The Impact of Chemical Allergies
If you, or someone on your surgical staff, have skin issues exhibited by red, irritated, cracked and itchy hands, what do you do?
One of your first steps may be to switch to powder-free surgical gloves. But what happens if the problem continues? You may then convert to surgical gloves not made with natural rubber latex. But what else could be causing this problem?
This type of skin reaction can be caused by other materials used in glove manufacturing, including a group of chemicals called accelerators, which can cause Type IV allergic reactions.7
Contact dermatitis (along with other occupational skin diseases) is the second-most common occupational disease, projects the U.S. Bureau of Labor Statistics.8

What Are Chemical Accelerators?
Chemical accelerators are added to the glove formulation during the manufacturing process to help make them more durable and provide elasticity. Accelerators are used in both latex and synthetic gloves.10
What happens when a Type IV allergic reaction occurs?11
Clinically, a Type IV allergy appears as a red, raised and palpable area at the point of contact with the glove, accompanied by subjective symptoms such as itching, burning and tingling. Additional symptoms include: erythema, swelling, cracking, weeping and dryness of the skin at the site of contact although dermatitis may extend beyond the area of contact.
- The Type IV response begins when the antigens (such as residual chemicals leached from the glove in one’s own perspiration) penetrate the skin, triggering the formation of T cells sensitized to the specific antigens.
- Repeated exposure to the antigen in allergic individuals results in the re-activation of sensitized T cells and the production of an inflammatory response causing the Type IV symptoms.
- These effects typically appear anywhere from six to 48 hours following exposure to the antigen containing product and can last up to four days.

References:
- 1. Heese, A. Hintzenstern, J, Peters, K, Uwe Koch, H, Hornstein, O. Allergic and irritant reactions to rubber gloves in medical health services. Journal of the American Academy of Dermatology. November 1991, Volume 25, Issue 5, Part 1, Pages 831–839. Available at: http://www.jaad.org/article/S0190-9622(08)80977-2/abstract. Accessed December 17, 2015.
- 2. NIOSH Stops Sticks Campaign website. Available at: http://www.cdc.gov/niosh/stopsticks/sharpsinjuries.html. Accessed December 17, 2015.
- 3. Thomas, S, Agarwala, M, Mehtab, G, Intraoperative glove perforation—single versus double gloving in protection against skin contamination. Post Graduate Medical Journal. 2001;77:458-460 doi:10.1136/pmj.77.909.458. Available at: http://pmj.bmj.com/content/77/909/458.full. Accessed December 18, 2015.
- 4. Partecke, Lars Ivo, Anna-Maria Goerdt, Inga Langner, Bernd Jaeger, Ojan Assadian, Claus-Dieter Heidecke, Axel Kramer, and Nils-Olaf Huebner. “Incidence of microperforation for Surgical Gloves Depends on Duration of Wear.” Infection Control and Hospital Epidemiology 30.5 (2009): 409-14.
- 5. Guterl, Gail, The Powerful Case for Double Gloving. Outpatient Surgery Magazine. September 2013. Available at: http://www.outpatientsurgery.net/surgical-facility-administration/personal-safety/the-powerful-case-for-double-gloving--10-13&pg=2. Accessed December 17, 2015.
- 6. Berguer R & Heller PJ. Preventing sharps injuries in the operating room. Journal of the American College of Surgeons. 2004; (199)3:462-467.
- 7. Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion. Available at: http://www.cdc.gov/oralhealth/infectioncontrol/faq/latex.htm.
- 8. Jacob,Sharon E., MD; Steele, Tace. Contact Dermatitis & Workforce Economics; Seminars in Cutaneous Medicine & Surgery 25: 105-109. 2006. Available at: https://www.deepdyve.com/lp/elsevier/contact-dermatitis-and-workforce-economics-qm8VqqgSYj. Accessed March 3, 2016.
- 9. AORN Allergy Management Survey Results, April 2010.
- 10. Gardner N. Accelerator free fact or fiction. Health & Safety International. October 2008. Available at: http://www.shieldscientific.com/include/USER_FileUpload/files/Press%20Release/HSInt-Accelerator-free-%20gloves-Oct-08.pdf. Accessed March 3, 2016.
- 11. Michael Zedalis, PhD, and Patty Taylor, RN, BA. Uncovering the Mystery of Type IV Allergies. Infection Control Today. April 5, 2012. Available at: http://www.infectioncontroltoday.com/articles/2012/04/uncovering-the-mystery-of-type-iv-allergies.aspx. Accessed December 17, 2015.