Allergic contact dermatitis to synthetic rubber gloves in caregivers

Guillaume Dejonckheere Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Summary :


A growing number of hospitals decided to completely abandon latex in order to avoid IgE-mediated allergic reactions (which can lead to anaphylaxis), as was the case for the Saint-Luc University Clinics in December 2010 (a premiere in Belgium). This measure concerns more than 300,000 pairs of sterile gloves per year. Since then, many caregivers who had been working for years without experiencing any allergic reaction developed contact dermatitis with the new gloves. The main allergens involved are vulcanization accelerators.



To perform a retrospective analysis of the allergic contact dermatitis cases observed at the Saint-Luc University Clinics of Brussels in order to identify the allergens involved and discuss alternatives for the sensitized subjects.



The study was conducted in a population of 44 caregivers who developed hand dermatitis after wearing synthetic rubber gloves. Results were collected from September 2010 to December 2017. Patch tests containing the European baseline series and the rubber series (Chemotechnique, Vellinge, Sweden) were performed. Pieces of gloves used by patients as well as accelerator-free gloves were tested.



The patch tests revealed that (i) the commercialized carba mix, which contains two carbamates and 1,3-diphenylguanidine (DPG), produced 37 positive reactions, representing 84% of the study population (ii); 38 subjects (86%) were sensitized to diphenylguanidine, and (iii) 13 subjects (30%) showed a positive reaction to thiuram mix. Regarding gloves, Esteem® Micro (secondarily rebranded as Protexis® Micro) caused a reaction in 12 of the 23 subjects tested. These gloves contain DPG. Gloves without vulcanization accelerators (Gammex® Dermaprene, Gammex® Sensoprene, Sempermed® Synthegra, Biogel® Neoderm) produced no positive reaction.



DPG is the allergen causing the greatest number of positive reactions, far ahead of thiurams, formerly described as the most sensitizing accelerators. We therefore recommend the use of DPG-free sterile gloves. None of the study participants reacted to gloves without accelerators, thus confirming the efficiency of the latter among accelerator-responders. Based on these results, recommendations for new gloves were issued at the Saint-Luc University Clinics.