An allergic reaction to latex rubber gloves

An allergic reaction to latex rubber gloves

M E * A ________ C L I N I C A L R E P O R T S An allergic reaction to latex rubber gloves Peter J. M arch, DDS M o st d e n ta l p r a c titio n e...

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M E * A ________ C L I N I C A L

R E P O R T S

An allergic reaction to latex rubber gloves Peter J. M arch, DDS

M o st d e n ta l p r a c titio n e rs are g lo v in g u p to work. W ith this trend, reports on m a n u a l d exterity, barrier effectiveness, a n d m ore have been recorded. T his case report describes a new co n sid era tio n — an allergic reaction by a p a tie n t to the d e n tist’s rubber-gloved hands.

eports in the literature of contact derm atitis of the m ucous m em ­ branes are few .1 A lthough aller­ gic re a c tio n s to ru b b e r p ro d u c ts have been re p o rte d ,2 6 n o reference has been m ad e to c o n ta c t d e rm a titis of m uco u s m em branes caused by latex exam ination g lo v es. T h is p a p e r d iscu sses p o ssib ly the first reported case of contact derm atitis of the m ucous m em branes caused by latex e x a m in a tio n gloves an d co n firm ed by patch testing.

R

Report of case A 65-year-old w hite m ale in good health re p o rte d to a p riv a te g e n e ra l p ra c tic e for fab ricatio n of a replacem ent for an e x is tin g m a x illa ry c o m p le te d e n tu re . A s h o r t w ritte n h e a lth h isto ry a t th e in itia l v isit in clu d ed queries regarding allergies to penicillin, local anesthetics, 590 ■ JADA, Vol. 117, October 1988

or other m edications. N one was reported. N o o th e r a lle rg y p o s s ib ilitie s w ere ex p lo re d a t th is in itia l v isit. A lg in a te im p re s s io n s w ere ta k e n a t th e in it ia l a p p o in tm e n t. T h e p a tie n t re tu rn e d to th e o ffic e 4 d ay s la te r fo r th e fin a l im pression taken w ith a custom acrylic tray and polyether im pression m aterial. T h e n e x t day, th e p a tie n t re tu rn e d to the office co m p lain in g of sw ollen tender lips and a dry m o u th . T h e exam ination show ed red, sw ollen, an d tender lab ial an d buccal m ucosa th ro u g h o u t the m o u th w ith the m ost sw ollen an d tender tissue centered a b o u t the lab ial com m issures. After the p atien t was questioned at this tim e a b o u t a n y k n o w n a lle rg ie s , he described a 30-year h isto ry of allergies to m any foods and especially to rubber p ro d u c ts . H e re p o r te d th a t h is sk in becam e sw ollen and blistered w henever he touched rubber products. C ontact derm atitis re su ltin g from an alle rg ic rea ctio n to p o ly eth er w as su s­ pected. P oly eth er has been rep o rted in the literatu re as capable of ca u sin g an a lle r g ic r e a c tio n .7 T h e p a t ie n t w as in s tru c te d to c o n s u lt a d e rm a to lo g is t for a patch test. The p atien t was taking p r e d n is o n e p re s c rib e d by a p re v io u s d e r m a to lo g is t to re lie v e th e c u r r e n t e p iso d e of d e rm a titis . W ith in 3 days, the reaction subsided.

T w o weeks after the fin al p o ly e th er im p re s s io n w as ta k e n , th e p a tie n t retu rn ed to the office for estab lish m en t of the vertical d im en sio n of occlusion, a b ite ch eck , a n d to o th se le c tio n . An acrylic baseplate w ith wax rim s was used th r o u g h o u t th e p ro c e d u re , a n d v in y l polysiloxane was used to register centric o c c lu s io n . T h e n e x t d ay , th e p a tie n t r e tu rn e d to th e office w ith d e rm a titis sim ilar to th at w hich occurred after his in itial im pressions were made. T h is tim e, the latex rubber gloves w orn by the dentist were suspected of causing the derm atitis (he wore gloves to treat this p atien t each tim e). W ith in 3 d ay s, th e r e a c tio n subsided. O n later visits, the doctor w ore vinyl gloves, an d treatm ent proceeded w ith o u t any further reactions. T h ree m o n th s after the in itial reaction, the p atien t was tested by a derm atologist for vinyl polysiloxane, polyether, a latex glove, and vinyl glove. A lso tested w ere som e ch em icals co m ­ m only used in the m an u factu rin g of latex gloves: m ercaptobenzothiazole, tetram eth y lth iu ra m (both ru b b er accelerators), an d h y d ro q u in in e m onobenzylether (an antioxidant). After 24 hours, the patches h ad to be rem oved because of the severity of reaction to both latex rubber accelerator chem icals a n d th e la te x glove. T h e p a tie n t was

CLINICAL

g iv e n a n in je c tio n of d e x a m e th a s o n e (Decadron), given prednisone orally, and d ip ro s o n e locally. T w o days a fte r th e patches were rem oved, his clinical con­ d itio n was m uch im proved. Final d iag ­ n o s is w as c o n ta c t d e r m a titis of th e m ucous m em branes caused by a reaction to latex rubber gloves. Discussion A lth o u g h contact derm atitis of m ucous m em branes is n o t com m on, an d reactions to ru b b er gloves d u rin g dental treatm ent h av e n o t been re p o rte d p re v io u sly , it is p la u s ib le to ex p ect sim ila r cases to surface w ith the increased use of gloves by d ental personnel d u rin g dental treat­ m e n t. O n e re c e n t s tu d y re p o rte d 93% of dentists wear gloves at least some of th e tim e .8 I d e n tif y in g p a tie n ts w ith allergies is made easier w ith a thorough h ea lth history. In this case, the p atien t h a d w ritte n o n th e h is to ry fo rm th a t

he w as n o t allergic to any m edicines— no questions were asked ab o u t any other allergies. F u rth e r q u e stio n in g p robably w ould have disclosed this p a tie n t’s allergy to ru b b e r p ro d u cts. If a p a tie n t has a h istory of allerg ic reactions, to k n o w n an d u n k n o w n allerg en s, p a tc h te stin g is re c o m m e n d e d to id e n tify sp e c ific allergens. S ubsequently, m aterials c o n ­ ta in in g these substances could be avoided d u rin g fu tu re d ental treatm ent. In this case, vinyl gloves were su b stitu te d for latex rubber gloves. Summary A case of contact derm atitis of the oral m ucous m em branes caused by an allergic reaction to latex rubber gloves w orn by a dentist is reported. Identification and m a n a g e m e n t of p a tie n ts w ith allergies is discussed. As m ore dentists are w earing gloves, m ore cases of allerg ic reactions

REPORTS

to latex rubber gloves may surface.

------------------j m A -----------------D r. M a rc h is a p r iv a te p r a c titio n e r , g e n e r a l dentistry, 107 W M ain St, Peotone, IL 60468. A ddress requests for reprints to Dr. M arch. 1. C o h e n , D .M ., a n d H o f f m a n , M. C o n ta c t sto m atitis to rubber products. O ral S urg O ra l M ed O ra l P a th o l 52(5):491-493, 1981. 2. E s tla n d e r, T .; J o la n k i , R.; a n d K a n erv a, L. D e rm a titis a n d u rtic a ria fro m ru b b e r a n d p la s tic gloves. C ontact D e rm atitis 14( 1):20-25, 1986. 3. B lin k h o rn , A.S., a n d L eggate, E.M. An allergic reaction to rubber dam . Br D ent J 156:402-403, 1984. 4. K leinhans, D. C ontact u rtica ria to ru b b er gloves. C o n tact D erm atitis 10(2):124-125, 1984. 5. M eding, B., a n d Fregert, S. C o n ta ct u rtic a ria from n a tu ra l latex gloves. C o n tact D erm atitis 10(1 ):5253, 1984. 6. Vizuete, J.R .; M adden, R .M .; a n d R oche, W .C. A s u s p e c te d ru b b e r a lle rg y d u r in g e n d o d o n tic treatm ent. J H o u sto n D ist D ent Soc 5:12-14, 1983. 7. B la n k e n a u , R .; Kelsey, W .; a n d C avel, W. A p o ssib le a lle rg ic resp o n se to p o ly e th e r im p ressio n m aterial: a case report. JA D A 108(4):609-610, 1984. 8. ADA News. AIDS in A m erica 18(12):!-2, 1987.

Know your benefits The tripartite system M em bership in the three-tiered structure of A m erican organized dentistry allow s today’s dentists to contribute to and influence the factors affecting their personal and professional success. Each level of m em bership offers special advantages an d benefits to the dentist w ho invests in organized dentistry. Ju st a few exam ples . . . At the national level. As d ental benefit plans proliferate, the ADA has im plem ented a u n iq u e and personal service for dentists considering contracts from alternative delivery systems. T h e contract analysis service w ill assist you in evaluating the opp o rtu n ities and p o ten tial trouble spots in the p la n th a t has been offered to you and w ill help you ask your ow n personal attorney an d consultants the m eaningful questions on w hich your success could depend. At the state level. T h e im pact of legislative an d regulatory influence on your dental practice grow s daily. Y our state dental society actively represents the interests of dentists in your state in the state house an d before the state dental board. P atien t freedom of choice, tort reform , and threats to the dental practice act are only a few of the areas w here organized dentistry is w orking to h elp you succeed in your chosen career. At the local level. D entistry’s h ighly acclaim ed p u b lic outreach activities, N ational C h ild ren ’s D ental H ealth M onth and N ational Senior Sm ile Week, offer you o p p o rtu n ities to b rin g dentistry’s “good new s” message ab o u t the value of dental health to the people in your hom etow n. Everything you need to enhance the im age a n d visibility of dentistry an d dental care is available for your use. Vital activities, services, and benefits are available to you th ro u g h the interactive netw ork of the three levels of organized dentistry. Now, m ore th an ever, you need the pow er of organized dentistry b ehind you to help m ake the m ost of these challenging times.

JADA, Vol. 117, October 1988 ■ 591