Quaternary ammonium compounds and occupational asthma.
OBJECTIVE
Quaternary ammonium compounds, among which benzalkonium chloride is one of the best-known, are commonly used as antiseptics, disinfectants, detergents and preservatives. They can cause occupational asthma, which however, has been rarely reported so far, despite wide use of these products. We report three such cases. Possible mechanisms causing asthma are discussed, taking into account their characteristics.


RESULTS
Our patients, all female nurses, manifested asthma symptoms upon handling disinfectant solutions containing benzalkonium chloride. Work-related fall in PEFR was observed in all of them. The diagnosis was confirmed by challenge tests where the patients were exposed, in a closed chamber, to suspected disinfectant contained in a tray. All of the women developed early or delayed symptoms upon exposure. Similar challenge tests to placebo or other disinfectants devoid of quaternary ammonium compound were negative.


CONCLUSIONS
These three cases, in addition to others reported in the literature, point out an as yet poorly known etiology of occupational asthma to quaternary ammonium compounds in hospital employees. The exact mechanism of the action remains unexplained.
Purohit
A
A
Service de Pneumologie, Hôpital Lyautey, Hôpitaux Universitaires de Strasbourg, France.
Kopferschmitt-Kubler
M C
MC
Moreau
C
C
Popin
E
E
Blaumeiser
M
M
Pauli
G
G
D000328:Adult; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D001249:Asthma / Q000209:etiology*; D001548:Benzalkonium Compounds / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D016273:Occupational Exposure; D000644:Quaternary Ammonium Compounds / Q000009:adverse effects*
D000891:Anti-Infective Agents, Local; D001548:Benzalkonium Compounds; D000644:Quaternary Ammonium Compounds