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  Many agents
able to cause immunoallergic manifestations can be found in the hospital
environment. Among these manifestations, the most common involve the skin
with contact dermatitis. In the last few years, however, there has been a
growing interest also of the respiratory system with asthmatic
manifestations and the appearance of generalised forms such as urticaria
and shock (anaphylaxis) has been observed. The main allergy-inducing
agents identified up to now in the hospital environment are of chemical
sort and vegetal or animal in origin.
Allergic risk factors
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Chemical
substances
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detergents
disinfectants
drugs
synthetic rubber gloves
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Vegetable
and animal products
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laboratory
animal products
house dust mites
latex
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Among the chemical agents, a remarkable role is held by detergents and
disinfectants because of their wide employment and because of the large
number of exposed subjects.
Among disinfectants gluteraldehyde, ammonium salts, formaldehyde and T
chlorammine are strong allery-inducing agents. They are largely used for
skin and environments disinfection and in the sterilization of surgical
and dentistry tools, endoscopes and catheters. These disinfectants, and
also some detergents, may cause both irritating and allergic contact
dermatitis, more frequently localized on the hands, around the wrists and
on the forearms; moreover, some disinfectants may be held responsible for
some forms of professional asthma. The employment of disinfectants and
detergents represents a risk for the whole health personnel: however, as
far as detergents are concerned, auxiliary personnel and
operating-theatre personnel are more at risk, whereas as far as
disinfectants are concerned, the higher exposure takes place in nursing
staff, operating-theatre staff and endoscopy staff.
Amongst drugs, some antibiotics, such as betalactamide, chloramphenicol
or neomycin may induce contact dermatitis. This may be also induced by
the employment of synthetic rubber and plastic gloves; in this case the responsible
allergens are thiurams and carbamates remaining after the vulcanisation
of rubber which may be released when using the gloves.
Amongst vegetal and animal substances, in the last few years cases of
occupational asthma (sometimes very severe) caused by derivatives of
laboratory animals (such as urine and dandruff of cavies, mice, rats and
rabbits) have been reported. They mainly concern animal breeding
department workers and researchers that make use of laboratory animals. A
further risk factor for asthma and rhinitis, above all for auxiliary
personnel, is represented by house dust mites, whose concentration in bed
materials may be elevated. At present, the most important risk factor for
allergic pathology in the hospital environment is represented by latex
gloves, both because they are widely used and because they have a strong
capacity to induce allergies. Clinical pictures caused by latex
sensitization are extremely varied and may be characterized by local
manifestations as contact dermatitis or by generalized manifestations
involving the skin and mucous membranes (generalized urticaria,
angioneurotic edema of the face or of other areas, edema of the glottis
with consequent severe respiratory difficulties), the respiratory system
(asthma and rhinitis), the eyes (conjunctivitis), up to the picture of
shock (anaphylaxis).
Health personnel exposed to latex is represented not only by personnel
wearing latex gloves, but also by personnel who, though not wearing them,
works in confined spaces where such gloves are extensively used; latex
particles, in fact, may adhere to the dust of corn starch used as
lubricant inside the gloves and may later be released in the air when
opening of gloves packagings occurs, therefore giving rise to inhalation
manifestations.
Latex sensitization may represent a problem also outside the working
environment, as this substance is contained in many manufactured articles
of common use (see following table); furthemore, possible cross reactions
have been shown between latex and food allergens, such as banana,
chestnut, hazelnut, avocado and kiwi.
Products Containing Latex
A
wide variety of products contain latex: medical supplies, personal
protective equipment, and numerous household objects. Most people who
encounter latex products only through their general use in society have
no health problems from the use of these products. Workers who repeatedly
use latex products are the focus of this Alert. The following are
examples of products that may contain latex:
Emergency Equipment
Blood pressure cuffs
Stethoscopes
Disposable gloves
Oral and nasal airways
Endotracheal tubes
Tourniquets
Intravenous tubing
Syringes
Electrode pads
Personal Protective Equipment
Gloves
Surgical masks
Goggles
Respirators
Rubber aprons
Office Supplies
Rubber bands
Erasers
Hospital Supplies
Anesthesia masks
Catheters
Wound drains
Injection ports
Rubber tops of multidose vials
Dental dams
Household Objects
Automobile tires
Motorcycle and bicycle handgrips
Carpeting
Swimming goggles
Racquet handles
Shoe soles
Expandable fabric (waistbands)
Dishwashing gloves
Hot water bottles
Condoms
Diaphragms
Balloons
Pacifiers
Baby bottle nipples
For additional information
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