10.5826/dpc.1303a187
Introduction: Glove-induced dermatoses are frequently seen among healthcare workers (HCWs) and are often mistakenly defined as latex allergy.
Objectives: To determine the prevalences of (i) the symptoms of immediate type hypersensitivity reactions, (ii) the symptoms of hand eczema, (iii) latex sensitization detected using SPT, and (iv) contact hypersensitivity to rubber additives or glove pieces detected using patch test, in Turkish HCWs.
Methods: Ninety-eight HCWs were included in the study. All subjects completed a questionnaire. All participants were skin prick tested for latex, and foods previously identified as concomitant allergens in latex-sensitive individuals; patch tested for 7 rubber additives, 3 additional haptens, and glove pieces.
Results: The mean age was 32.1 (± 9.4) years, and 71 (72.4%) participants were nurses. Eighty-four (85.7%) subjects had a history of mucocutaneous symptoms of immediate-type hypersensitivity occurring within the first 24 hours after latex glove contact, while 9 (9.2%) subjects demonstrated SPT positivity for latex. Eighty (81.6%) subjects had a history of glove-induced hand eczema symptoms, while patch test positivity for the rubber additives or glove pieces was in 17.3%.
Conclusions: About one-tenth of those with a history of glove-induced type I hypersensitivity symptoms had true latex allergy, and one-quarter of those with a history of glove-related hand eczema symptoms had contact hypersensitivity to glove products. Therefore, rote avoidance of latex use is generally ineffective in the management of glove-related skin complaints. Individual measures should focus on reducing the use of soaps and disinfectants, and promoting the use of moisturizers, rather than glove choice.
text/xml
2160-9381
3028
en
Fatma Karakurt
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
rubber additives
Prevalence of Type I Allergy to Latex and Type IV Allergy to Rubber Additives in Turkish Healthcare Workers 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-07-31
2022-11-26
2023-07-31
2023-08-24
e2023187
Dermatol Pract Concept
Introduction: Glove-induced dermatoses are frequently seen among healthcare workers (HCWs) and are often mistakenly defined as latex allergy.
Objectives: To determine the prevalences of (i) the symptoms of immediate type hypersensitivity reactions, (ii) the symptoms of hand eczema, (iii) latex sensitization detected using SPT, and (iv) contact hypersensitivity to rubber additives or glove pieces detected using patch test, in Turkish HCWs.
Methods: Ninety-eight HCWs were included in the study. All subjects completed a questionnaire. All participants were skin prick tested for latex, and foods previously identified as concomitant allergens in latex-sensitive individuals; patch tested for 7 rubber additives, 3 additional haptens, and glove pieces.
Results: The mean age was 32.1 (± 9.4) years, and 71 (72.4%) participants were nurses. Eighty-four (85.7%) subjects had a history of mucocutaneous symptoms of immediate-type hypersensitivity occurring within the first 24 hours after latex glove contact, while 9 (9.2%) subjects demonstrated SPT positivity for latex. Eighty (81.6%) subjects had a history of glove-induced hand eczema symptoms, while patch test positivity for the rubber additives or glove pieces was in 17.3%.
Conclusions: About one-tenth of those with a history of glove-induced type I hypersensitivity symptoms had true latex allergy, and one-quarter of those with a history of glove-related hand eczema symptoms had contact hypersensitivity to glove products. Therefore, rote avoidance of latex use is generally ineffective in the management of glove-related skin complaints. Individual measures should focus on reducing the use of soaps and disinfectants, and promoting the use of moisturizers, rather than glove choice.
Fatma Karakurt
2023/07/31
10.5826/dpc.1303a187
e2023187
Department of Dermatology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
2160-9381
rubber additives
en
e2023187
Alenius H, Turjanmaa K, Palosuo T. Natural rubber latex allergy. Occup Environ Med. 2002;59(6):419-424. DOI: 10.1136/oem.59.6.419. PMID: 12040121. PMCID: PMC1740299.
Prevalence of Type I Allergy to Latex and Type IV Allergy to Rubber Additives in Turkish Healthcare Workers 
https://dpcj.org/index.php/dpc/article/download/3028/2192
    Prevalence of Type I Allergy to Latex and Type IV
         Allergy to Rubber Additives in Turkish
                  Healthcare Workers
                             Hasan Aksoy1, Necmettin Akdeniz 2, Fatma Karakurt 3


1 Dermatologist; Department of Dermatology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
2 Department of Dermatology, Uskudar University Faculty of Medicine, Memorial Atasehir Hospital, İstanbul, Turkey
3 Department of Dermatology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey



Key words: glove, healthcare workers, latex, rubber additives
Citation: Aksoy H, Akdeniz N, Karakurt F. Prevalence of type I allergy to latex and type IV allergy to rubber additives in Turkish
healthcare workers. Dermatol Pract Concept. 2023;13(3):e2023187. DOI: https://doi.org/10.5826/dpc.1303a187
Accepted: March 5, 2023; Published: July 2023
Copyright: ©2023 Aksoy et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: This study was funded by Turkish Society of Dermatology.
Competing Interests: None.
Authorship: H.A, N.A. and F.K. performed the research. H.A. and N.A. designed the research study. F.K. applied, and N.A and H.A read
the skin tests. H.A and F.K. collected and processed the data. H.A. analysed and interpreted the data. H.A. wrote the paper. N.A. performed
the critical review. All authors have read and approved the final manuscript.
Corresponding Author: Hasan Aksoy, Department of Dermatology, Istanbul Medeniyet University, School of Medicine, Suleyman Yalcin
City Hospital, Fahrettin Kerim Gokay St., 34722, Kadıkoy, Istanbul, Turkey. Email: haxoil@yahoo.com




  ABSTRACT             Introduction: Glove-induced dermatoses are frequently seen among healthcare workers (HCWs) and
                       are often mistakenly defined as latex allergy.
                       Objectives: To determine the prevalences of (i) the symptoms of immediate type hypersensitivity
                       reactions, (ii) the symptoms of hand eczema, (iii) latex sensitization detected using skin prick test
                       (SPT), and (iv) contact hypersensitivity to rubber additives or glove pieces detected using patch test,
                       in Turkish HCWs.
                       Methods: Ninety-eight HCWs were included in the study. All subjects completed a questionnaire. All
                       participants were skin prick tested for latex, and foods previously identified as concomitant allergens
                       in latex-sensitive individuals; patch tested for 7 rubber additives, 3 additional haptens, and glove
                       pieces.
                       Results: The mean age was 32.1 (± 9.4) years, and 71 (72.4%) participants were nurses. Eighty-
                       four (85.7%) subjects had a history of mucocutaneous symptoms of immediate-type hypersensitivity
                       occurring within the first 24 hours after latex glove contact, while 9 (9.2%) subjects demonstrated SPT
                       positivity for latex. Eighty (81.6%) subjects had a history of glove-induced hand eczema symptoms,
                       while patch test positivity for the rubber additives or glove pieces was in 17.3%.




Original Article | Dermatol Pract Concept. 2023;13(3):e2023187                                                                           1
                       Conclusions: About one-tenth of those with a history of glove-induced type I hypersensitivity
                       symptoms had true latex allergy, and one-quarter of those with a history of glove-related hand eczema
                       symptoms had contact hypersensitivity to glove products. Therefore, rote avoidance of latex use is
                       generally ineffective in the management of glove-related skin complaints. Individual measures should
                       focus on reducing the use of soaps and disinfectants, and promoting the use of moisturizers, rather
                       than glove choice.




Introduction                                                        obtained from the local ethics committee (decision number:
                                                                    2019/0046). An informed consent was obtained from all sub-
During the novel Coronavirus disease of 2019 (COVID-19)             jects. All participants filled out a questionnaire including the
pandemic, implementation of several hygiene measures have           following information: (i) age, (ii) gender, (iii) occupation,
gained importance among healthcare workers (HCWs). The              (iv) workstation (internal, surgery, laboratory, radiology, in-
Centers for Disease Control (CDC) published guidelines high-        tensive care unit, emergency), (v) duration of exposure to
lighting the importance of using personal protective equip-         gloves (years), (vi) length and frequency of glove usage (per
ment, including gloves1. In this unusual situation, HCWs had        day), (vii) frequency of hand washing (per day), (viii) history
exposed to gloves, water, soaps, disinfectants, and hand sani-      of contact with irritants, (ix) history of atopy and food/drug
tizers more frequently than before, leading to an increase in the   allergy, (x) history of type I allergy-related symptoms devel-
prevalence of occupational irritant contact dermatitis [1-5].       oping within 24 hours of contact with a latex glove, and (xi)
     Skin complaints that manifest after exposure to latex ex-      history of symptoms related to hand eczema.
amination gloves are often attributed to contact with natural          Skin prick test was performed on all participants using
rubber latex (NRL) [6]. Although the majority of medical            standardized commercial extracts of natural non-ammoniated
staff misidentify their dermatose as “latex allergy”, previ-        latex and of foods to which individuals with latex hyper-
ous studies show that more than two-thirds of those with            sensitivity are often simultaneously hypersensitive including
glove-related symptoms do not have any allergies to latex or        banana, kiwi, chestnut, apple, melon, tomato, and pineapple
rubber chemicals [7-10]. This fact necessitates the detection       (ALK-Abelló A/S, Hørsholm, Denmark). The SPT for avo-
of hypersensitivity to NRL and rubber additives and illumi-         cado was performed using fresh avocados, by prick-to-prick
nation of HCWs about the correct management of their oc-            technique. Histamine dihydrochloride was used as positive
cupational dermatoses.                                              control while normal saline was used as negative control.
     The prevalence of latex allergy among Turkish HCWs has         SPTs were performed on the anterior aspect of the partici-
previously been investigated via measuring the serum levels of      pants’ forearm using a standardized device (MedBlue 10®,
latex-specific IgE [11]. However, there is no study evaluating      Asistan Medikal), and evaluation was done 15 minutes after
latex allergy by skin prick test (SPT) and contact hypersensi-      application. A wheal with a mean diameter of 2 mm or more
tivity to rubber additives using patch test in Turkish HCWs.        was interpreted as a positive reaction, also considering the
                                                                    positive and negative controls.
Objectives                                                             All participants were patch tested with 7 rubber addi-
                                                                    tives (thiruam mix, colophony, mercapto mix, carba mix,
In the present study, we aimed to determine                         mercapto-benzothiazole, 1,3-diphenylguanidine, N-isopropyl
                                                                    N-phenyl 4 phenylenediamine), 3 additional haptens (meth-
• the prevalence of latex hypersensitivity assessed by SPT,         yldibromo glutaronitrile, quaternium-15, formaldehyde), and
• the prevalence of delayed type hypersensitivity to rubber         1 cm2 pieces of two types of (powdered/non-powdered latex)
    additives assessed by patch test,                               gloves. The IQ Chambers and haptens were purchased form
• glove usage and hand washing habits, symptoms of                  Chemotechnique MB Diagnostics AB. The chambers were
    type I allergy, and symptoms of hand eczema using a             placed on the upper back and removed after two days. Read-
    self-administered questionnaire; in our hospital staff.         ings were performed 48 and 72 hours after application and
                                                                    reactions were interpreted in accordance with the European
Methods                                                             Society of Contact Dermatitis guidelines [12].
                                                                       SPSS (Statistical Package for Social Sciences) v17.0 was
We designed a cross-sectional study among 98 healthcare             used to perform statistical analysis. Continuous data were
professionals working in our hospital. Ethics approval was          expressed as means (± standard deviation, SD). Chi-square



2                                                                       Original Article | Dermatol Pract Concept. 2023;13(3):e2023187
techniques were performed for categorical variables, and         >20 times a day (Table 1). Thirty-seven (37.8%) cases had a
continuity correction or Fisher exact test was used when         history of at least one atopic disease (Table 1), 84 (85.7%)
necessary. P value < 0.05 was considered significant.            had a history of any mucocutaneous symptom of type I
                                                                 hypersensitivity which developed within the first 24 hours
                                                                 after latex glove exposure (Table 2), and 80 (81.6%) had a
Results                                                          history of any symptom of hand eczema (Table 3).
Of the 98 participants, 87 (88.8%) were female and                   Nine (9.2%) subjects had positive SPT to natural rub-
11 (11.2%) were male. The mean age was 32.1 (± 9.4)              ber latex. All of these 9 cases were among those with a
years. Seventy-one (72.4%) of the subjects were nurses, and      history of immediate type hypersensitivity symptoms.
those working in the internal and surgical divisions were        Besides, SPTs were positive for tomato in 12 (12.2%), for
31 (31.6%) and 34 (34.7%), respectively (Table 1).               kiwi in 8 (8.2%), for banana in 8 (8.2%), and for apple
    Duration of occupational exposure to gloves was 9.5          in 8 (8.2%) subjects (Table 4). One case revealed dermog-
(8.1) years. The frequency of latex glove use was 94.9%, and     raphism. No adverse reactions were observed in any sub-
powdered glove use was 80.6%. Of the participants, 60.2%         jects during the test procedure. The presence of the history
were using gloves >4 hours/day, 63.3% were changing the          of urticaria, redness, scaling, eye redness/lacrimation, and
gloves >10 times a day, and 45.9% were washing their hands       rhinorrhea within the first 24 hours after latex exposure




                                       Table 1. Characteristics of the participants.
 Characteristics                                Value            Characteristics                             Value
 Age                                                             duration of exposure to gloves
    mean (± SD [years])                     32.14 (±9.39)           mean (± SD [years])                  9.49 (±8.14)
    range (years)                               21-60
 Gender                                         N(%)             exposure time to gloves                    N (%)
    female                                   87 (88.8%)             >4 hours a day                        59 (60.2%)
    male                                     11 (11.2%)             >4 hours a day                        37 (37.8%)
 Job title                                      N (%)               weekly                                  1 (1%)
    nurse                                    71 (72.4%)             monthly                                 1 (1%)
    laboratory technician                     9 (9.2%)
    physician                                 5 (5.1%)           frequency of glove change                  N (%)
    radiology technician                      4 (4.1%)              1-5 pair daily                        14 (14.3%)
    anesthetic technician                     3 (3.1%)              6-10 pair daily                       22 (22.4%)
    physiotherapist                           1 (1.0%)              >10 pair daily                        62 (63.2%)
    other                                     5 (5.1%)
 Division                                       N (%)            frequency of hand-washing                  N (%)
    surgical                                 34 (34.7%)             <10 times per day                      9 (9.2%)
    internal                                 31 (31.6%)             10-20 times per day                   44 (44.9%)
    laboratory                               12 (12.2%)             >20 times per day                     45 (45.9%)
    radiology                                 6 (6.1%)
    intensive care unit                       6 (6.1%)           personal history of atopy/allergy          N (%)
    emergency                                 4 (4.1%)             no atopy                               61 (62.2%)
    other                                     5 (5.1%)             at least one atopic disease            37 (37.8%)
 Type of glove used                             N (%)              atopic dermatitis                      13 (13.3%)
    powdered                                 79 (80.6%)            allergic rhinitis                      17 (17.3%)
    non-powdered                             88 (89.8%)            allergic conjunctivitis                 3 (3.1%)
    latex                                    93 (94.9%)            asthma                                  6 (6.1%)
    vinyl                                    30 (30.6%)            urticaria/angioedema                    8 (8.1%)
    nitrile                                  18 (18.4%)            food/drug allergy                      11 (11.2%)

SD = standard deviation.




Original Article | Dermatol Pract Concept. 2023;13(3):e2023187                                                             3
      Table 2. Prevalence of immediate-type hypersensitivity symptoms and SPT positivity for latex.
                                SPT positive for latex N =9      SPT negative for latex N =89            Total N=98
     Immediate type           rate (%) within the cases SPT      rate (%) within the cases SPT
    allergy symptoms                positive for latex                 negative for latex                 rate (%)            P
 urticaria                             5/9 (55.6%)                      16/89 (18.0%)                  21/98 (21.4%)       0.02
 itching                               8/9 (88.9%)                      65/89 (73.0%)                  73/98 (74.5%)       0.441
 redness                                9/9 (100%)                      41/89 (46.1%)                  50/98 (51.0%)       0.003
 scaling                               8/9 (88.9%)                      37/89 (41.6%)                  45/98 (45.9%)       0.011
 eye redness/                          4/9 (44.4%)                        6/89 (6.7%)                  10/98 (10.2%)       0.00
 lacrimation
 rhinitis                              3/9 (33.3%)                        4/89 (4.5%)                   7/98 (7.1%)        0.016
 respiratory symptoms                    0/9 (0%)                         1/89 (1.1%)                   1/98 (1.0%)        1.0
 at least one symptom                   9/9 (100%)                      75/89 (84.3%)                  84/98 (85.7%)       0.35

SPT = skin prick test.




             Table 3. Prevalence of hand eczema symptoms and patch test positivity for rubber
                                           additives/glove pieces.
                         Patch test positive for rubber       Patch test negative for rubber
                          additive/glove pieces N=17           additive/glove pieces N =81              Total N=98
    Hand eczema          rate (%) within the patch test       rate (%) within the patch test
     symptoms                    positive cases                      negative cases                      rate (%)             P
 itching                         11/17 (64.7%)                        48/81 (59.3%)                   59/98 (60.2%)        0.789
 burning                         8/17 (47.1%)                         26/81 (32.1%)                   34/98 (34.7%)        0.270
 redness                         9/17 (52.9%)                         39/81 (48.1%)                   48/98 (49.0%)        0.793
 fissure                         11/17 (64.7%)                        34/81 (42.0%)                   45/98 (45.9%)        0.111
 exudation                       4/17 (23.5%)                          5/81 (6.2%)                     9/98 (9.2%)         0.046
 dyshidrosis                     3/17 (17.6%)                         10/81 (12.3%)                   13/98 (13.3%)        1.0
 at least one                    14/17 (82.4%)                        66/81 (81.5%)                   80/98 (81.6%)        1.0
 symptom




was significantly higher in those with positive SPT for           reaction developed to the fixation tape in three cases and
NRL compared to those without (55.6% versus 18%                   to the chamber in one case. In participants with a positive
P = 0.02; 100% versus 46.1% P = 0.003; 88.9% versus               patch test, history of hand eczema symptoms and length
41.6% P = 0.011; 44.4% versus 6.7% P = 0.006; 33.3% ver-          and frequency of glove usage were not different than those
sus. 4.5% P = 0.016; respectively) (Table 2). Eight (88.9%)       without (Table 3).
of latex-sensitive subjects had a frequency of glove change
>5 times a day and all (100%) were washing their hands
                                                                  Conclusions
>10 times a day.
     There were 25 positive patch test results in 19 cases.       Natural rubber latex is a raw material obtained from the rub-
The most common patch test positivity had detected for            ber tree (Hevea Brasiliensis), widely used in gloves and sev-
powdered latex gloves (N = 7; 7.1%), non-powdered latex           eral medical devices [13]. The term “latex allergy” not only
gloves (N = 5, 5.1%), mercapto mix (N = 3, 3.1%), and             defines glove-related localized dermatological symptoms
1,3-diphenylguanidine (N = 3, 3.1%) (Table 5). Seventeen          on hands, and encompasses immediate-type hypersensitiv-
(17.3%) cases had a positive patch test for at least one          ity reactions, which can be induced by any latex-containing
of the rubber additives or glove pieces (Table 3). Irritant       product such as gloves, catheters, balloons, or pads [14,15].




4                                                                     Original Article | Dermatol Pract Concept. 2023;13(3):e2023187
Therewithal symptoms that develop after the use of                   latex exposure, to avoid unnecessary restriction of the latex
latex-containing gloves correspond to 3 types of reactions:          use is one of the goals of management of glove-related occu-
                                                                     pational dermatoses [16].
1. Irritant contact dermatitis, a nonspecific response to               We found the latex hypersensitivity in 9 (9.2%) of our
    chemical or mechanical factors, can be defined as a              participants. All these nine subjects had a history of type I al-
    non-immunologic reaction.                                        lergy symptoms, and the frequency of SPT positivity for NRL
2. Allergic contact dermatitis, occurs due to contact with           in symptomatic cases was 10.7%. In previous studies con-
    rubber additives present in gloves and is an example of          ducted on HCWs of various professions, latex sensitization
    delayed type (type IV) hypersensitivity reaction.                was found to be between 4.2% and 18.2% [6,9-11,17-20].
3. True latex allergy, which may present with a spectrum of          Previously, Nettis et al found latex sensitization in 9.1% of the
    clinical manifestations from contact urticaria to anaphy-        295 symptomatic, prick-tested subjects [8]. In another study
    laxis, is a kind of immediate type (type I, IgE mediated)        by Tang et al on 313 HCWs, the prevalence of latex sensitivity
    hypersensitivity reaction [15].                                  determined using SPT was 9.6% [18]. In a study of Turkish
                                                                     HCWs like ours, latex sensitization was found in 4.2% of
    Contrary to the glove-choice behaviour of many HCWs,             1115 subjects [11]. The prevalence of latex hypersensitivity
in the presence of irritant or allergic contact dermatitis, avoid-   was lower in above-mentioned study because it was deter-
ance of latex products (especially latex gloves) is usually in-      mined only by the measurement of latex-specific IgE levels.
effective, unnecessary, and even –economically- problematic.            Glove-related dermatological symptoms are quite com-
While protecting HCWs from serious reactions caused by               mon in HCWs. In a study of 98 laboratory workers, 36.9%
                                                                     of subjects reported hand dermatitis, and 24.6% reported im-
                                                                     mediate hypersensitivity symptoms including urticaria [7]. In
             Table 4. Skin prick test results.                       another study on 1584 HCWs, 24.4% of participants reported

 Allergen                                     N (%)                  glove-induced dermatological complaints, either hand dermati-
                                                                     tis symptoms or urticaria/angioedema [8]. In the present study,
 tomato                                    12 (12.2)
                                                                     the presence of the history of any mucocutaneous symptom of
 natural rubber latex                         9 (9.2)
                                                                     type I hypersensitivity and any symptom of hand eczema was
 kiwi                                         8 (8.2)
                                                                     85.7% and 81.6%, respectively. The higher frequencies in our
 banana                                       8 (8.2)
                                                                     study can be explained by taking the history using a question-
 apple                                        8 (8.2)
                                                                     naire without deepening the anamnesis, an expected disabil-
 melon                                        7 (7.1)
                                                                     ity of the participants to differentiate the eczema symptoms
 pineapple                                    5 (5.1)                from type I hypersensitivity symptoms, and the possibility of
 chestnut                                     3 (3.1)                the participants’ experiencing these symptoms at least once in
 avocado                                      1 (1.0)                their professional life. On the other hand, in our study and pre-
                                                                     vious studies, the prevalences of glove-related symptoms are
                                                                     3 to 8 times higher than the prevalence of latex sensitization.
               Table 5. Patch test results.                          These findings suggest that the majority of glove-related symp-
 Allergen                                             N (%)          toms are not caused by true latex allergy and therefore cannot
 powdered latex glove piece                          7 (7.1)         be controlled by avoidance of latex glove use.
 non-powdered latex glove piece                      5 (5.1)            The history of urticaria, redness, and scaling within
 mercapto mix                                        3 (3.1)         the first 24 hours after exposure to latex was significantly
                                                                     higher in latex-sensitive individuals compared to those with-
 1,3-diphenylguanidine                               3 (3.1)
                                                                     out. This result was consistent with that of previous stud-
 carba mix                                           2 (2.0)
                                                                     ies. Liss et al found the prevalence of skin rash, hives, and
 mercapto-benzothiazole                              2 (2.0)
                                                                     itchy skin, Diéguez et al found the proportion of urticaria
 colophony                                           1 (1.0)
                                                                     and dermatitis, Tang et al found the frequency of the his-
 quaternium-15                                       1 (1.0)
                                                                     tory of glove-related urticaria, Nettis et al found the preva-
 formaldehyde                                        1 (1.0)
                                                                     lence of localized and generalized hives significantly higher
 thiruam mix                                            0 (0)        in subjects with latex hypersensitivity than in those without
 N-isopropyl N-phenyl                                   0 (0)        [8,18-20]. Although a minority of HCWs with glove-related
 4 phenylenediamine
                                                                     symptoms have latex sensitization, it is an expected finding
 methyldibromo glutaronitrile                           0 (0)        that the prevalence of latex sensitization is higher in those




Original Article | Dermatol Pract Concept. 2023;13(3):e2023187                                                                      5
with a history of glove-related urticaria or erythema com-       was performed. Lastly, we did not measure the serum levels
pared to those without.                                          of latex-specific IgE.
    We also investigated SPT positivity for foods that have          In summary, our study investigates whether glove-related
been previously identified as concomitant allergens in           dermatoses in Turkish HCWs are caused by a true allergy
latex-sensitive individuals [21,22]. Twelve per cent of the      to latex or rubber additives utilizing both the skin prick test
cases were sensitive to tomato, 8% to kiwi, 8% to banana,        and patch test. Approximately one-tenth of those with a his-
and 8% to apple. In our study, sensitization to any food was     tory of glove-induced immediate type hypersensitivity symp-
not more frequent in latex-sensitive subjects, and our results   toms demonstrated SPT positivity to latex. Again, about
did not exemplify the phenomenon previously defined as           one-quarter of those with a history of glove-related hand
“latex-fruit syndrome”.                                          eczema symptoms showed patch test positivity for rubber
    Although 81.6% of the subjects had a history of              additives or glove pieces. We can speculate that the major-
glove-related hand eczema symptoms, only 17.3% of them           ity of glove-related dermatoses correspond to irritant con-
demonstrated patch test positivity for any of the rubber ad-     tact dermatitis, and contrary to popular belief, avoidance of
ditives or glove pieces. In previous studies performed by Miri   latex gloves is unnecessary and ineffective. Moreover, from
et al and Nettis et al, only those with glove-related symptoms   an economic point of view, latex is still an indispensable raw
were patch-tested, and patch test positivity for rubber addi-    material for gloves and many medical devices. Therefore the
tives and/or glove pieces was found to be 27.1% and 10.5%,       development of glove-induced skin disorders in HCWs should
respectively [8,10]. In other studies by Japundžić et al and     rather be attributed to high frequency of hand-washing and
de Groot et al, the prevalences of dermatological symptoms       glove-change, high exposure time to gloves, and insufficient
were 56.1% and 36.9%, and the rates of patch test positivity     use of moisturizers; and individual measures at the work-
for glove products were 4.8% and 6.6%, respectively [6,7].       place should target these mentioned causes.
The results of our study and previous data indicate that the
frequency of glove-related symptoms was 6-10 times the rate
of patch test positivity. Therefore we can say that the major-   References
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Original Article | Dermatol Pract Concept. 2023;13(3):e2023187                                                                                7
