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Review Article

Latex glove allergy: The story behind the

invention of the surgical glove and the
emergence of latex allergy
Anokha Oomman, Susmita Oomman1
Department of Plastic Surgery, Morriston Hospital, Swansea, 1Department of Anaesthesia, Withybush General Hospital,
Haverfordwest, Pembrokeshire, UK

ABSTRACT
Latex rubber gloves have become increasingly common over the last 30 years. This has led to an increase in allergy to natural rubber
latex (NRL) proteins in health care professionals using protective gloves and/or in those exposed to products made of NRL. This has
led to a growing need to monitor the allergenicity of gloves and other latex goods to prevent sensitization and clinical allergy. There is
still considerable amount of misinformation regarding latex allergy. In this article, we examine the history behind the invention of
the surgical glove, the emergence of latex allergy and the diagnostic tests available and possible remedies. We searched PubMed and
MedLine using key words such as Latex allergy, surgical gloves, rubber, immunoglobulin E proteins, radioallergosorbent test. Recent
and old papers on the subject were reviewed and analyzed. Surgical gloves were a huge milestone in the field of surgery as it allowed
the development in the field of asepsis. It was instrumental in reducing the rates of infection and making health care professionals
think about aseptic techniques. However, the emergence of latex allergy over the last few decades has proved a challenge in the
perioperative setting. Surgical gloves are important tools in performing safe surgery. However, the increasing incidence of latex
allergy and its effects on theatre personnel is of great concern.
Key words: Latex allergy, radioallorgosorbent test, surgical gloves

Introduction
Latex products have been in use since 1600 BC in
Mesoamerica. [1] However, surgical latex gloves were
invented only in the late 1890s. Several individuals
have helped in the invention of the rubber surgical
gloves.[2] In 1813, Adam Elias von Siebold first suggested
that physicians should protect themselves from infections
by wearing horse or swine bladder as gloves whilst
Address for correspondence: Dr. Anokha Oomman,
8, Maple Avenue, Haverfordwest SA61 1EF,
Pembrokeshire, UK.
E-mail: Anokha.oomman@gmail.com
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Website:
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DOI:
10.4103/2278-9596.129563

Archives of International Surgery / September-December 2013 / Vol 3 / Issue 3

delivering babies.[2] In 1843, the process of vulcanization

was discovered almost at the same time by Charles
Goodyear and Nathaniel Hayward in the United States
and Thomas Hancock in England, which allowed the
possibility of making rubber gloves that were stable.[3] In
1889, William Halstead ordered a pair of rubber gloves
from the Goodyear tyre company as the carbolic acid he
was using to sterilize his instruments were damaging the
hands of his scrub nurse (who later on became his wife)
and causing her severe dermatitis.[4]
Allergy to latex rubber gloves has become increasingly
common today. Looking back 30 years ago, chances are
that most health care professionals didnt know what latex
allergy was. However, over the last decade the incidence
of natural latex glove allergy has increased in prevalence
and attained world-wide importance.[5,6] This is thought
to be due to the huge rise of the use of the latex gloves
following the recommendations in 1987 by the US Center for
Disease Control, which suggested that latex gloves should
be used for touching blood and bodily fluids and handling
items or surfaces soiled with blood or bodily fluids and for
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Oomman and Oomman: Latex glove allergy: A Review

performing vascular access procedures.[7] This surge in

the use of latex gloves led to an increase in concomitant
exposure.[6] The increase in demand in latex gloves meant
that during importation products were not subjected to
rigorous quality assurance procedures appropriate for
medical devices.[6] It remains unclear whether the increase
in allergic reactions to natural rubber latex (NRL) is a
direct result of increased glove use or abnormally high
levels of residual latex antigen in those gloves as a result
of manufacturing issues.[7]
The first published case of immediate hypersensitivity
to natural latex was in 1979, which documented case of
a woman with a history of dermatitis who presented with
pruritis after 5 min of wearing latex gloves. A skin prick
test with natural rubber glove extract demonstrated a
wheal on testing.[8]

Epidemiology
Latex sensitization prevalence rate ranges from 2.9%
to 22% in health care workers and from 0.12% to about
20% in occupationally unexposed populations.[9] It can
present with glove hypersensitivity, contact urticaria,
rhinitis, conjunctivitis, asthma and anaphylaxis.[10] It
has been suggested that there is an association between
long-term work in health care institutions and latex
sensitization.[11] Studies have shown that sensitization is
related to the degree of exposure.[11,12] Health care workers
at the beginning of their training have the same likelihood
of latex allergy as the general population.[12]

What is Latex?
Latex is the milky fluid derived from the lactiferous cells
of the rubber tree, Hevea brasiliensi.[13] It contains a large
variety of sugars, lipids, nucleic acids and highly allergenic
proteins. The milky fluid is made to undergo a complex
process when ingredients such as sulfur and organic
chemicals are added. The allergic protein components
cannot be fully removed during the manufacturing
process.[14] These latex proteins present in the gloves
mediate latex allergy and have been shown to adhere to
glove powder, which acts as a vehicle for the allergens.[15]
Cornstarch powder is the donning agent used in making
latex gloves in order to make them easier to put on and take
off, it can remain in the air for as long as 5 h.[16] Powdered
gloves have higher latex allergen content than powder-free
gloves.[17] There is evidence that the use of powdered gloves
is associated with a substantially higher prevalence and
rate of latex sensitization.[6]
202

Latex Sensitization versus Latex

Allergy?
The presence of immunoglobulin E (IgE) antibodies
specific to latex without symptoms is defined as latex
sensitization.[11] Whilst latex allergy is described as an
immunologically mediated reaction to latex that are either
type IV or type I mediated hypersensitivity. It is believed
that latex sensitization can occur through skin contact or
through inhalation of the aerosol glove powder coming into
contact with the mucous membranes of the nose and lungs.[18]
In sensitized individuals, re-exposure to latex antigens may
result in anaphylaxis, urticaria, angioedema, asthma and
allergic rhinitis.[11] There seems to be a greater risk of
sensitization associated with spina bifida, multiple surgeries,
history of atopy and some food allergies (e.g. banana, Avocado,
Kiwi and Chestnut).[5] Essentially patients with medical
problems that cause frequent NRL exposure during surgery
or catheterization are at a high risk for NRL protein allergy.
Latex gloves are associated with 3 types of adverse
reactions: Irritant contact dermatitis, immediate-type
(type I) allergic reactions and allergic contact dermatitis
(type IV or delayed type hypersensitivity reactions).[5]
Immediate reaction appears within 30 min of contact with
latex and is due to proteins present in the NRL. The main
symptoms are urticaria and edema. However asthma, nasal
congestion and conjunctivitis may be noted if the mucous
membranes are breached.[19] If the latex protein comes into
contact with broken skin then very rarely anaphylactic
reactions may occur. The delayed hypersensitivity reaction
occurs after contact with latex and usually occurs by 2448 h. It is caused by accelerating agents that have been
added to latex in the manufacturing process. This leads to
allergic contact dermatitis of the skin and is characterized
particularly by an erythematous or itching rash on the back
of the hands.[14]

Diagnosing Latex Allergy

The clinical diagnosis of latex-induced contact urticaria is
based on a compatible history and evidence of sensitization
to NRL. The diagnosis of latex allergy should not be made
on the basis of either of these criteria alone.[20]
Methods available to measure NRL allergen activity
1. Skin prick testing:
A microscopic amount of an allergen is introduced
into patients skin by pricking the skin with a needle.
The immune response in terms of an urticarial rash or
more worrying anaphylaxis is noted.[13,21] The size of the
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Oomman and Oomman: Latex glove allergy: A Review

reaction is dependent on and is directly proportional to

the quantity of allergens to which the patient has IgE
class antibodies. A patch test can also be done. This
involves a 2-day occlusion of the test material to intact
skin and the response is noted after 48-72 h. Patch
testing however, could lead to sensitivity in previously
non-sensitized individuals.[14]
2. Human IgE-based immunologic inhibition assays:
There are two different types of immunoassays
available. Radioallegosorbent test inhibition and
enzyme-linked immunosorbent assay inhibition test.
They both help in measuring total allergen content.
It involves the reaction of the patients serum with an
antigen polymer complex in the presence of a labeled
IgE antibody.[22]
3. Methods based on immunoelectrophoresis and
imunoblotting:
Studies have described a large variety of NRL proteins
binding IgE from sera of NRL allergenic patients.[23]
However if a patients history is strongly suggestive
of latex allergy; then even if his tests are negative, he
should still be managed as a latex allergy.[13]

exposure to the allergens, most adverse responses to latex

gloves can be controlled. Latex-free alternatives include
nitrile, vinyl, neoprene and styrene butadiene.[23]

Hospital Staff Allergic to Latex

Conclusion

There is evidence to suggest that latex containing gloves

are the primary source of allergen in the health care
environment. Avoiding contact with latex-containing
gloves is the most effective method of preventing
sensitization of high-risk groups. Measures to create
a latex-safe environment should be undertaken for
healthcare workers who are sensitized to latex. In an
attempt to create a latex safe environment it has been
suggested that latex gloves should only be used under
universal precautions. Therefore, it should not be used
by domestic staff, food handlers and transportation
personnel. Low-allergen, non-powdered latex gloves
should be used as they reduce sensitization. Lastly
hospital staff that are allergic to latex should be provided
with latex free gloves.[5]

NRL is a widely-used and cost-effective material, which

for the majority of the population is not a clinical risk. It
has many benefits which are yet to be equaled. However,
it remains to be seen whether an increased use of nonlatex gloves will lead to an increase in non-latex glove
allergies in the future.

It has been suggested that questionnaires relating

to latex allergy should be included as part of preemployment assessment, with examinations in the hospital
Occupational Health Department, especially when dealing
with individuals who might be working in an environment
such as operating theater where frequent glove use is
anticipated.[24,25] This will help identify individuals who are
at risk of developing latex allergy. If a patient or a health
care professional is allergic to latex allergy, then avoidance
and substitution of latex gloves is essential. By avoiding
Archives of International Surgery / September-December 2013 / Vol 3 / Issue 3

Why Dont We Switch to Non-latex

Gloves?
The use of NRL alternative gloves has met with some
resistance. There are clinical advantages of using latex
gloves which outweigh non-latex gloves. These include
lower rates of glove tear, better tactile sensitivity, better
strength, elasticity and a better fit. The rates of viral
leakage are also noted to be higher in non-latex gloves.
Non-latex gloves have a higher rate of failure to protect
against herpes simplex virus type I.[5]
Even though, synthetic or non-latex gloves may be free of
protein, they can also cause an allergic reaction. Cases of
type 1 and type 4 hypersensitivity have been noted with the
non-latex gloves too.[21] Furthermore, disposing off latex gloves
is easier as they are biodegradable and unlike the synthetic
gloves do not produce harmful emissions when incinerated.[21]

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How to cite this article: Oomman A, Oomman S. Latex glove allergy:
The story behind the "invention" of the surgical glove and the emergence
of latex allergy. Arch Int Surg 2013;3:201-4.
Source of Support: Nil. Conflict of Interest: None declared.

Archives of International Surgery / September-December 2013 / Vol 3 / Issue 3