Table 2. Key question 5a: evidence for prevention of asthma due to natural rubber latex (NRL).
First author [ref.] | Main conclusion | Origin | SIGN grade | Study type | Exposure/occupation | Subjects |
LaMontagne [29] | Substitution of powdered latex gloves with low-protein powder-free NRL gloves or latex-free gloves greatly reduces NRL aeroallergens, NRL sensitisation, and NRL asthma in healthcare workers | Literature search | 1+ | Systematic review | NRL exposure | Eight studies ranging from exposure studies and observational data from cohort studies |
Allmers [30] | Decreased use of powdered gloves and increased use of powder-free gloves correlated with decline in suspected NRL occupational asthma and skin allergy cases, 1997–2001 Conclusion: primary prevention of occupational NRL allergies is possible with properly implemented practical interventions |
LaMontagne [29] | 3 | Case series, reported number of suspected NRL allergy cases from German healthcare system | NRL exposure from gloves | 3 million insured healthcare workers in Germany |
Heilman [31] | Latex aeroallergen levels and extractable latex glove allergen contents in an operating room measured on 52 consecutive days, including 19 non-surgery days, with 12 exposure crossovers On 33 surgery days, all personnel wore either high-allergen gloves (n=18 days) or low-allergen gloves (n=15 days) Internal comparison (cross-over) Conclusion: substitution of low-allergen NRL gloves for high-allergen NRL gloves can reduce latex aeroallergen levels by more than 10-fold in an operating room environment |
LaMontagne [29] | 2++ (cross-over design like RCT) | Prospective evaluation of an intervention | Operating room personnel exposed to NRL | Measurements on 52 days |
Jones [32] | Studied dental students from first to final year in training Students used only powder-free NRL gloves and were tested annually Students were 65% atopic, but none developed latex sensitivity in 5 yrs of study Conclusion: exposure to powder-free NRL gloves was not associated with sensitisation over 5 yrs in a highly atopic population |
LaMontagne [29] | 2+ | Prospective evaluation of intervention | NRL exposure in dental students | 63 dental students at baseline, 34 at final year (loss to follow-up) |
Lee [33] | Education to reduce NRL glove use in food handlers, use was reduced from 10 stalls to one Conclusion: educate food handlers to prevent NRL allergy in workers and customers |
LaMontagne [29] | 3 | Intervention among food handlers in Australia | NRL glove use in food handlers | 30 food stalls at market |
Levy [34] | Final year dental students in Paris, France and London, UK completed a questionnaire and SPT with NRL extract Latex sensitivity was OR 11.3 (95% CI 2.4–53.0) for using protein-rich gloves Conclusion: use of powder-free protein poor NRL gloves may reduce latex sensitisation |
LaMontagne [29] | 2- | Cross-sectional study: some students used protein-rich gloves and others did not | Use of protein-rich versus protein- poor NRL gloves in dental clinic | 189 fifth year (graduating) dental students working in clinics |
Liss [35] | In 1996, the Ontario government recommended change to powder-free, low-protein or non-NRL gloves in healthcare, and hospitals changed related policies at the same time Researchers documented a decline in worker compensation claims for NRL occupational asthma, from 7–11 per yr in 1991–1994 to 1–2 per yr in 1997–1999 Conclusion: use of low-protein or non-NRL gloves is associated with a decrease in number of NRL occupational asthma cases |
LaMontagne [29] | 3 | Case series based on workers' compensation claims in Ontario province, Canada | Use of powdered NRL gloves and change to low-powder NRL and non-NRL gloves in healthcare facilities | 66 workers' compensation claims for NRL through 1999 |
Saary [36] and Tarlo [37] | Dental school in Ontario province, Canada, changed from high-protein/powdered to low-protein/non-powdered NRL gloves A positive NRL SPT in students decreased from 10% in 1995 to 3% in 2000 (p=0.03) There was a decline in per cent with urticaria, immediate pruritis and rhino-conjunctivitis, but not asthma or eczema Conclusion: suggestive preventive effect by change to low-protein/powder-free NRL gloves in dental school |
LaMontagne [29] | 2- | Intervention for students and staff in dental school, between cross-sectional surveys in 1995 and 2000 (two different study cohorts) | NRL gloves in dental school | 131 in 1995 and 97 in 2000 |
Liss [35] and Tarlo [38] | Study conducted in teaching hospital in Ontario, Canada Intervention was education and medical surveillance, and change to powder-free NRL gloves Decline in symptom onsets and clinic visits after change in non-sterile gloves in 1995 and sterile gloves in 1997, to final year of study in 1999 Conclusion: NRL allergy reduced |
LaMontagne [29] | 3 | Intervention and retrospective record review to detect NRL allergy cases in occupational health and allergy clinics | NRL in gloves in hospital | 8000 employees, 52 staff with positive skin test responses and clinical NRL allergy |
SIGN: Scottish Intercollegiate Guidelines Network; RCT: randomised controlled trial; SPT: skin-prick test.