Drs. Sussman and Beezhold [1] reviewed the increasing problems associated with natural rubber latex allergy and the roles played by latex gloves but did not address the option of simply shifting from natural rubber latex gloves to medically and economically acceptable nonlatex gloves.

Although extensive precautions are now available to patients known to be allergic to latex [1], a significant number of health care workers and persons in the general population have an unrecognized latex allergy [1].

Some powder-free latex gloves are designated "hypoallergenic," implying that the risk for anaphylaxis or other serious allergic reactions may be greatly reduced or eliminated. Recent studies [2, 3] indicate that use of powder-free latex gloves can significantly reduce airborne latex antigen levels. The cornstarch powder used in some gloves is known to increase the bioavailability of latex antigens. In vitro studies indicate that powder-free gloves release less latex antigen [4]; however, no data indicate that substituting powder-free latex gloves is safe for routine use by or on latex-allergic health care workers or patients. Percutaneous, respiratory, or mucous membrane exposure to latex antigens can elicit allergic reactions, and each may represent a route of sensitization. Persons who already express IgE may sustain or increase their sensitivity with continued exposure to even powder-free latex gloves.

We have observed some latex-allergic health care workers who developed contact urticaria after donning powder-free latex gloves. As a consequence, we have begun to study the antigens elutable from "hypoallergenic" powder-free latex gloves. Aqueous extracts were made (1 g of glove fragments in 10 mL of water for 20 hours, 1:10 weight in volume) of four brands of such gloves. Duplicate percutaneous skin tests were done on four adult volunteers allergic to latex. Powder-free glove extracts elicited positive wheal and flare reactions (average wheal diameter, >3.5 mm) to all four extracts in one or more test participants. Controls showed no reaction. In confirmation of previously reported in vitro radioallergosorbent test inhibition data [4], our data indicate that clinically significant amounts of latex antigens can elute from "hypoallergenic," powder-free latex gloves.

Clearly, the latex gloves currently in widespread use pose an immunologic hazard to an increasing number of patients and health care workers [1-4]. The data indicate to us that little justification exists for the continued use of powdered latex gloves. Until data are available to assure the safety of modified latex gloves, serious consideration should be given to the routine use of nonlatex gloves.