Skin Reactions to Gloves

Skin reactions and allergic responses to glove usage can be a serious health concern. This is particularly evident in healthcare, hospitality, veterinary and life science industries, where people use latex or nitrile gloves on a daily basis over a long period time. Both allergic and non-allergic reactions that are associated with glove usage can be discomforting, distracting and in severe cases, detrimental to the health of the wearer. To stay protected, it’s important to be aware of the different types of allergic and non-allergic skin reactions, causes, symptoms, and methods of treatment.

Type I Hypersensitivity

Type I Hypersensitivity is classified as the most severe allergic response to natural rubber latex products, as it involves an immediate hypersensitive response which stems from an immune dysfunction to the latex protein.

Causes

According to The Australasian Society of Clinical Immunology and Allergy Guidelines – Management of latex allergic individuals (2010), the cause of Type I Hypersensitivity is associated with direct contact or inhalation of latex proteins from powdered latex gloves.

Symptoms

Due to the nature of Type I Hypersensitivity, the allergic symptoms range from mild to potentially life-threatening. These symptoms include contact urticaria, rhinoconjunctivitis, asthma, angioedema, and pharyngeal edema and anaphylaxis (Miri et al, 2007).

Treatment

For the best results, a natural rubber latex free work environment is recommended and can be achieved through transitioning to powder free synthetic nitrile gloves. Reduced exposure to latex gloves has been shown to decrease instances of symptomatic latex allergy (Douglass et al, 2006).

Type IV Hypersensitivity (Allergic Contact Dermatitis)

Type IV Hypersensitivity, commonly referred to as allergic contact dermatitis (ACD), is a delayed hypersensitive response to the chemical accelerators found in rubber gloves (Burkhart et al, 2015). This skin reaction is not the same as an allergy to natural rubber latex, but instead an allergy to accelerators in all types of gloves, even synthetic rubber nitrile gloves.

Causes

The primary cause of ACD is exposure to the chemical substances used in the manufacturing process of rubber gloves. According to Cao et. al (2010), accelerators, such as Mercaptobenzothiazole (MBT) or Diphenyl Guanidine (DPG), are added to quicken rubber vulcanization, and antioxidants are added to help prevent rubber deterioration of gloves.

Symptoms

ACD occurs within 1 to 2 days following glove use and presents with localised symptoms on the hands including redness, itchiness, and peeling skin that appears dry and cracked (Al-Otaibi et al, 2015). As this allergic reaction has a similar appearance to non-allergic irritant contact dermatitis, it is vital to get patch tested to ensure the correct course of treatment.

Treatment

For the best outcome, seek medical advice to confirm which chemical accelerators are positive from patch testing and avoid all contact with the allergens. Depending on the severity of the condition, topical steroids are suitable for mild to moderate symptoms and short-term oral steroids are more appropriate for severe symptoms (Weston, 2019). To continue glove use, look for hand gloves with non-detectable levels of accelerators such as GloveOn COATS Nitrile.

Irritant Contact Dermatitis (ICD)

Irritant contact dermatitis (ICD) is a non-allergic reaction caused by disruption to the natural protective skin barrier (Burkhart et al, 2015). Recognised as one of the most common work-related skin conditions, this type of reaction is not an allergy, but instead an irritation.

Causes

There are a variety of factors that can lead to ICD, including friction and sweating from continued glove use, as well as frequent hand washing and contact with detergents (The Australasian Society of Clinical Immunology and Allergy, 2010).

Symptoms

ICD arises within minutes or several hours after glove use, with initial localised symptoms including redness, swelling, itchiness, pain and ulcerated skin. Prolonged use of latex or nitrile gloves can lead to chronic symptoms on hands and fingers including eczematous skin, erythema, dryness, cracking and skin fissures (Al-Otaibi et al, 2015).

Treatment

The most effective treatment for ICD involves good hand care and hand hygiene practice, such as applying a daily moisturiser to prevent your hands from drying and washing hands only when required. In severe cases, topical corticosteroids or oral steroids can be prescribed for use, but are not suitable for long-term treatment (Weston, 2019).

References

1. Al-Otaibi, S.T & Alqahtani, H.A.M 2015, ‘Management of contact dermatitis’, Journal of Dermatology & Dermatologic Surgery, vol. 19, no. 2, pp. 86-91, viewed 7 August 2019, Academic Search Complete database, ScienceDirect, doi: 10.1016/j.jdds.2015.01.001
2. Australasian Society of Clinical Immunology and Allergy 2010, ASCIA Guidelines – Management of latex allergic individuals, ASCIA, viewed 1 August 2019, <https://allergy.org.au/hp/papers/management-of-latex-allergic-patients/?task=view&id=33>
3. Burkhart, C, Schloemer, J & Zirwas, M 2015, ‘Differentiation of Latex Allergy From Irritant Contact Dermatitis’, Cutis, vol. 96, no. 6, pp. 369-371, 401, viewed 6 August 2019, Academic Search Complete database, MDedge Dermatology
4. Cao, L.Y, Taylor, J.S, Sood, A, Murray, D & Siegel, P.D 2010, ‘Allergic Contact Dermatitis to Synthetic Rubber Gloves: Changing Trends in Patch Test Reactions to Accelerators’, Arch Dermatol, vol. 146, no. 9, pp. 1001–1007, viewed 8 August 2019, Academic Search Complete database, JAMA Dermatology, doi:10.1001/archdermatol.2010.219
5. Douglass, J.A & O’Hehir, R.E 2006, ‘1. Diagnosis, treatment and prevention of allergic disease: the basics’, The Medical Journal of Australia, vol. 185, no. 4, pp. 228-233, viewed 1 August 2019, doi: 10.5694/j.1326-5377.2006.tb00539.x
6. Miri, S, Pourpak, Z, Zarinara, A, Heidarzade, M, Kazemnejad, A, Kardar, G, Firooz, A & Moin, A 2007, ‘Prevalence of type I allergy to natural rubber latex and type IV allergy to latex and rubber additives in operating room staff with glove-related symptoms’, Allergy and Asthma Proceedings, vol. 28, no. 5, pp. 557 – 563, viewed 2 August 2019, doi: 10.2500/aap2007.28.3031
7. Weston, W.L & Howe, W 2019, Patient education: Contact dermatitis (including latex dermatitis) (Beyond the Basics), UpToDate, viewed 6 August 2019, <https://www.uptodate.com/contents/contact-dermatitis-including-latex-dermatitis-beyond-the-basics>