Food and Drug Reactions and Anaphylaxis
Primary prevention of natural rubber latex allergy in the German health care system through education and intervention

https://doi.org/10.1067/mai.2002.126461Get rights and content

Abstract

Background: The development of occupational asthma and allergic skin reactions caused by natural rubber latex (NRL) allergy are risks for health care workers. There are few published studies to suggest that intervention programs to reduce exposure will lead to primary prevention of sensitization. Objective: This study assesses the effects of intervention to reduce the incidence of NRL allergy in personnel working in health care facilities insured by the German statutory accident insurance company for health care workers, Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, with approximately 3 million insured employees, by switching to powder-free NRL gloves. Methods: The timing of introduction of intervention strategies, such as education of both physicians and administrators, together with regulations demanding that health care facilities only purchase low-protein, powder-free NRL gloves are reported. We reviewed the annual numbers of reported suspected cases of NRL-caused occupational allergies and the amount and type of gloves used in German acute-care hospitals since 1986. Results: The purchase of powder-free NRL examination gloves exceeded that of powdered gloves for the first time in 1998. This only became true for powder-free NRL sterile gloves 2 years later in 2000. The incidence of suspected occupational NRL allergy cases rose until 1998 and has declined steadily since. There was a 2-year lag between the beginning of the decline in the purchase of powdered NRL examination gloves and the beginning of a decline in suspected NRL-caused occupational asthma cases. Conclusions: Despite the effect of increased recognition of NRL allergies, education about NRL allergies in health care facilities combined with the introduction of powder-free gloves with reduced protein levels has been associated with a decline in the number of suspected cases of occupational allergies caused by NRL in Germany on a nationwide scale. These results clearly indicate that primary prevention of occupational NRL allergies can be achieved if these straightforward and practical interventions are properly carried out and maintained. (J Allergy Clin Immunol 2002;110:318-23.)

Section snippets

Educational and regulatory measures

In December 1995, an interdisciplinary work group from the departments of dermatology, allergy, and occupational medicine of 7 German universities met in the Berufsgenossenschaftliches Forschungsinstitut für Arbeitsmedizin (BGFA), Bochum, Germany, to decide on recommendations concerning the prevention of NRL allergy in HCWs and allergic patients. Those guidelines for hospital administrators and personnel were published in several scientific journals15 and were also distributed by the BGFA. Two

Results

The greatest increase in the use of powdered NRL gloves was registered in 1990, when the purchase of nonsterile examination gloves more than doubled, from 166 million pieces in 1989 to 364 million pieces. The second largest increase took place in 1995, when a peak of 738 million powdered gloves was bought, resulting in an increase of 151 million from the previous year. Afterward, the number of purchased powder-free NRL examination gloves increased dramatically, and by 1998, sales of these

Discussion

The number of powdered NRL gloves purchased in acute-care hospitals in Germany for use in operating theaters and for examination purposes has dramatically fallen since 1996, after a massive increase beginning in 1986. Historically, there were 2 main reasons for the increased use of powdered NRL examination gloves in Germany: (1) the increasing environmental pressure to reduce the use of polyvinyl chloride gloves because of their difficulty to decompose in landfills (lack of biodegradability)

Acknowledgements

We thank Ms Alexandra Ziegenhain, GPI Krankenhausforschung (Frankfurt am Main, Germany), for her invaluable help in supplying the glove data from the archives of the Gesellschaft für Pharma-Informationssysteme mbH. We are grateful for the detailed analysis of suspected NRL cases by Hans Peter Scheer, BGW Hamburg. The evaluations of subjects were carried out at the Berufs-genossenschaftliches Forschungsinstitut für Arbeitsmedizin in Bochum, Germany. We thank Mr Brian Thomas for his meticulous

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    Reprint requests: Henning Allmers, MD, Universität Osnabrueck, Department of Dermatology, Environmental Medicine and Health Sciences, Sedanstrasse 115, 49090 Osnabrück, Germany.

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