Changing Trends in Patch Test Reactions to Accelerators

Lauren Y. Cao, BS; James S. Taylor, MD; Apra Sood, MD; Debora Murray, LPN; Paul D. Siegel, PhD

Arch Dermatol. 2010;146(9):1001-1007. doi:10.1001/archdermatol.2010.219

Background Rubber gloves are one of the most frequent causes of occupational allergic contact dermatitis, especially in health care workers.

Observations We describe 23 patients with allergic contact dermatitis due to rubber accelerators in rubber gloves, some with disseminated dermatitis, treated during a 2-year period. Three had IgE-mediated latex allergies. Sixteen were health care workers from a single institution whose dermatitis was temporally related to the switch to latex-safe gloves. Each had positive patch test reactions to 1 or more rubber accelerators, including carbamates, thiurams, 2-mercaptobenzothiazole, and 1,3-diphenylguanidine. Chemical analysis of 6 glove samples identified 2-mercaptobenzothiazole in 4 and zinc diethyldithiocarbamate in 1. There were discordances between patch test results for glove chemicals and glove swatches and between available information on chemicals used during glove production and chemicals detected during glove analysis. Although these factors may complicate the search for culprit and alternative gloves, dermatitis cleared in each of 9 patients with follow-up data and for whom alternative gloves were provided based on published information of glove composition.

Conclusions Allergic contact dermatitis due to synthetic rubber gloves occurs even with the use of latex-safe products. More knowledge about chemicals present in these gloves, to which the skin is exposed during use, is necessary to prevent and treat allergic contact dermatitis.

Author Affiliations: Clinical Research Scholars Program, Case Western Reserve University School of Medicine (Ms Cao), and Department of Dermatology, Dermatology–Plastic Surgery Institute, Cleveland Clinic (Drs Taylor and Sood and Ms Murray), Cleveland, Ohio; and National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia (Dr Siegel).

http://archderm.ama-assn.org/cgi/content/short/146/9/1001