Natural Rubber Latex Aeroallergen Exposure and Allergy in Nursing Staff in Thailand

Abstract

Exposure to natural rubber latex (NRL) allergens from NRL gloves, particularly powdered latex gloves (PLGs) has been reported to induce adverse symptoms and sensitisation in health care workers (HCWs). Previous studies have shown a relatively low prevalence of NRL sensitisation in Thai HCWs who wore powdered latex gloves (2% - 3%) with little information on risk factors. The aims of this study are therefore to determine the prevalence of NRL allergy in nurses and risk factors, to investigate the incidence of NRL allergy and to assess levels of NRL allergy knowledge. To achieve these aims, a cross-sectional and a prospective cohort study have been carried out. The cross-sectional study was conducted among 917 nurses in three hospitals in Thailand. A self-reported questionnaire (SRQs) determining lifestyle, ill-health, symptoms related to NRL use, and working conditions was administered to nurses. NRL sensitisation was determined by using a serological test for anti-NRL IgE antibodies. Pulmonary function was examined by spirometry. Levels of inhalable aerosol were measured in different nursing workplaces in each hospital by using an area air sampler and levels of total protein and NRL aeroallergen in those samples were measured by a modified Lowry assay and a competitive inhibition immunoassay respectively. Health effects related to NRL glove use were reported by 17.5% of the nurses (160/916). Reported symptoms were primarily dermal symptoms, particularly eczema (97.7%, 129/132). The most common respiratory symptom was sneezing (67.4%, 29/43).The prevalence of NRL sensitisation was 4.3% (16/375). NRL sensitisation was strongly associated with respiratory symptoms (OR 3.8, 95% CI 1.0 - 14.5). Dermal symptoms were significantly associated with working conditions including working in the operating theatre (OR 2.5, 95% CI 1.5 - 4.2), wearing more than 15 pairs of PLGs a day (OR 2.1, 95% CI 1.3 - 3.4) and washing hands with chlorhexidine (OR 2.1, 95% CI 1.2 - 3.5). Respiratory symptoms were associated with working in the labour unit (OR 3.5, 95% CI 1.3 - 9.9). Non-occupational factors, including atopy, grass allergy, operation and food allergy, were also associated with dermal and respiratory symptoms. Working as a technical or practical nurse, NRL glove use for more than 10 years and NRL sensitisation were associated with decreased pulmonary function. High exposure to NRL aeroallergens and inhalable dust tended towards increasing risk of NRL sensitisation. In the prospective cohort study, 70 2nd year student nurses in a nursing college were recruited and they complete a SRQ and underwent a health examination at baseline and follow-up. Whilst 8 student nurses were sensitised at baseline, no new student nurses were sensitised after follow-up. However, the incidence of self reported NRL gloves-related symptoms was 10% per year. The student nurses' knowledge was not different from nurses and both of them had insufficient NRL allergy knowledge. In conclusion, this study shows that use of PLGs was associated with increasing risk of developing health problems in nurses. Given ongoing occupational exposure to NRL and lack of knowledge on NRL latex allergy in the workforce, the use of alternative gloves and improved training/education should be considered in Thai hospitals.

Date of Award	31 Dec 2012
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Andrew Povey (Supervisor) & Frank De Vocht (Supervisor)