We have been having a Facebook conversation with Lynne Saunt on a subject which has been causing her some concern – surgical gloves – and thought that it deserved a wider airing.
Lynne is a coeliac who can tolerate neither oats nor Codex Wheat Starch. (She is not alone in finding Codex problematic but that is another topic for another day.) Her concern over the gloves was sparked by a post on the Nurses.com site about Ostar oat powdered surgical gloves.
(For those for who know nothing about surgical gloves, they used to be made from latex rubber and often used latex powder inside to help them slip on and off easily. However, their increased use for hygiene purposes in the 1970s/’80s and ’90s set off a minor epidemic of latex allergy among health care professionals, patients, and among food professionals.
Sadly latex did not just give you a bit of an itch – although it also did that – but caused serious anaphylactic reactions and some deaths. Since latex rubber was present not just in surgical gloves but in everything from balloons to the rubber bungs in medicine bottles to condoms to poinsettias, this was a hugely disabling allergy.
Once it was realised what was happening, gloves were developed using alternative materials such as neoprene, nitrile and vinyl even though many practitioners still maintain that they are not as flexible or easy to work with as the latex ones. But as a result the incidence of latex allergy in the US and UK over the last ten years has significantly decreased.
(However, a brief word of warning. In the process of searching the web for a suitable picture of a surgical glove to illustrate this piece I found a sizeable number of both Indian and Chinese sites all of which were selling almost entirely latex, not latex free gloves. So, anyone who is latex allergic, take care when travelling east…)
But to return to the oat powdered gloves. Thin rubbery type gloves are difficult to pull on and off and are hot a sweaty to use. Indeed, many healthcare and food professionals who wear them all day long end up with skin problems on their hands. To try and combat this the insides of the gloves are often powdered to help them slip on and off. In the case of the oat powdered ones the makers obviously hope that using soothing powders such as colloidal oat powder may help combat skin issues for the wearers.
Lynne messaged us on Facebook because, as a coeliac who reacts to oats, she wanted to know why on earth anyone would use oat powder rather than talc – and whether it was likely to cause her any problems. We replied:
Hi Lynne – These gloves appear to be using colloidal oatmeal as an alternative to talc to make gloves easier to pull on and off.
(Talc is often avoided as the inhalation of talc can cause a lung irritation called talcosis. Talc, in its natural form, could also be carcinogenic as it contains asbestos – although all talc used domestically, in the US at least, has been asbestos free since the 1970s.)
So the powder, whatever it is, is used inside the gloves rather than outside which means that it is less likely to be in contact with coeliac patients. However…
Colloidal oatmeal is very finely ground up oatmeal, mainly used in baths to soothe dry, itchy skin. Because it is so finely ground it disperses better in the water instead of just sinking to the bottom of the bath. It is not clear from the various websites I have looked at whether the colloidal oatmeal is loose in the gloves or is in some way bound to the inside of the gloves. If it is loose it could ‘fly around’ very easily when the gloves are pulled on or off. So a small amount could be ingested by a coeliac patient being treated by a healthcare professional using oat powdered gloves.
There is very little evidence that gluten can be absorbed through the skin although if you, as a patient, are ultra sensitive it is probably wise to avoid it. If it were to affect you, it would be likely only to do so if you ingested some of the powder.
If however, you are a healthcare or food professional the situation might be slightly different. If you did have skin issues as a result of wearing gloves, and especially if the skin on your hands was broken as a part of those issues, oat or corn (see below) protein fractions might get through the skin barrier into the blood stream. This could possibly trigger an allergic/coeliac reaction of some kind.
Lynne went on to point us to the Australian Coeliac position on oats but in fact it is very similar to the UK one – it is just that they call oats from guaranteed uncontaminated sources ‘wheat free’ rather than ‘gluten free’.
(The position on oats and gluten changed some 15+ years ago following on from Finnish research in which it appeared that oat consumption had no deleterious effect on coeliacs. However, these were not longitudinal trials so there is little long term follow up. Coeliac UK’s position is that you should not consume oats if you are newly diagnosed or if you are extra sensitive – that you should never consume them to excess and that, as in Australia, you should monitor your health. A significant number of coeliacs are not able to eat oats. However, the inclusion of oats for coeliacs, especially as far as gluten free manufacturers are concerned, makes for a much more varied and interesting diet so they are widely used.)
But to return again briefly to the gloves. Lynne then further messaged us to say that she had heard that corn powder was also used in surgical gloves although she thought that these might have been banned in the US. Since a surprising number of coeliacs also react to corn, could this also be a problem?
Corn is not one of the EU’s 14 major allergens because relatively few people in Europe suffer from corn allergy – it is much more common in the US where corn products feature much more widely in the diet. (Although not one of the 14 major allergens in Europe, corn allergy very much exists and is a potentially anaphylactic allergen. It is extremely trying to live with as corn/maize very widely used in food processing and is the ‘go to’ substitute for wheat in gluten free products. For more on corn allergy see the short section on the FoodsMatter site and a further article to come soon from corn allergy sufferer, Anna Jacobs.)
Corn does not contain gliadin so theoretically it should not affect coeliacs. However, corn does contain gluten, just not gliadin. And it would appear that a significant number of coeliacs may also react to that corn gluten. See this page on the GlutenFree Society’s website for more detail.
However, as far as the gloves are concerned, the situation is similar to that with the oats. The powder will be used inside the gloves so while this could be an issue for a health/food professional using the gloves if they had skin issues on their hands, it should not be an issue for patients unless they were to ingest any of the powder which might be released from the gloves as they are pulled on or off.
NB. Please see the very helpful comment to this blog from Dr Claudia Miller in relation to multiple food intolerances and chemical exposure.