Effectiveness of a nationwide interdisciplinary preventive programme for latex allergy

  • Ute LatzaEmail author
  • Frank Haamann
  • Xaver Baur
Original Article


Objectives: The increasing prevalence of latex allergy among healthcare workers is a large socio-economical problem for the society and affected individuals. The objective of this study was to describe and evaluate a nationwide, interdisciplinary campaign by the institution for the German workers’ compensation scheme for non-public healthcare providers that targeted the reduction of exposure to powdered high-protein latex gloves. Methods: The effectiveness of the prevention programme is described and evaluated with a before-and-after design comparing data on compensation claims for latex-related skin and airway diseases of the German statutory compensation scheme for work-related diseases in non-public health services. A survey on change in glove use was conducted after the programme. Results: The main feature of the campaign among healthcare workers (budget €340,000) was to increase awareness by means of educational components on the aetiology of latex hypersensitivity for healthcare workers and their providers, and professional trainers. The number of reported compensation claims for latex-induced skin diseases increased from a pre-measure of 664 in 1996 to 884 during the programme in 1998 and decreased after the programme (post-measure n=567 in 1999 and n=204 in 2002). Doctors’ assistants in practices and nurses/nurse assistants/midwives filed most claims. Similar decreases were observed for confirmed claims and latex-related respiratory diseases, while two other prevalent occupational diseases in healthcare workers (low-back disorders, infections) increased during this time period. The survey demonstrated a considerable concurrent drop in the use of powdered latex gloves (hospitals 76% vs 37% for unsterile gloves and 86% vs 62% for sterile gloves). Conclusions: The campaign against latex allergy in connection with concurrent corresponding recommendations, activities of State authorities for worker protection, and regulations, is an example for the successful incorporation of research results into preventive measures that directly affect the frequency of a work-related disease. This effective programme can be regarded as a model for the reduction of other occupational diseases such as bakers’ or isocyanate asthma.


Healthcare workers Occupational diseases Latex allergy Evaluation Compensation claims Prevention Intervention 



The authors thank Monika Hergel, Institution for Statutory Accident Insurance for Non-Public Healthcare and Welfare Providers in Germany (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), Reha-Koordination, Hamburg, Germany), Willi Standke, German Federal Statutory Accident Insurance (Bundesverband der Unfallkassen, Munich, Germany), and Dr. Martin Butz, Federation of Statutory Accident Insurance Institutions for the industrial sector (Hauptverband der gewerblichen Berufsgenossenschaften, HVBG-Referat ZIGUV, Sankt Augustin, Germany) for excellent cooperation in providing data on the number of compensation claims.


  1. Allmers H, Brehler R, Chen Z, et al. (1998) Reduction of latex aeroallergens and latex-specific IgE antibodies in sensitized workers after removal of powdered natural rubber latex gloves in a hospital. J Allergy Clin Immunol 102:841–846PubMedGoogle Scholar
  2. Allmers H, Schmengler J, Skudlik C (2002) Primary prevention of latex allergy in the German health care system through education and intervention. J Allergy Clin Immunol 110:318–323PubMedGoogle Scholar
  3. Allmers H, Schmengler J, John SM (2004) Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers. J Allergy Clin Immunol 114:347–351PubMedGoogle Scholar
  4. Altman DG (1991) Proportions in two independent groups. In: Altman DG (ed) Practical statistics for medical research. Chapman & Hall, London, pp 232–235Google Scholar
  5. Arellano R, Bradley J, Sussman G (1992) Prevalence of latex sensitization among hospital physicians occupationally exposed to latex gloves. Anesthiology 77:905–908Google Scholar
  6. Baur X, Ammon J, Chen Z, Beckmann U, Czuppon AB (1993) Health risk in hospitals through airborne allergens for patients presensitised to latex. Lancet 432:1148–1149Google Scholar
  7. Baur X (1996) Naturlatex-Allergie. Empfehlungen der Interdisziplinären Arbeitsgruppe. Arbeitsmed Sozialmed Umweltmed 31:471–474Google Scholar
  8. Baur X, Chen Z (1999) Summary of appropriate measures to prevent natural latex allergy. Allergy Int 48:31–36Google Scholar
  9. Baur X, Chen Z, Allmers H, Raulf-Heimsoth M (1996) Reduktion des Allergierisikos durch Naturgummi-Produkte. Dtsch Ärztebl 16:A1043–A1045Google Scholar
  10. Baur X, Chen Z, Allmers H (1998a) Can a threshold limit value for natural rubber latex airborne allergens be defined?. J Allergy Clin Immunol 101:24–27PubMedGoogle Scholar
  11. Baur X, Chen Z, Allmers H, Raulf-Heimsoth M (1998b) Results of wearing test with two different latex gloves with and without the use of skin-protection cream. Allergy 53:441–444PubMedGoogle Scholar
  12. Beezhold DH, Beck WC (1992) Surgical glove powders bind latex antigens. Arch Surg 127:1354–1357PubMedGoogle Scholar
  13. Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW) (1999). Allergiegefahr durch Latex-Einmalhandschuhe. Stand 10/99 [Allergy hazard through latex disposable gloves], Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege [Institution for Statutory Accident Insurance for Non-Public Healthcare and Welfare Providers in Germany], Hamburg, Germany, reference no. GUV 38.9Google Scholar
  14. Brehler R, Rütter A, Kütting B (2002) Allergenicity of natural rubber latex gloves. Contact Dermatitis 46:65–71PubMedGoogle Scholar
  15. Bundesministerium für Arbeit und Gesundheit [Ministry of Labour and Health] (1997) Technische Regeln für Gefahrstoffe, TRGS 540, Sensibilisierende Stoffe [Technical guidelines for hazardous substances, TRGS 540, sensitizing substances]. Bundesministerium für Wirtschaft und Arbeit [Ministry of Economics and Labour], Bonn, Germany Bundesarbeitsblatt 12:58-63. ISSN 007-5868.
  16. Bundesverband Medizinprodukte e.V. [German Medical Technology Association] (1998) Verbrauch von gepuderten Latexhandschuhen [Consumption of powdered latex gloves]. Umwelt und Medizintechnik [Consumer Protection/Technical Issues], Berlin, GermanyGoogle Scholar
  17. Charous B, Blanco C, Tarlo S, et al. (2002) Natural rubber latex allergy after twelve years: recommendations and perspectives. J Allergy Clin Immunol 109:31–34PubMedGoogle Scholar
  18. Chen Z, Cremer P, Baur X (1997) Latex allergy correlates with operation. Allergy 2:873Google Scholar
  19. Food and Drug Administration (1999) Medical glove guidance manual. US Department of Health and Human Services, Rockville, MDGoogle Scholar
  20. Fuchs Th (1995) Gummi und Allergie [Rubber and allergy]. Dustri-Verlag Dr. Karl Feistle, Munich-Deisenhofen, Germany, ISBN 3-87185-244-9Google Scholar
  21. Gautrin D, Ghezzo H, Infante-Rivard C, Malo J-L (2000) Incidence and determinants of IgE-mediated sensitisation in apprentices. A prospective study. Am J Resp Crit Care Med 162:1222–1228PubMedGoogle Scholar
  22. Hammer AL, Paulsen PR (1997) Latex allergy: implementation of an agency program. Gastroenterology Nurs 20:156–161Google Scholar
  23. Heilman DK, Jones RT, Swanson MC, Yunginger JW (1996) A prospective, controlled study showing that rubber gloves are the major contributor to latex aeroallergen levels in the operating room. J Allergy Clin Immunol 98:325–330PubMedGoogle Scholar
  24. Hunt LW, Boone-Orke JL, Fransway AF, et al. (1996) A medical-center-wide, multidisciplinary approach to the problem of natural rubber latex allergy. J Occup Environ Med 38:765–770PubMedGoogle Scholar
  25. Jäger D, Kleinhans D, Czuppon AB, Baur X (1992) Latex-specific proteins causing immediate-type cutaneous, nasal, bronchial, and systemic reactions. J Allergy Clin Immunol 89:759–768PubMedGoogle Scholar
  26. Konrad C, Fieber T, Gerber H, Schuepfer G, Muellner G (1997) The prevalence of latex sensitivity among anesthesiolgy staff. Anesth Analg 84:629–633PubMedGoogle Scholar
  27. Lagier F, Vervloet D, Lhermet I, Poyen D, Charpin D (1992) Prevalence of latex allergy in operating room nurses. J Allergy Clin Immunol 90:319–322PubMedGoogle Scholar
  28. Leung R, Ho A, Chan J, Choy D, Lai C (1996) Prevalence of latex allergy in hospital staff in Hong Kong. Clin Exp Allergy 27:167–174Google Scholar
  29. Levy D, Allouache S, Chabane MH, Leynadier F, Burney P (1999) Powder-free protein-poor natural rubber latex gloves and latex sensitisation. J Am Med Assoc 281:988Google Scholar
  30. Liss GM, Tarlo SM (2000) Natural rubber latex-related occupational asthma: association with interventions and glove changes over time. Am J Ind Med 40:347–353Google Scholar
  31. Liss G, Sussman G, Deal K, Brown S, Cividino M, Siu S, et al. (1997) Latex allergy: epidemiologic study of 1351 hospital workers. Occup Environ Med 54:335–342PubMedGoogle Scholar
  32. Mace S, Sussman G, Liss G, et al. (1998) Latex allergy in operating room nurses. Ann Allergy Asthma Immunol 80:252–256PubMedGoogle Scholar
  33. Mahler V, Fischer S, Fuchs T, Ghannadan M, valent P, Fartasch M, Kraft D, Schuler G, Valenta R (2000) Prevention of allergy by selection of low-allergen gloves. Clin Exp Allergy 20:509–520Google Scholar
  34. Nolte B (1997) Vermeidung beruflich bedingter Naturlatexallergien [Avoidance of occupational natural rubber latex allergy]. Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege [Institution for Statutory Accident Insurance for Non-Public Healthcare and Welfare Providers in Germany], Hamburg, GermanyGoogle Scholar
  35. Phillips ML, Meagher CC, Johnson DL (2001) What is “powder free”? Characterisation of powder aerosol produced during simulated use of powdered and powder free latex gloves. Occup Environ Med 58:479–481PubMedGoogle Scholar
  36. Ruëff F, Przybilla B (1999) Soforttyp-Allergie gegen Naturlatex. Gemeinsame Leitlinie von DGAI und ÄDA [Immediate type natural rubber latex allergy. Joint guideline of DGAI und ÄDA]. Allergo J 55:181-182 or AWMF—the Association of the Scientific Medical Societies in Germany, guideline no. 0611022. /ll/061-002.htmGoogle Scholar
  37. Swanson MC, Bubak ME, Hunt LW, Yunginger JW, Warner MA, Reed CE (1994) Quantification of occupational latex aeroallergens in a medical center. J Allergy Clin Immunol 94:445–451PubMedGoogle Scholar
  38. Tarlo SM, Wong L, Roos J, Booth N (1990) Occupational asthma caused by latex in a surgical glove manufacturing plant. J Allergy Clin Immunol 85:626–631PubMedGoogle Scholar
  39. Tarlo SM, Sussman GL, Contala A, Swanson MC (1994) Control of airborne latex by use of powder-free gloves. J Allergy Clin Immunol 93:985–989PubMedGoogle Scholar
  40. Tarlo SM, Sussman GL, Holness DL (1997) Latex sensitivity in dental students and staff: a cross-sectional study. J Allergy Clin Immunol 99:396–401PubMedGoogle Scholar
  41. Tarlo SM, Easty A, Eubanks K, et al. (2001) Outcomes of a natural rubber latex control program in an Ontario teaching hospital. J Allergy Clin Immunol 108:628–633PubMedGoogle Scholar
  42. Tomazic VJ, Shampaine EL, Lamanna A, Withrow TJ (1994) Cornstarch powder on latex products is an allergen carrier. J Allergy Clin Immunol 93:751–758Google Scholar
  43. Turjanmaa K (1987) Incidence of immediate allergy to latex gloves in hospital personnel. Contact Dermatitis 17:270–275PubMedGoogle Scholar
  44. Turjanmaa K, Reunala T, Alenius H, Brummer-Korvenkontio H, Palosuo T (1990) Allergens in latex surgical gloves and glove powder. Lancet 336:1588Google Scholar
  45. Turjanmaa K, Kanto M, Kautiainen H, Reunala T, Palosuo T (2002) Long-term outcome of 160 adult patients with natural rubber latex allergy. J Allergy Clin Immunol 110:S70–S74PubMedGoogle Scholar
  46. Vandenplas O, Delwiche JP, Evrard G, et al. (1995) Prevalence of occupational asthma due to latex among hospital personnel. Am J Respir Crit Care 151:54–60Google Scholar
  47. van der Meeren HLM, van Erp PEJ (1986) Life-threatening urticaria from glove powder. Contact Dermatitis 14:190–191PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Occupational Epidemiology, Institute for Occupational Medicine, Hamburg State Department of Environment and HealthUniversity of HamburgHamburgGermany
  2. 2.BGW - Berufsgenossenschaft für Gesundheitsdienst und WohlfahrtspflegeHamburgGermany

Personalised recommendations