This course reviews both Type I and Type IV allergic reactions associated with NRL exposure. The risk factors and clinical manifestations for both patients and healthcare workers are discussed.

Upon completion of this course, participants should be able to do the following:

1. Define latex sensitivity as it affects patients and healthcare workers.
2. Describe the different physiologic mechanisms and symptomology of irritant and allergic reactions (Type I and IV) to NRL.
3. Describe strategies to protect healthcare professionals and patients from NRL related allergies and reactions.
4. Review diagnostic options and strategies.
5. Discuss the implementation of latex avoidance protocols and management strategies in the dental office.
6. Understand product selection criteria for dental professionals dealing with glove-related allergies and irritations.

Latex sensitivity and its ramifications have become topics of concern for dental professionals and patients. In the late 1980's, fear of exposure to the HIV virus and other blood-borne pathogens resulted in skyrocketing demand for and use of latex products and gloves by healthcare workers (HCWs). This was accompanied by an increased reporting of natural rubber latex (NRL) reactions and allergies. As of 1997, more than 2,300 allergic reactions associated with latex had been reported to the FDA's MedWatch Program. Over 200 of these cases were associated with anaphylaxis and 17 were fatal. As more cases accumulated, the FDA issued a ruling on Sept. 30, 1997, requiring a warning label on all NRL medical devices. Recent studies of health care workers have estimated Type I latex allergy to be as high as 17%. Assuming a conservative 10% prevalence, over 800,000 healthcare workers in the United States have a Type I allergy to latex and 2 million workers may experience allergic contact dermatitis (Type IV). Healthcare organizations have recommended reducing occupational exposure to latex. Some states have introduced legislation attempting to prohibit the use of all powdered latex products in healthcare facilities. Recently, the FDA has proposed changes to medical glove manufacturing regulations to include additional labeling requirements as well as limits on the amounts of protein and powder acceptable for medical gloves. This course reviews the dermal reactions common in dentistry and both Type I and Type IV allergic reactions associated with NRL exposure. The underlying mechanisms as well as the risk factors and clinical manifestations of latex allergies for both patients and healthcare workers are discussed. Diagnostic methods, management strategies, product selection and regulatory requirements are presented, with emphasis on current efforts to reduce and prevent sensitizations and elicitation of symptoms in the future.

COURSE OUTLINE 

1. Glossary
   
   
2. Introduction
   
   
3. What is NRL?
   
   
   1. How are Plant Proteins Incorporated?
      
   
   
4. Why Have Allergies Developed?
   
   
   1. Prevalence in Healthcare
      
      
   2. Reactions
      
   
   
5. Occupational Irritants
   
   
   1. Type IV Delayed Allergy to Chemicals
      
      
   2. Type I Allergy to NRL
      
      
      1. Cutaneous
         
         
      2. Urticaria
         
         
      3. Systemic
         
         
      4. Anaphylaxis
         
         
         1. Late Phase
            
   
   
6. NRL Management Protocols
   
   
   1. Accurate Diagnosis
      
      
      1. Diagnostic Tests
         
         
         1. Patch Test
            
            
         2. Skin Prick
            
            
         3. Serologic Immunoassays
            
      
      
   2. Identify Patients and Coworkers at Risk
      
      
      1. Risk Factors
         
      
      
   3. Co-Occurrence of Type I NRL and Food Allergies
      
      
   4. Routes of Exposure
      
      
   5. Product Identification
      
      
   6. Synthetic Alternatives to NRL Gloves
      
      
      1. Assess Glove Needs
         
         
         1. User Preferences
            
            
         2. Chemical Compatibility
            
            
         3. Durability
            
         
         
      2. Examine Features
         
         
         1. Powder Levels
            
            
         2. Powder-Free Alternatives
            
   
   
7. Current Regulatory Requirements and Advisories
   
   
   1. Reductions and Limits on Total Protein
      
      
   2. Reductions and Limits on NRL Antigenic Protein
      
      
   3. Reductions and Limits on Powder Levels
      
   
   
8. Summary

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