Benzalkonium Chloride

Wentworth, Ashley B.; Yiannias, James A.; Davis, Mark D.P.; Killian, Jill M.

doi:10.1097/der.0000000000000160

Cited by 45 publications

(12 citation statements)

References 33 publications

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“…12,13 Although also reported as a common irritant, 5 BAK has controversial classification as a true allergen. 14,15 Studies have estimated the rate of allergenicity between 5.5% and 8.8%, 12 although many false-positives have been reported. 11 In 2009, a case of anaphylaxis after the use of eye drops with BAK was reported.…”

Section: Responsible Allergens Benzalkonium Chloridementioning

confidence: 99%

Prevalence of Contact Allergens in Best-Selling Ophthalmic Products

Yeung²,

Feld³

2020

Dermatitis

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BackgroundOphthalmic products are a common but often overlooked contributor to allergic contact dermatitis. Frequency of allergenic ingredients in over-the-counter ophthalmic products has not been well characterized.ObjectiveThe purpose of this study was to determine the prevalence of allergenic ingredients in most commonly bought eye lubricants and contact lens solutions.MethodsA product list of Amazon.com's best-selling ophthalmic products was curated by searching for “Best Sellers in Eye Drops, Lubricants & Washes” and “Best Sellers in Contact Lens Care Products.” For exploratory analysis, indication, price, consumer ratings, number of reviews, and US Food and Drug Administration approval status were recorded. The products' ingredients were compiled using NLM DailyMed, and products that had 1 or more allergens or relevant cross-reactors on either the 2018 American Contact Dermatitis Society Core Allergen Series or the 2015–2016 North American Contact Dermatitis Group Standard Allergen Series were noted.ResultsForty-eight percent (n = 49) of the total products, (57.8% [n = 37] of eye lubricants, and 31.6% [n = 12] of contact lens solutions) had 1 or more allergens or associated cross-reactors. Identified allergens were benzalkonium chloride, propylene glycol, sorbic acid, amidoamine, sorbitan sesquioleate, chlorhexidine digluconate, lanolin alcohol, parabens, benzyl alcohol, and butylated hydroxytoluene.ConclusionsAwareness of potential allergens is crucial to diagnosing allergic contact dermatitis to ophthalmic products and helping patients navigate online pharmacological chaos.

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Section: Responsible Allergens Benzalkonium Chloridementioning

confidence: 99%

Prevalence of Contact Allergens in Best-Selling Ophthalmic Products

Yeung²,

Feld³

2020

Dermatitis

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“…Of active ingredients with allergenic potential, contact allergy to alcohols themselves is exceedingly rare 9 . Benzalkonium chloride has previously been considered largely irritant in nature with low sensitization potential; however, studies are increasingly documenting its allergenicity 16–18 . Kadivar and Belsito 19 demonstrated that HCWs were significantly more likely to develop relevant allergic reactions to benzalkonium chloride than non-HCWs.…”

Section: Discussionmentioning

confidence: 99%

“…9 Benzalkonium chloride has previously been considered largely irritant in nature with low sensitization potential; however, studies are increasingly documenting its allergenicity. [16][17][18] Kadivar and Belsito 19 demonstrated that HCWs were significantly more likely to develop relevant allergic reactions to benzalkonium chloride than non-HCWs. Similarly, Warshaw et al 20 found significantly higher rates of allergy to chloroxylenol among HCWs (0.96% of HCWs with patient contact and 0.88% of HCWs without patient contact) as compared with non-HCWs (0.07%).…”

Section: Active Ingredientsmentioning

confidence: 99%

Allergenic Ingredients in Health Care Hand Sanitizers in the United States

2021

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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.

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“…In at least 3 (43%) of the 7 cases, the cleaning wipe/spray was quaternary ammonium compound based. Quaternary ammonium compounds, such as alkyl dimethyl benzyl ammonium chloride (benzalkonium chloride) and alkyl dimethyl benzyl ammonium saccharinate, are common disinfectants with broad antibacterial, antiviral, and antifungal effects, known to cause predominantly not only ICD but also allergic contact dermatitis 2,3 . Only 1 patient (patient 7) was patch tested and was negative to the North American Contact Dermatitis Research Group Series, which includes benzalkonium chloride, 0.1% in petrolatum.…”

Section: Discussionmentioning

confidence: 99%

“Desktop Dermatitis”: A Case Series of 7 Patients with Forearm Contact Dermatitis from Frequent Surface Cleaning

Hamann

Duprat²,

Dagrosa³

et al. 2021

Dermatitis

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milii-related ICD has not been described before, it may induce keratoconjunctivitis causing burning pain, photophobia, lacrimation, and even decreased visual acuity. 4 Although one study testing sap or herb extracts from 60 different species in the Euphorbia genus on mice ears for the irritant effects concluded that 7 species including E. milii failed to produce irritation, the phorbol esters (one of the contents in croton oil), milliamines, euphorbol, and euphorbin in the sap were actually irritants to human skin. 1,5 Weber et al 3 suggested that Euphorbia sap-induced dermatitis is the result of a complex of cytopathogenic and proinflammatory effects. The direct pH-induced cytotoxicity of phorbol esters may induce corrosive effect leading to keratinocytes necrosis, whereas ingenol mebutate may cause recruitment of immune cells and augment the irritant reaction. 3 This report highlights the first case of ICD caused by E. milii with an atypical presentation as purpuric patches and provides an explanation of possible underlying pathophysiologic mechanisms. ZEBRAThe sap of E. milii is a potential source of ICD, and protective measures are necessary during handling these ornamental plants. ACKNOWLEDGMENTThe patient in this article has given written informed consent to publication of case details.

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Benzalkonium Chloride

Cited by 45 publications

References 33 publications

Prevalence of Contact Allergens in Best-Selling Ophthalmic Products

Prevalence of Contact Allergens in Best-Selling Ophthalmic Products

Allergenic Ingredients in Health Care Hand Sanitizers in the United States

“Desktop Dermatitis”: A Case Series of 7 Patients with Forearm Contact Dermatitis from Frequent Surface Cleaning

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