When I began my tattoo career in 1984 I was immediately instructed in the concept of the sterile field, and the many ways that a tattoo artist must maintain constant vigilance in their working environment. My mentor Cliff Raven was ahead of his time in his awareness of medical concepts, and as a result wearing gloves has always been a part of my tattoo experience. It is important to note how recently they have become a part of tattooing, and how ubiquitous their presence is now.

After five years or so I started to notice that I would get a rash on the back of my hands if I used gloves for long hours in hot weather. This is called a contact dermatitis, caused by direct contact with a substance. These little bumps are called comedomes, and if scratched at they become tiny open sores, perfect portals for entry of virus. When I learned that the vaseline commonly used to maintain the stencil on the skin is capable of breaking down the latex, causing it to become porus (why they advise NOT to use petroleum products with latex condoms) I started changing them every twenty minutes and making sure I let my hands cool off in between.

Eventually I started hearing rumours of latex allergy, which I learned was caused by the powder in the gloves. It acts as an abrasive substance, wearing down the skin surface, the epidermal layer, inviting the allergy-causing latex proteins to enter into the body. So at a cost almost double that of powdered gloves I switched to powder-free latex, marketed for the electronics clean-room industry. Things were fine for the next decade or so, no rashes, except I did notice that I coughed when I ate kiwi fruit, said to be an indicator of increasing sensitivity to latex. I figured, ok, how often do I eat kiwi?

Then in February 2002 I worked at the Mad Hatter's Tea Party in Portland, Maine, one of my favorite conventions. It was a very intense three day event in a room full of artists and fans, and immediately afterwards I developed a wierd barking cough. At the time I thought it was some sort of virus or fungus I'd caught on the plane flight in, and laughed with my friends about how the airlines never change the filters in the planes and we are all lucky not to get Legionnaire's Disease when we fly.

But the cough didn't go away, and it developed into something that felt like asthma. I was running on reduced oxygen, feeling like I was pre-pneumonial, and very tired all the time.

Then one day it hit me: maybe I had developed a latex allergy? I went to my Macintosh and spent the next three nights reading many of the over one thousand websites devoted to and discussing latex allergy. What I found out scared me a lot, and I am writing this article not as a medical expert but as a person who is immediately affected, to warn the rest of the profession that this problem is waiting to affect all of us.

My theory is that working in that room, where most of the artists were using powdered gloves, pushed me over a toxicity limit and caused me to develop a greater sensitivity to latex than I had previously.

On one website I saw a photograph of a powdered glove being taken off, and the lighting is arranged to show the three-feet-across cloud of powder filling the air around it. It is barely visible to us under normal circumstances, but it is a real problem. The proteins in the latex have bonded to the powder in the gloves, and once they are airborne they go into the lungs. This is how the allergic reaction develops. Once enough of this protein-bonded powder gets breathed in, it causes the body to develop immunities and the response is like asthma or a hayfever allergy.

Originally the gloves were powdered with talc, but in 1988 this was switched to corn starch which caused fewer cases of contact dermatitis. Now many are switching to oat powder, said to dry out the skin less and bind less to the proteins. Most manufacturers offer all their gloves in powdered and unpowdered forms.

The powder is the vehicle for transferrance for the proteins, and the rate at which this happens can vary greatly between suppliers or even between batches from the same supplier. Unpowdered gloves go through a chlorine wash that should lower the level of concentration of the proteins on the surface by rinsing them away.

But it doesn't stop with itchy dry skin and asthma. If exposure to the allergin continues, the reaction becomes more severe. It progresses from simple irritant contact dermatitis, to allergic contact dermatitis, to full latex allergy.

There are several of the websites I read that are dedicated to the memory of doctors and nurses who have dropped dead of heart attacks or anaphylactic shock because of this. Many medical professionals have had to leave their chosen careers because of it, and now cannot even enter a hospital. Many wear Medic-Alert bracelets warning of latex allergy, because if emergency treatment is given (say, after a car crash) with a latex tube for intravenous fluids, they will go into shock and die.

Scared yet?

How about not being able to ever again wear sneakers, or touch a rubber band. The average home or workplace is filled with things made from natural rubber latex, a fascinating substance whose discovery led to a host of products making use of the unique qualities of this natural polymer, a chain of molecules that can be stretched out and then retain its shape.

No more latex condoms! Now you can see this can get serious. Working around latex once you have the allergy could have disastrous consequences, and latex-free living could get very confining. No elastic in underwear! No pencil erasers. Let your imagination run a bit.

Fortunately there is a way to use an alternative product in the tattoo studio, and I am very pleased to say that within a week of converting my shop over to Nitrile gloves all my symptoms are gone. My employee at the time had been experiencing mild problems breathing and chest constriction for years, but hadn't ever thought it was work-related or if it was he figured it was no big deal. In his other life his rock band often played in smoke-filled bars, and he'd considered any wheeziness an unavoidable side-effect of a rock-and-roll lifestyle. He also noticed the difference as soon as we switched to Nitrile, those symptoms are gone.

Nitrile butadiene rubber, a completely synthetic polymer that mimics natural rubber, was developed many years ago; but until 2003 a patent made it the closely held product of only one supplier. The cost was prohibitive, and as a result few artists experimented with it. Nitrile gloves are commonly blue or white, but recently have become available in deep purple and black. You may have seen a trendy few at conventions wearing them and wondered if this was a fashion preference. I predict they are going to be an important assist in the preservation of many careers that could otherwise be cut short.

I emailed all forty companies I could find on the web who listed themselves as suppliers of Nitrile. I asked them all for samples. Nine replied, and the result of my small bit of consumer testing was that I stayed with the same glove distributor I had been buying from.

Of the few who did send samples, not all of them were identified as medical quality. Beware what may seem like a good price on nitrile, because if the glove is not clearly marked for EXAM use it may be industrial or food industry grade and NOT have the FDA class one medical device 510K status. No gloves are actually "approved" by the FDA, but to be labeled exam quality they must pass more stringent quality control testing.

I ended up buying a case from my usual glove supplier, who was also so good as to accept back for trade-in my two cases of powder-free latex I had in backstock at the studio. He is very knowledgeable about the glove industry, a world-wide trading frenzy that involves Malaysian and Indonesian raw materials and production coordinated with international supply routes. In conversations with him I sorted through all that I was reading on the websites and got a deeper understanding of the problem.

Since the advent of AIDS and the several hepatitis strains the worldwide demand for latex gloves has skyrocketed, and not all the factories overseas keep to the medical-grade standards of production that are crucially necessary. If they do not rinse the latex gloves thoroughly there are more proteins left on the surface, and these possibly cheaper gloves will bring on an allergic reaction quicker. If they use a cheaper grade of powder, ditto.

It is these same companies that are now going into the business of producing Nitrile gloves. They have the factories in place, the technology is similar, and most importantly they have the international distribution routes in place. The gloves are brought in from Malaysia or Indonesia in containers on cargo ships, and hopefully they are inside the ship as it makes the forty day journey across hot tropical seas. If the container is on the top deck, a whole side of cases of gloves can be damaged, where they were overheated in transport. The mystery of why some batches of gloves break easily or stick together is solved.

It is quoted on numerous websites that twelve to eighteen percent of the medical personnel in America are now experiencing some form of latex allergy. A current flyer from the Center for Disease Control and the US Dept. of Health and Human Services warns: "Workers exposed to latex gloves and other products containing natural rubber latex may develop allergic reactions such as skin rashes; hives; nasal, eye, or sinus symptoms; asthma; and (rarely) shock."

Johns Hopkins University teaching medical center became the first hospital to go latex-glove-free. They cannot go completely latex-free, that would require doctors and nurses to give up elastic in their underwear and shoes, but it is a start. Some patients, such as those with spinal bifida and certain auto-immune diseases, develop severe reactions to latex. Ask any nurse or doctor, they will tell you personal stories of co-workers and patients affected.

Another synthesized protein-free glove does exist, vinyl stretch elastomer, polyvinyl chloride, or poly-ethelyne gloves. These are the 1.0 mil thick sandwich-bag type gloves used in food handling. They are non-conforming to the hand, not safe for use around blood, offer no tactile sensitivity, and are not at all an adequate alternative. Also PVC plastic contains DEHP, a probable carcinogen, and is being withdrawn from medical applications. I got samples of vinyl labeled exam quality but the fit was way too floppy and totally inadequate for use around blood.

Tattoo artists are now competing for supply with many others who have non-medical applications for barrier gloves, such as automobile garage mechanics and food service workers who are increasingly being encouraged or required to glove up. All these new customers are putting a real strain on the world supply of gloves, and many new companies are entering the marketplace, often with substandard product. It is vital that tattoo artists remember that for their safety any glove much be rated for medical use, not industrial.

For me, I feel extremely lucky to have had the flash of inspiration to self-diagnose this in time, and also that the cost of Nitrile gloves has dropped now to a manageable amount, not much more than latex. I consider it a small extra price to pay to continue in the occupation I love. But I did become hesitant about working any more conventions, worried that I might risk another major sensitising event. I want to do everything I can to not get any more allergic. When I do work at an expo I have found ways to make accomodations, such as asking for a booth space near the front door, for instance, so I am in a stream of fresh air, not in a cloud of latex dust.

Much as I don't want to make myself into the poster child for this problem, informing my fellow tattoo artists of this very real threat to their continued ability to remain within this industry is very important to me. If this article saves a few people some illness and allows them to continue their work, I've done my bit.