Title: Use of a Breathable Glove Liner for Prevention of Delayed Hypersensitivity to Rubber Accelerators
Abstract: To the Editor: Delayed hypersensitivity to the rubber accelerators used in the manufacture of latex gloves has been estimated to cause approximately 82% of allergic reactions to rubber gloves.1 Glove materials other than latex either do not protect adequately against HIV2 or are too costly to be practical in most settings. Protective glove liners are generally bulky, allow perspiration buildup, and are impractical for most health care workers. We evaluated the ability of a thin, waterproof, breathable glove liner (Dermapor Gloves; W.F. Gore and Associates, Elkton, MD) to protect against delayed hypersensitivity to common accelerators found in latex gloves. Thirteen subjects with confirmed Type IV allergy to rubber accelerators used in latex gloves1 were enrolled in a pilot study. Subjects with a history of immediate reactions to latex were excluded. Two patch tests each of 1% thiuram mix, 3% carba mix, 2% mercapto mix, and 2% mercaptobenzathiazole (all in petrolatum) (Chemotechnique Diagnostics, Malmo, Sweden) were applied using Hermal Finn Chambers (Central Laboratories, Hermal Dermatology Group, Delmar, New York) to dry, normal-appearing skin on the upper back of each subject in a random double-blinded manner. Two samples each of disposable latex exam glove material from Henry Shein, Inc. and Tillotson, Inc. were also applied to all subjects in the same manner. Each subject acted as his or her own control since for every tested material, one patch was applied directly to the subject's back and the second patch was applied with glove liner material totally covering the filled Finn Chamber. The patches were removed at 48 hours, read at 72 hours, and graded 0 to 3+ according to standard patch test definitions. Patch test results for each material were compared to similar sites with glove liner material, using chi-square. A total of 33 positive reactions in the 13 subjects were recorded to the standardized rubber-related allergens in petrolatum. Of these, 24 (73%) were entirely blocked by the insertion of the glove liner material (P < 0.01) and five more (15%) were reduced in intensity. The seven 3+ reactions (five of these to thiuram mix) were not entirely blocked; however, four were reduced in intensity. These results are impressive because petrolatum provides an organic environment that may assist in chemical penetration of the liner. Eleven reactions to actual latex glove material were also recorded. Ten of these reactions (91%) were totally blocked by insertion of the glove liner material (P < 0.01), including three of four reactions graded 3+. These results are a more relevant clinical model than the petrolatum-based allergens. The results suggest that use of the tested glove liners may be able to eliminate many Type IV reactions to rubber accelerators. These glove liners may prove to be more practical than previous liners because they are thin, waterproof, breathable, reusable, washable, and can be autoclaved. Further studies will need to test the liner in actual clinical usage. Also, it is necessary to address whether reusing glove liners without washing between patients will create a problem with infection control. These liners are not advocated for prevention of Type I allergy to latex. Acknowledgments The authors wish to acknowledge W. L. Gore & Associates, Inc., Elkton, MD, for financial support of this work. Andrew Scheman, MD; Anne Osburn, RN Northwestern University; School of Medicine; Evanston, IL