Response

To the Editor: The following is our response to the comments and concerns of the authors of the letter regarding our study. Allergy Guard (VSP Technologies, Inc., Ossining, NY) is not just a barrier cream although its barrier capabilities are significantly better than those of other protective creams we tested (see the results in Table 3 of our article). Furthermore, Allergy Guard containing zinc showed a significant reduction in sodium lauryl sulfate-induced skin irritation in volunteers. Zinc salts have been shown to have antiinflammatory and antiirritant properties and have been reported to inhibit the release of specialized T lymphocytes expressed in allergic reactions.1-4 The zinc salts in Allergy Guard appear to bind the proteins and other chemicals present in natural rubber latex (NRL) gloves, and this presumably leads to lower skin reactions. The results shown in Table 2 of the article show reduced concentration of protein in Allergy Guard-treated gloves when tested by the ultraviolet (UV) absorption method. We agree with the authors that this method may not give absolute protein levels. The protein extract may have some UV-absorbing contaminants such as mercaptobenzothiazoles from the glove. However, the lower concentration of UV-absorbing materials in the Allergy Guard-treated gloves indicate that the zinc salts in Allergy Guard may interact and precipitate the proteins and other chemicals in the latex glove. Regarding specific criticisms in the letter, we have the following comments. Our study does not suggest that the use of Allergy Guard can reduce symptomatic reactions of a type I NRL protein hypersensitivity. In fact, we did caution that Allergy Guard is not indicated for use as a prophylactic agent against immediate type I hypersensitivity (see “Conclusions” in our article). We do not agree with the authors that there is misrepresentation of reactions to NRL throughout the paper. We do recognize the complexity of reactions to NRL products. In the introduction and discussion sections of our paper, we referred to other published reports that suggest that type IV reactions are mainly due to chemicals used in the manufacturing of gloves, in addition to the components in raw latex.5-9 In response to the comment that we have trivialized glove-related contact dermatitis, we would like to reiterate the complete statement in the introduction of our article, which is as follows: “Type IV hypersensitivity is not usually a serious condition since it resolves when the person stops wearing the gloves. However, there have been reports of anaphylactic reactions to latex in persons who previously had experienced only contact dermatitis.”8 The importance of preventing type IV contact dermatitis is again stated in the second paragraph of the introduction. The volunteers selected in this study were health care workers who exhibited delayed type IV reactions after the use of latex gloves, due to the presence of processing chemicals or proteins. These volunteers were using vinyl gloves in spite of the disadvantages of using these gloves. The problems of using vinyl gloves are inflexibility and permeability to fluids and infectious organisms.10,11 One study reported that 63% of vinyl gloves (as against 7% of latex gloves) leaked after users repeatedly attached and removed syringe needles.12 Vinyl gloves also contain chemicals that can cause contact dermatitis.13 Some health care workers who used latex gloves on a regular basis at least once a day exhibited contact dermatitis and continued to use gloves but remained symptomatic.14,15 Allergy Guard is recommended for use as a prophylactic cream for individuals who exhibit mild contact dermatitis after wearing latex gloves but do not wish to use alternative glove materials or by health care workers to delay the initial onset of contact dermatitis from repeated exposure to latex glove irritants and allergens.

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