Endotoxin as a factor in adverse reactions to latex gloves

Background: Endotoxin is an inflammatory agent made by gram negative bacteria that can irritate the skin, induce respiratory problems, fever, and shock. It is an adjuvant for both delayed hypersensitivity and IgE production and has been shown to magnify antigen specific mediator release. Since many of the clinical problems associated with natural latex products involve similar clinical sequelae, we investigated the possibility that latex gloves might be contaminated with endotoxin. Objective: To measure the endotoxin content of a variety of natural latex gloves, investigate its distribution and origin, association with latex proteins, and determine the particle sizes associated with its release. Methods: Endotoxin, protein, and allergen were measured using a quantitative kinetic Limulus assay, modified Lowry, and PAST inhibition, respectively. Particle size and density were determined using an Anderson multistage air sampler and CsCl2 gradient. Results: Endotoxin was found to be a highly significant contaminant of some latex gloves. Levels ranged from 0.09 ng to 2.8 mu g/g of glove. Protein levels ranged from <25 to 1150 mu g/g of glove while allergen levels ranged from <1 to 837 mu g/g of glove. Endotoxin and protein eluted rapidly from the interior of the gloves tested. Greater than 70% of the endotoxin was found to be associated with particles in the <7 mu m aerodynamic diameter range. The highest levels of endotoxin were found in nonsterile examination gloves with a tendency towards powdered loves containing more endotoxin and protein. A slurry containing cross-linked dextran through which gloves were dipped revealed very high endotoxin contamination (64 mu g/mL) while unused cross-linked dextran has very little associated endotoxin. Conclusions: These data demonstrate that some natural rubber latex gloves, particularly nonsterile examination gloves, are contaminated with high amounts of endotoxin and proteins. These were found mostly on the inside of gloves and were released as very small respirable particles that were not physically associated with the powder. These findings support the hypothesis that endotoxin may be responsible for some of the tissue irritation associated with latex glove use. In addition, this material may be responsible for the enhancement of delayed and immediate hypersensitivity reactions to chemicals and proteins found in these products and offers a possible explanation for the disproportionate severity of these reactions.