Work-Related Asthma in an ICU Nurse Exposed to Powdered Latex
A 41-year-old ICU nurse has 8 years of service. Over the past year she developed itching and swelling of the hands, then sneezing and a runny nose, and for the past three months chest tightness and wheeze that begin within 15–20 minutes of starting a shift and improve over days off and completely during a two-week vacation. The ICU uses powdered natural rubber latex gloves; she wears them 3–4 hours per day. Spirometry at the start of a shift shows FEV1 2.1 L (68% predicted) and FVC 3.1 L, giving an FEV1/FVC of 0.68. After four days off, FEV1 is 2.55 L, a 23% improvement. Skin prick testing is positive to latex and to banana and kiwi. She had no asthma before this employment and asks whether she must change jobs.
1. What is the diagnosis, and what evidence establishes work-relatedness?
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This is occupational asthma caused by natural rubber latex, with associated latex-fruit syndrome (banana, kiwi). Work-relatedness is supported by the temporal pattern - symptoms begin within minutes of starting a shift, improve away from work, and resolve on vacation - and by objective testing: airflow obstruction on shift-spirometry with a 23% improvement in FEV1 after time away, plus a positive latex skin prick test. The absence of asthma before employment strengthens causal attribution. Serial peak expiratory flow or serial spirometry across work and rest periods would further confirm the pattern. The diagnosis should be documented as work-related asthma, which has implications for workers' compensation, accommodation, and surveillance of co-workers.
2. What is your fitness-for-duty and accommodation recommendation?
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She should not be required to leave her job. The goal is a latex-safe work environment: replace powdered latex gloves with nitrile or other non-latex gloves, remove latex-containing supplies from her work area, and provide a latex-free kit. With these accommodations she can continue patient care. If the employer cannot create a latex-safe environment, reassignment should be a last resort after documented attempts at accommodation. She should remain under asthma management with a written action plan and rescue inhaler, and have follow-up spirometry. Under the ADA the employer must provide reasonable accommodation, and a workers' compensation claim should be filed. Document the restrictions: no powdered latex gloves and no direct latex contact.
3. What should the employer do for the worksite and for other workers?
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Eliminate powdered latex gloves, which generate airborne latex aeroallergen, and transition to powder-free low-protein latex or non-latex alternatives. Provide training on latex allergy, maintain a list of affected workers, stock latex-free kits, and post signage. Offer surveillance - symptom questionnaires and spirometry - to exposed staff, because sensitization can develop in co-workers. Under OSHA's general duty clause the employer must provide a safe workplace, and under the ADA it must accommodate affected employees. Document the interventions and re-evaluate after the glove change to confirm that airborne allergen exposure has been reduced.