, F. M. Murphy, D. N. Weissman, M. Hodgson, D. Foster, S. Dejativongse, K. Colella, K. Kestenberg, V. P. Kurup, R. K. Bush, A. M. Chiu, K. J. Kelly, and J. N. Fink, "Latex hypersensitivity in department of veterans affairs health care workers: Glove use, symptoms, and sensitization," Annals of Allergy, Asthma & Immunology, vol. 91, pp. 539-45, 2003. View at Google Scholar | View at Publisher

[10]      M. J. Galindo, S. Quirce, and O. L. Garcia, "Latex allergy in primary care providers," Journal of Investigational Allergology and Clinical Immunology, vol. 21, pp. 459-65, 2011. View at Google Scholar 

[11]      A. Copertaro, M. Bracci, M. Barbaresi, and G. Bianchini, "Usefulness of a questionnaire and RAST in screening of health care workers allergic to latex," Medicina Lavoro, vol. 97, pp. 779-786, 2006. View at Google Scholar 

[12]      F. Ly, I. Mbaye, I. Wone, C. Gaye-Fall, M. L. Sow, B. Ndiaye, and A. Mahé, "Allergy to latex gloves among healthcare workers in Dakar," Annales Dermatologie Venereologie, vol. 133, pp. 971-974, 2006. View at Google Scholar 

[13]      K. S. Wan and H. C. Lue, "Latex allergy in health care workers in Taiwan: Prevalence, clinical features," International Archives of Occupational and Environmental Health, vol. 80, pp. 455-457, 2007.View at Google Scholar | View at Publisher

[14]      W. Boonchai, W. Sirikudta, P. Iamtharachai, and P. Kasemsarn, "Latex glove-related symptoms among health care workers: A self-report questionnaire-based survey," Dermatitis, vol. 25, pp. 135-139, 2014.View at Google Scholar | View at Publisher

[15]      K. J. Kelly, M. L. Wang, M. Klancnik, and E. L. Petsonk, "Prevention of IgE sensitization to latex in health care workers after reduction of antigen exposures," Journal of Occupational and Environmental Medicine, vol. 53, pp. 934-940, 2011. View at Google Scholar | View at Publisher

[16]      C. Epling, J. Duncan, E. Archibong, T. Østbye, L. A. Pompeii, and J. Dement, "Latex allergy symptoms among health care workers: Results from a university health and safety surveillance system," International Journal of Occupational and Environmental Health, vol. 17, pp. 17-23, 2011. View at Google Scholar | View at Publisher

[17]      C. T. Lin, D. Z. Hung, D. Y. Chen, H. J. Wu, J. L. Lan, and Y. H. Chen, "A hospital-based screening study of latex allergy and latex sensitization among medical workers in Taiwan," Journal of Microbiology, Immunology and Infection, vol. 41, pp. 499-506, 2008. View at Google Scholar 

[18]      M. C. Diéguez, Z. Pulido, B. De la Hoz, R. Blanco, I. Cerecedo, E. Fernández-Caldas, and M. Swanson, "Latex allergy in healthcare workers: An epidemiological study in a Spanish hospital," Allergy & Asthma Proceedings, vol. 28, pp. 564-570, 2007. View at Google Scholar | View at Publisher

[19]      N. Verna, L. Di Giampaolo, A. Renzetti, L. Balatsinou, F. Di Stefano, G. Di Gioacchino, P. Di Rocco, C. Schiavone, P. Boscolo, and M. Di Gioacchino, "Prevalence and risk factors for latex-related diseases among healthcare workers in an Italian general hospital," Annals of Clinical & Laboratory Science, vol. 33, pp. 184-191, 2003.View at Google Scholar 

[20]      G. Holter, A. Irgens, A. Nyfors, T. B. Aasen, E. Florvaag, K. B. Overå, S. Elsayed, and J. Naerheim, "Self-reported skin and respiratory symptoms related to latex exposure among 5,087 hospital employees in Norway," Dermatology, vol. 205, pp. 28-31, 2002. View at Google Scholar | View at Publisher

[21]      I. M. Ghasemi, M. Rezaee, J. N. Jonaidi, and M. Izadi, "Latex gloves allergy in dental workers, Iran," Pakistan Journal of Biological Sciences, vol. 10, pp. 1068-1072, 2007. View at Google Scholar | View at Publisher

[22]      M. Crippa, M. Gelmi, E. Sala, R. Zefferino, T. P. Baccolo, and L. Alessio, "Latex allergy in health care workers: Frequency, exposure quantification, efficacy of criteria used for job fitness assessment," Medicina Lavoro, vol. 95, pp. 62-71, 2004.View at Google Scholar