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This worksheet is an aid to help you differentiate between a common skin irritation and a more serious allergy. Consult your doctor if you have concerns about your results.

Instructions
Latex products may cause reactions for healthcare professionals or patients. To help you identify a reaction, we’ve developed this self-test. Simply check the most appropriate boxes for each symptom. Leave blank symptoms that don’t apply to you.

If the Web browser you are using is JavaScript enabled, click the buttons below to add up your score; otherwise, we suggest you print this page and complete the chart manually.

Dermal Reactions
 
Symptom
Description
 
A
B
C
1) Onset of dermatitis post exposure
  Minutes to hours
  One to two days
  Minutes to one hour
2) Sensory description
  Pain, burning, stinging, discomfort, exceeding itching
  Itching first, continuing to pain as skin breaks down
  Itching, tingling
3) % reacting within affected population
  Large percent
  Small percent
  Small percent1
4) Appearance
  Redness, crusting, thickening of skin, swelling, fissures, scabbing, sores, drying, papules, peeling, blisters
  Redness, crusting, thickening of skin, swelling, papules, drying, peeling, vesicles
  Pink raised areas, hives often blanched in the center, swelling
5) Fissures or papules
  Prone to fissures
  Prone to papules rather than fissures
  No fissures or papules
6) Skin contacting product was generally:
  Glazed, parched, scalded appearance
  Dry and crusted
  Tight due to swelling, no dryness
7) Healing (unoccluded)
  Follows substance removal (0-2 weeks)
  Condition does not necessarily diminish following glove abstinence (but may within 1-2 weeks)
  Condition diminishes within hours of glove abstinence
8) History of allergies
  Most of the reactors do not have a history of allergies
  Most of the reactors have a history of allergies
  Most of the reactors have a history of allergies
9) Boundaries of the reaction
  Sharp, definite, may show border of gown cuff under glove
  Less definite demarcation
  Undefined. May be under glove or whole body
10) Tendency of spread
  No. Inflammation limited to glove contact area
  Yes. May spread beyond glove contact area, especially after repeated exposures
  Yes. May spread beyond glove contact area, especially after repeated exposures
11) Respiratory
  None
  None
  Wheezing, difficulty in breathing, runny nose
12) Facial involvement
  Possible only by contacting face with glove irritant
  None
  Swelling of eyelids, lips, face in general, tearing, itchy eyes
13) Systemic involvement
  None
  None
  Nausea, abdominal cramps, rapid heart rate, decreased blood pressure, shock
14) How acquired
  Skin contact
  Skin contact
  Skin, mucous membrane, or open wound contact; or aspiration of aerosolized allergen
  1 Except in special cases such as spina bifida patients
A: B: C:

The results indicated above can help you identify possible symptoms of common skin irritation or a more uncommon allergy.

To interpret the results, add up the number of boxes checked in each column and put the total in the box at the bottom of each column. If your Web browser is JavaScript enabled, the columns will be added up for you. Whichever column total has the highest number determines what your reaction might be (as follows):

Majority A Tends toward the determination of irritation (non-allergic reaction)
Majority B Tends toward the determination of delayed type hypersensitivity (Type IV allergic reaction)
Majority C Tends toward the determination of URTICARIA (Type I allergic reaction which may, but not necessarily, become systemic in susceptible individuals and, in some cases, be referred to as anaphylaxis)

For more information, or if you have any questions about the results of this self-test, you should consult your doctor.

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