[Criteria for choice and purchase of gloves: quality or cheapness? The role of the Occupational Health Physician]. / Criteri per l'acquisto e la scelta dei guanti: qualità o economicità? II ruolo del medico competente.

BACKGROUND: The choice of gloves in the healthcare settings is very important because of the high biological and chemical risks present in these workplaces. In order to rationalize and optimize this choice we must balance cost, quality, security and comfort. OBJECTIVES: The aim of this study was to analyse the rules in force and to point out the relevant role of the Occupational Health Physician in the right choice and purchase of sanitary gloves. METHODS: We reviewed the rules in force and the most relevant studies on these topics. RESULTS AND CONCLUSIONS: The regulations in force provide that the manufacturers must perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results are reported in the technical sheets. Thus the manufacturers have only to declare to be "in accordance with the rules". Therefore purchasers should require the manufacturing companies to give detailed information and verify their reliability. Moreover rules could be adapted to higher quality standards. The Occupational Health Physician should suggest the purchase of gloves with high biocompatibility, assuring the protection from the risks of specific tasks and suitable for preventing the onset of new glove-related diseases and the relapses in workers with already diagnosed occupational diseases.

[Consensus Document. Update on latex exposure and use of gloves in Italian health care settings]. / Documento di Consenso. Aggiornamenti in tema di esposizione a latice e impiego di guanti in ambito sanitario.

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.

[Occupational allergic IgE-mediated disease from Boletus edulis: case report]. / Patologia allergica IgE-mediata di origine professionale da Boletus edulis: descrizione di un caso clinico.

BACKGROUND: Fungal components can cause allergic symptoms either through inhalation, ingestion or contact. Allergic disease from occupational exposure to Boletus edulis (BE) has only seldom been reported. OBJECTIVES: Report on a female worker who developed respiratory and skin symptoms from occupational exposure to BE in selecting and packing dried mushrooms. She never had symptoms after eating mushrooms. METHODS: An environmental study was performed by personal air samplings and settled dust collection. The RAST-inhibition procedure was used to detect BE allergen potency in collected dust. The subject underwent clinical evaluation, spirometry, skin prick-tests, RAST methacoline and specific inhalation challenge with BE extract. A follow-up study was made 2, 4 and 8 months after the first evaluation and after cessation of exposure. RESULTS: BE allergens were found in the settled dust. Clinical examination showed eczema on the face and hands. The worker had hyper-eosinophilia, bronchial hyper-responsiveness to methacoline, no allergy to common inhalants and foods, positive prick-test and RAST for BE. The specific inhalation challenge induced broncho-constriction. At follow-up we observed a progressive clinical and functional improvement. CONCLUSIONS: Our data show that BE can induce cutaneous and respiratory symptoms from occupational exposure to dried mushroom dusts. The pathogenesis is an IgE-allergy. Our patient had no symptoms from ingestion, which supports the hypothesis that respiratory allergy is due to mushroom antigens that differ from those involved in food-related allergic reactions.