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Laying Off Latex

by Sheila Smith Noonan

Dr. Ellen Patterson ('92) wouldn't dream of working on patients without protective gloves. But natural rubber latex gloves, the type most dentists use, are her nightmare.

Like a growing number of people, many of them healthcare professionals, Dr. Patterson is allergic to latex. Her reactions are so severe that in April 1996 she opened a "latex-safe" practice in Fair Haven, N.J. It was either that, she says, or stop practicing dentistry.

The first hint of this career-threatening problem surfaced when Dr. Patterson was working as a dental assistant while an undergraduate at Rutgers College. That's when she first noticed a rash on her hands. "I thought nothing of it," she says. "Like everyone else, I assumed it was the powder in the gloves, and tried different brands." By chance, she found that vinyl gloves weren't as irritating, but she didn't make an all-out effort to avoid latex.

During dental school, a troubling problem reemerged for Dr. Patterson. She had asthma as a child, but went without an attack for many years; in fact, she ran cross-country in high school and enjoyed running. Now the asthma was back, and Dr. Patterson was using her inhaler every hour, much more frequently than the recommended one-to-four hours. She avoided latex gloves while a dental student, but in retrospect, Dr. Patterson believes the airborne latex dust from her classmates' gloves triggered the asthma.

Dr. Patterson's most serious latex reaction came during her residency at Robert Wood Johnson University Hospital. As she prepared to assist oral surgeons with a procedure, she took a pair of gloves that the package label claimed was "for hands allergic to latex," and gowned up. "Soon after, I didn't understand why my hands itched or why I was sneezing into my mask," she says. "I went to a non-sterile area, took off the gloves and found my hands had swollen twice their size. I tried to go unnoticed, but the anesthesiologist asked what was wrong, and I told him I had latex allergies."

By now, Dr. Patterson's throat was closing off, and she was going into anaphylactic shock. The anesthesiologist administered epinephrine, Benadryl®, and steroids. When doctors measured her oxygen saturation level, it was worse than the original patient's by six points.

After her residency, Dr. Patterson became an associate at one of the offices where she had been a dental assistant. Healthwise, she was not doing well. "Five minutes after I came into the office, I would have an asthmatic reaction," she says. "I used my inhaler every hour and took antihistamines so I could work."

Dr. Patterson knew she needed to avoid latex, but it wasn't until attending a national support group, Education for Latex Allergy Support Team and Information Coalition, or Elastic, that she realized how others' use of the product affected her through the airborne particles. So she asked her employer to adapt their office to be as latex-safe as possible. He bought a filtration unit, which helped somewhat, and partly converted to non-latex gloves. But sometimes latex gloves were used, and Dr. Patterson's problems continued.

After not working one Friday, she came into the office Saturday and used the computer. "I must have brushed my hair from my eyes, because within minutes both of my eyes were completely swelled shut. I gave myself epinephrine, but appointments still were canceled," recalls Dr. Patterson. With latex, there's a phenomenon known as touch transfer, where the dust settles everywhere. The other dentist must have been wearing latex gloves, she believes, took them off and then used the computer, inadvertently contaminating it.

At that point, Dr. Patterson says she "had a lot of soul searching to do." In late 1995 she left the practice and had to decide whether to quit dentistry, start a new practice, or purchase an existing one. She chose the latter, and because the previous dentist used latex, had the office thoroughly cleaned before opening her doors in April 1996.

Dr. Patterson describes her office as latex safe instead of latex free because she says it's impossible to claim all of the product is eliminated. There is latex tubing in some of the office's larger equipment, and the diaphragm under her computer keyboard is made of natural rubber latex. Still, she uses plastic syringes and purchases local anesthetic in individual glass ampules. Her gloves are either nitrile, which she prefers and uses most often, or vinyl. Nitrile offers better puncture-resistance than latex and is not worn down by glutaraldehyde, she says. Many studies have faulted vinyl for its tearing, but Dr. Patterson says its use, for her, is procedure-dependent. "When I wear vinyl gloves for 10 to 20 minutes, I feel I'm afforded the protection I'm looking for," she says. As for tactile sensitivity, Dr. Patterson says nitrile and vinyl perform as well for her as latex.

About 10 percent of Dr. Patterson's patients are allergic to latex. Many have either delayed dental care because of their allergies or asked dentists not to wear latex gloves and been refused. Latex-safe dental offices are so difficult to find, one of Dr. Patterson's patients comes from Boston for treatment.

Dr. Patterson believes all dentists should, at the least, switch to non-powdered latex gloves. (The cornstarch powder binds with protein in latex, then carries it into the air.) It's to their benefit as well as patients', she says, because the more a person uses latex, the more likely he or she will develop allergic reactions. She tells of a Connecticut dentist who practiced for 25 years, walked into his office one day and had difficulty breathing. Tests showed he had become allergic to latex; subsequently, because of his poor health, he gave up his practice.

"Unfortunately, I don't think many dentists understand the airborne component of latex allergies," says Dr. Patterson. "Their resistance to latex-safe offices isn't from lack of compassion. They just don't grasp the full effects of latex allergies. However, I'm hopeful dentistry will come through on this important matter. Dentists are traditionally prevention oriented, and this is a very prevention-oriented issue."

Dr. Patterson's health has improved since she opened her latex-safe office, although she still has to avoid latex products in all aspects of her life. Balloons are taboo ("I see balloons as some people view guns-extremely dangerous"), and she phones restaurants ahead to find out whether food preparation workers use latex gloves.

Professionally, Dr. Patterson is coming into her own. There were many times, she admits, when she felt like walking away from dentistry. But when she treats patients with latex allergies, it's as though she has answered a calling. "I know how lucky I am to be healthy and practicing dentistry," she says. "After I treat someone with this allergy, I know it's what I need to do."