Latex Gloves and the Americans With Disabilities Act

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A medical assistant (MA) has developed an allergic reaction to the latex in her office gloves. At first, her hands were pruritic. Now she has asthmatic attacks when she gets anywhere near latex gloves. Her employer, “Dr Doe,” has purchased thousands of such gloves and refuses to buy any other kind. Their workplace relationship, over this issue, has become so strained that Dr Doe has decided to terminate her employment in his office. Can he do so?

With an increased use of gloves by all medical staff in every office, the use of latex gloves has increased to hundreds of billions of gloves. This increase, as might be expected, has caused some glove manufacturers to cut corners in their production. These shortcuts included eliminating some of the steps that had once removed certain proteins that caused skin allergies. This caused an increase in the protein and allergen content in the latex products, leading to a rise in what has now been called the “latex protein toxicity syndrome.”¹ The COVID-19 pandemic also presented an opportunity to gather data on the impact of hospital-mandated gloves, types of soap, and types of hand sanitizer on the skin, and investigators found that hospital-grade personal protective equipment and soap can disrupt the skin barrier’s function.²

The MA hands case is not unique. Similar cases have led to litigation. In 1 case, a radiology technician recovered $1 million from a manufacturer of latex gloves, including $584,000 for pain and suffering as a result of injuries caused by an allergic reaction to latex. Initially the technician experienced eczematous dermatitis only at work. Ultimately, she developed severe breathing problems from her latex hypersensitivity. She became limited in where she could go, what she could eat, and what she could do.³ Of those who have reported latex allergy, approximately 75% are health care workers. This may suggest that repetitive and continual contact with latex may lead to allergic reactions.⁴

Statistics suggest that thousands of workers die each year nationwide from work-related diseases.⁵ Latex gloves present a complicated problem in that reactions are not just cutaneous. A reaction may also occur due to proteins that become airborne when workers remove their gloves. It should be noted that health care workers who suffer from severe latex allergies are covered by the Americans with Disabilities Act (ADA). Despite this, some hospitals and physicians consider affected employees to be a liability and seek to terminate them.

Recent court cases also suggest that such work-related reactions may be considered injuries under various workers’ compensation statutes. Generally, to recover workers’ compensation benefits, a plaintiff must show by a preponderance of the evidence that the injury arose out of and in the course of employment. An injury occurs out of employment if there is a causal connection between the employment and the injury. The employee must show that the ailment resulted from the peculiar nature of the employment rather than from her particular atopic diathesis. Thus, some courts would suggest, that if Dr Doe can show that his MA had an atopic diathesis, even if the condition was aggravated by the current work situation, it is unlikely that she will be able to collect under most workers’ compensation statutes. Courts have concluded that the allergic reaction must be one that is commonly regarded as “natural to, inherent to an incident and concomitant of the work in question.”

Other courts have been inconsistent in their application of the workers’ compensation statutes. Some courts have suggested that the connection between latex gloves and injury must be expressed in probability, not mere possibility. There must be a direct connection between occupational exposure and reaction to gloves. Since there is no certainty that the MA will be able to collect money based on workers’ compensation statutes, she may wish to seek redress under the ADA. Her latex allergy would be considered as a disability under ADA. Dr Doe should consider changing her job description to one that does not involve the use of latex gloves. Alternatively, he should provide her with nonlatex gloves. If he terminates her simply because of her latex allergy, he is likely to be in violation of the ADA.

David J. Goldberg, MD, JD, is medical director of Skin Laser and Surgery Specialists of New York and New Jersey; director of cosmetic dermatology and clinical research at Schweiger Dermatology Group in New York, New York; and clinical professor of dermatology and past director of Mohs Surgery and Laser Research at the Icahn School of Medicine at Mount Sinai in New York, New York.

References

1. Nucera E, Aruanno A, Rizzi A, Centrone M. Latex allergy: current status and future perspectives. J Asthma Allergy. 2020;13:385-398. Published 2020 Sep 28. doi:10.2147/JAA.S242058

2. Montero-Vilchez T, Martinez-Lopez A, Cuenca-Barrales C, et al. Assessment of hand hygiene strategies on skin barrier function during COVID-19 pandemic: a randomized clinical trial. Contact Dermatitis. 2022;86(4):276-285. doi:10.1111/cod.14034

3. Green v Smith Nephew AHP Inc. (Wisc Super Ct 2001). Accessed June 6, 2024. https://caselaw.findlaw.com/court/wi-supreme-court/1372300.html.

4. Ngamchokwathana C, Chaiear N. Latex anaphylaxis in healthcare worker and the occupational health management perspective: a case report. SAGE Open Med Case Rep. 2023;11:2050313X231179303. doi:10.1177/2050313X231179303

5. IIF Home. U.S. Bureau of Labor Statistics. December 19, 2023. Accessed June 11, 2024. https://www.bls.gov/iif/home.htm