Can a threshold limit value for natural rubber latex airborne allergens be defined?☆,☆☆,★

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Abstract

Background: Recent studies have shown that systemic or respiratory occupational responses to latex can be induced by inhalation of latex aeroallergens. Objective: Our objectives were to study the relationship between exposure to different latex aeroallergen levels and type I allergic reactions in subjects with occupational contact with latex and to assess a threshold value for latex airborne allergens required for sensitization and symptom elicitation. Methods: We screened 145 subjects working in 32 hospitals or operating rooms with different latex aeroallergen levels. The quantified latex aeroallergen concentrations in the 32 rooms were compared with latex-related allergic symptoms. Results: Different latex aeroallergen concentrations could be detected in rooms where powdered latex gloves were used and no effective ventilation systems were installed. In environments with latex aeroallergen levels of 0.6 ng/m3 or greater, the reported workplace-related symptoms were significantly increased (p < 0.02). All 22 subjects with latex-specific IgE antibodies worked in rooms contaminated with latex aeroallergens (p < 0.05). Conclusions: Our results demonstrate that symptoms and presence of latex-specific IgE antibodies in subjects are significantly associated with measurable levels of latex aeroallergens. A latex aeroallergen level of 0.6 ng/m3 is a critical threshold, especially for health care workers who are sensitized to natural rubber latex.(J Allergy Clin Immunol 1998;101:24-7.)

Section snippets

METHODS

Air samples were collected in 30 rooms of different hospital units and two physicians' offices where different amounts of powdered latex gloves were used each day. The number of latex gloves used in these rooms varied from two to thirty-five pairs per day. In 16 rooms, continuously working ventilation systems with filters for respirable dust were present. Collection of air samples and quantification of latex aeroallergens in the samples by inhibition immunoassay were performed as previously

RESULTS

Latex aeroallergens were present in all 16 rooms without ventilation systems and in four of the 16 rooms with ventilation systems and a fresh air supply. The concentration of latex aeroallergens ranged from 0.4 to 205 ng/m3. Interestingly, a relationship between total dust and latex aeroallergen concentration, on the basis of an investigation of 30 rooms, was not detectable (Fig. 1).

. Distribution of inhalable dust and latex allergen concentrations in hospital rooms with (open symbols) and

DISCUSSION

Our results (shown in Table II) demonstrate that NRL allergy–related symptoms in subjects are significantly associated with latex aeroallergen concentrations in their work areas. It appears likely that symptoms were induced when allergen levels exceeded a threshold value (i.e., 0.6 ng/m3) as shown in our results. This effect was confirmed by our additional clinical observations: five of our patients allergic to latex developed conjunctivitis, rhinitis, and/or asthma (asthma in two patients)

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From the Research Institute for Occupational Medicine (BGFA), Ruhr-University of Bochum, Bochum.

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Reprint requests: Xaver Baur, MD, BGFA, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.

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