Allergenic Ingredients in Health Care Hand Sanitizers in the United States

Abstract

Background: Health care workers with occupational contact dermatitis often attribute their symptoms to frequent use of alcohol-based hand sanitizers. However, ingredient lists are difficult to obtain, and safe alternatives typically must accommodate brands utilized by a particular hospital system.Objective: The aims of this study were to investigate allergenic ingredients present within health care hand sanitizers and to provide a comprehensive product list to assist with allergen avoidance.Methods: Five major hospitals in Minnesota and 20 hospitals across the United States were called to obtain a product list. The National Library of Medicine's DailyMed Web site was searched to retrieve ingredients. Ingredients were compared with the American Contact Dermatitis Society 2017 Core Allergen Series and cross-reactors.Results: The most common brands included Purell, Ecolab, DebMed, and Avagard. Active ingredients consisted of ethyl alcohol (85.0%), benzalkonium chloride (8.8%), or isopropyl alcohol (2.5%). Top 5 allergens included tocopherol (51.3%), fragrance (40.0%), propylene glycol (27.5%), benzoates (25.0%), and cetyl stearyl alcohol (12.5%). Four sanitizers were free of all American Contact Dermatitis Society allergens; 15 products contained only tocopherol or propylene glycol as allergens.Conclusions: We identified 19 low-allergen hand sanitizers within the most common brands utilized by US hospital systems. This product list will be useful for patients and health care workers seeking allergen avoidance.

Alcohol-Based Hand Sanitizers in COVID-19 Prevention: A Multidimensional Perspective

“…Tocopherol, fragrances, propylene glycol, benzoate, and cetyl stearyl alcohol have been reported as common potential allergens in ABHS used in the United States [ 82 ]. Fragrances in particular are a frequent cause of contact allergies in personal care products [ 83 ].…”

“…While some fragrance compounds may themselves be weak sensitizers, the oxidation of parent compounds may result in the generation of potent allergens [ 84 ]. ABHS users with specific allergen sensitivities are advised to review ABHS product ingredient lists and use low-allergen sanitizers [ 82 ].…”

What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic?

“…A study conducted evaluating the ingredients of 100 hand cleansers and disinfectants commercially available in the USA found propylene glycol to be present in approximately 15% of waterless skin soaps, 33% of water-needed skin soaps, and just under 40% of surgical scrubs [35]. In a similar study assessing allergenic ingredients in hand sanitizers used across five major Minnesota hospitals and 20 hospitals across the USA, propylene glycol was listed as an ingredient in 22/80, or 27.5% of the products [36]. Schlarbaum and Hylwa found the prevalence of propylene glycol among 267 operating room scrubs and disinfectants to be 6.7% [37].…”

“…Studies suggest a wide array of allergens may be present in medical hand cleaners [35,36]. Quaternary ammonium compounds, a group which includes benzalkonium chloride, were the most common active ingredients in over 200 EPAregistered disinfectants approved for SARS-CoV-2 [107,108].…”

Alcohol-Based Hand Sanitizers – A Multidimensional Perspective

“…Tocopherol, fragrances, propylene glycol, benzoates, and cetyl stearyl alcohol have been reported as common potential allergens in ABHS used in the United States [74]. Fragrances in particular are a frequent cause of contact allergies in personal care products [75].…”