1.1. Natural rubber latex (NRL) is a durable flexible material composed of natural proteins and added chemicals. At UCL NRL is present in gloves and may also be present in other devices.
1.2. Latex allergy results from a reaction to one or more of the components of NRL or residues from the manufacturing process. Allergic reactions can vary in severity from a localised allergic rash to rare cases of anaphylaxis. Further information is provided in the accompanying guidance notes.
2. Policy Statement
UCL recognises its responsibility under the Health and Safety at Work etc. Act 1974, the Management of Health and Safety At Work Regulations 1992 (Revised 1999) and the COSHH Regulations 2002, to ensure adequate procedures are in place to reduce the risk of staff developing an allergy to latex by reducing exposure to NRL to as low a level as reasonably practicable.
NRL gloves should only be used where risk assessment indicates that there is no suitable alternative. Where NRL gloves are identified as necessary, they must be powder free and have low levels of extractable protein.
3. Prevention, Identification and management of latex allergy in staff
3.1. Managers have a responsibility to:
- ensure that NRL gloves are only used where risk assessment indicates that there is no suitable alternative
- ensure that only powder free gloves that have low levels of extractable protein, are purchased
- ensure that staff are aware of the risk of latex allergy and the need to report any adverse reaction
- inform the Occupational Health Service of employees using NRL to ensure inclusion in the health surveillance programme
3.2. Employees have a responsibility to:
- Only use NRL gloves where risk assessment indicates that there is no suitable alternative
- Comply with health surveillance programmes as advised by the Occupational Health Service
- report to their manager and the Occupational Health Service any suspected reaction to latex products
adopt modifications to the work tasks and environment and use suitable alternatives to latex as recommended by the Occupational Health Service in consultation with the employee and manager
- report any defects in products to their line manager
3.3. The Occupational Health Service has a responsibility to:
- undertake routine health surveillance of staff using NRL
- investigate any suspected cases of latex allergy in staff
- advise managers and staff on modifications to the work tasks and environment in cases where latex allergy is suspected or confirmed
- Advise UCL of diagnosed cases of occupational allergy to natural rubber latex in order that UCL can fulfil its obligations to make reports to:
a) The Health and Safety Executive under RIDDOR 1995 via UCL Safety Service
b) The Adverse Incident Centre at the Medical Devices Agency (where appropriate)
3.4. Safety Services have a responsibility to:
4. Further Guidance
- Advise on risk assessment relating to the use of latex products
Allergic reactions to natural rubber latex (NRL) occur as a result of exposure to residues of accelerating agents used in the glove manufacturing process and/or extractable latex protein residues present in the finished product.
Modern manufacturing processes result in powder free latex gloves with low extractable protein residues. As it is not yet possible to determine an extractable protein level that can be defined as non-sensitising, no safe limit can be set in standards or specifications for gloves.
Powdered NRL gloves generally have higher extractable protein levels than powder free gloves. There is also a greater risk of airborne exposure, as the protein residue binds to the starch in the powder. This can lead to absorption of allergens via the respiratory tract and affect the eyes and nose. The exposure may not be confined to the glove user: others working in the vicinity may also be affected. NRL gloves must only be used where risk assessment indicates that there is no suitable alternative. In these cases powder free NRL gloves that have low levels of extractable protein must be used.
1.1. Risk assessment
A risk assessment of working practices will help to determine the type of glove used in a particular circumstance, taking into account:
- The nature of the substances or chemicals to which exposure might occur
- The concentration and/or temperature of the chemicals both of which can affect penetration rates
- The frequency and duration of contact with the substance or chemical
- The requirement for the glove material to be robust and resistant to physical damage such as tearing or abrasion or where inoculation injury risks exist
- The need for dexterity and "feel" with the glove on
- The extent of protection – e.g. hand only, or full length to elbow
Glove Manufacturers provide information on:
- Breakthrough Time ~ the time, in minutes, for a measurable amount of chemical to pass through the glove material, one side of the glove being immersed in that chemical
- Permeation Rate ~ the units are milligrams per square metre per minute
- Degradation ~ Loss of physical quality, perhaps becoming brittle or soft. May be measured as change in tensile strength after fixed periods of immersion
- Useful Time ~ A parameter combining permeation and degradation data. 1
2. The Prevention or Early Detection of Latex Related Allergic Reactions
The use of natural rubber latex (NRL) gloves is the most common source of latex exposure, usually by direct skin contact. However, the use of powdered latex gloves causes airborne exposure affecting the eyes, mucous membranes and the lungs.
2.1. Risk Factors
2.1.1. Research has shown that some individuals are more susceptible to latex allergy, the risk factors include:
- Frequent or prolonged exposure to latex products (e.g. Health Care Workers or individuals requiring frequent surgical interventions)
- Certain food allergies – e.g. Avocado, chestnut or banana
2.2. Reactions to Latex Gloves
2.2.1. Irritant Contact Dermatitis. This is the most common reaction to latex gloves, as a result of direct skin contact and the build up of perspiration causing a moist environment. Irritation is often exacerbated by frequent hand washing. This is a not an allergic reaction, but may result in dry itchy skin on the hands. The condition normally resolves once contact is discontinued. Good skin care can reduce the risk of skin problems.
2.2.2. Allergic Contact Dermatitis (type IV reaction). This is a less common reaction and results from hypersensitivity to residues of accelerating agents used in latex glove manufacturing. This type of reaction is often delayed, occurring several hours after contact with latex. It is usually localised, resulting in a rash on the back of the hands and between the fingers. There may be blisters present.
2.2.3. Immediate Hypersensitivity (type I reaction). This is an allergic reaction to naturally occurring protein residues found in NRL. This type of reaction occurs within 5 - 30 minutes of exposure. There is generally localised swelling and itching; however, a more general reaction may occur. This could include itchy eyes, runny nose and sometimes wheezing, chest tightness or asthma. In rare cases, exposure of a sensitised individual may result in anaphylaxis, a life threatening condition.
2.3. Early reporting of symptoms
2.3.1. Any member of staff who develops symptoms of irritation or suspected allergy to gloves or other latex products should immediately report this to their manager and the Occupational Health Service, to enable investigation, diagnosis and appropriate advice on work activities.
1HSE Latex Allergy, Laboratory work: http://www.hse.gov.uk/latex/labs.htm