Contact Dermatitis & Latex Allergy
Contact dermatitis can develop from frequent and repeated use of hand hygiene products, exposure to chemicals, and glove use. Contact dermatitis is classified as either irritant or allergic. Irritant contact dermatitis is common, nonallergic, and develops as dry, itchy, irritated areas on the skin around the area of contact. Allergic contact dermatitis can result from exposure to accelerators and other chemicals used to manufacture rubber gloves or from exposure to other chemicals found in the dental practice setting. Allergic contact dermatitis often causes a rash beginning hours after contact and, like irritant dermatitis, is usually confined to the areas of contact.
Latex allergy is a reaction to certain proteins in latex rubber. It usually begins within minutes of exposure but can sometimes occur hours later. It produces varied symptoms, which commonly include runny nose, sneezing, itchy eyes, scratchy throat, hives, and itchy burning sensations. However, it can involve more severe symptoms, such as asthma, marked by difficult breathing, coughing spells, and wheezing; cardiovascular and gastrointestinal ailments; and in rare cases, anaphylaxis and death.
DHCP who have contact dermatitis or latex allergy symptoms should see an experienced health care professional (e.g., dermatologist, allergist) to determine the diagnosis, treatment, and any necessary work restrictions or accommodations.
The following recommendations are based on those issued by the National Institute for Occupational Safety and Health (NIOSH):
If diagnosed by a medical provider with allergy to natural rubber latex (NRL) protein:
- Avoid, as far as feasible, subsequent exposure to the protein and use only nonlatex (e.g., nitrile or vinyl) gloves.
- Make sure that other staff in the dental practice wear either nonlatex or reduced-protein, powder-free latex gloves.
- Use only synthetic or powder-free rubber dams.
The following steps will further reduce the risk of latex reactions for DHCP:
- Educate dental staff on the signs and symptoms of latex allergies.
- Frequently change ventilation filters and vacuum bags used in latex contaminated areas.
- Check ventilation systems to ensure they provide adequate fresh or recirculating air.
- Frequently clean all work areas contaminated with latex dust.
All patients should be screened for latex allergy (e.g., take health history and refer for medical consultation when latex allergy is suspected). Patients with a latex allergy should not have direct contact with latex-containing materials and should be treated in a latex-safe environment. Such patients also may be allergic to the chemicals used in manufacturing natural rubber latex gloves, or to metals, plastics, or other materials used to provide dental care.
DHCP should take the following precautions for patients with a possible or documented latex allergy:
- Ensure a latex-safe environment in which all latex-containing products have been removed from the vicinity. Any latex-containing devices that cannot be removed from the treatment environment should be adequately covered or isolated.
- Consider sources of latex other than gloves, such as prophylaxis cups, rubber dams, and orthodontic elastics.
- Be aware that latent allergens in the air can cause respiratory or anaphylactic symptoms among patients with latex hypersensitivity. Schedule patients with latex allergies for the first appointment of the day to minimize their exposure to airborne latex particles.
- Communicate latex allergy procedures (e.g., verbal instructions, written protocols, posted signs) to other personnel to prevent them from bringing latex-containing materials into the treatment area.
- Frequently clean all working areas contaminated with latex powder or dust.
- Have latex-free kits (e.g., dental treatment and emergency kits) available at all times.
American Dental Association. Oral Health Topic: Allergy to Latex Rubber. http://www.ada.org/en/member-center/oral-health-topics/allergy-to-latex-rubberexternal icon. Accessed March 17, 2016.
CDC. National Institutes of Occupational Safety and Health (NIOSH). NIOSH Alert: Preventing allergic reactions to natural rubber latex in the workplace. Cincinnati, OH: US Department of Health and Human Services, Public Health Service, CDC, National Institute for Occupational Safety and Health, 1997. Available at: www.cdc.gov/niosh/docs/97-135/. Accessed March 17, 2016.
CDC. National Institutes of Occupational Safety and Health (NIOSH). Latex Allergy: A Prevention Guide. Questions and Answers about identifying and preventing latex allergy. Cincinnati, OH: US Department of Health and Human Services, Public Health Service, CDC, National Institute for Occupational Safety and Health DHHS NIOSH Publication No. 98-113. Available at: www.cdc.gov/niosh/docs/98-113/. Accessed March 17, 2016.
CDC. National Institutes of Occupational Safety and Health (NIOSH). Occupational Latex Allergies. US Department of Health and Human Services, Public Health Service, CDC, National Institute for Occupational Safety and Health, 1997. Available at: https://www.cdc.gov/niosh/topics/latex/. Accessed March 17, 2016.
CDC. Guidelines for infection control in dental health-care settings – 2003. MMWR 2003; 52(No. RR-17):1–66. https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf pdf icon[PDF-1.2M]. Accessed March 17, 2016.