title: 754 exposures to reed diffusers reported to the United Kingdom National Poisons Information Service 2010-2014.
abstract: OBJECTIVE
  The objective of this study is to review the reported toxicity of reed diffuser fragrance liquid which, in addition to essential oils, commonly contains glycol ethers but other ingredients and/or alternatives are 3-methoxy-3-methyl-1-butanol, petroleum distillates, ethanol and isopropanol.
  
  
  METHODS
  We analysed retrospectively enquiries to the United Kingdom National Poisons Information Service between 1 January 2010 and 31 December 2014.
  
  
  RESULTS
  754 patients were exposed to reed diffusers; the majority (n = 712) were children < 5 years. Ingestion was the most common route of exposure (706 of 754 patients) and involved the liquid alone (n = 570), water beads alone (n = 84), sucking on the reeds (n = 31) or ingesting the liquid and water beads (n = 21). The reported amount of fragrance liquid ingested was known in only 76 of 591 cases (12.9%), with a median (IQR) volume of 20.0 (IQR = 10-40) mL. The WHO/IPCS/EC/EAPCCT Poisoning Severity Score (PSS) was known in 702 of 706 sole ingestions: in 574 (81.3%), the PSS was 0 (asymptomatic); in 117 (16.6%) patients, the PSS was 1 (minor toxicity); in 11 (1.6%), the PSS was 2 (moderate toxicity); there were no patients with features graded PSS 3 (severe toxicity). Significantly (p = 0.008) more patients became symptomatic (PSS 1 and PSS 2) following the ingestion of a reed diffuser containing 3-methoxy-3-methyl-1-butanol than propylene glycol monobutyl ether, though there was no significant difference when compared with those containing dipropylene glycol monomethyl ether (p = 0.181). The most common features following ingestion of fragrance liquid were nausea and vomiting (n = 53), coughing (n = 17) and CNS depression (n = 9). Seven patients suffered eye exposure alone: two developed eye pain and four conjunctivitis. Dermal exposure alone was reported in six patients, two of whom developed skin irritation.
  
  
  CONCLUSIONS
  The majority of patients in our study developed no features or only minor symptoms following ingestion of reed diffuser fragrance liquid.
authors.affiliation: a NPIS (Birmingham Unit), City Hospital , Birmingham , UK ;
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Panchal
authors.affiliation: b NPIS (Edinburgh Unit), Royal Infirmary , Edinburgh , UK ;
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.affiliation: c NPIS (Newcastle Unit), Regional Drug and Therapeutics Centre , Newcastle , UK ;
authors.forename: Simon H L
authors.initials: SH
authors.lastname: Thomas
authors.affiliation: d NPIS (Cardiff Unit), University Hospital Llandough , Cardiff , UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Thompson
authors.affiliation: a NPIS (Birmingham Unit), City Hospital , Birmingham , UK ;
authors.forename: J Allister
authors.initials: JA
authors.lastname: Vale
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005123:Eye / Q000187:drug effects; D006801:Humans; D007223:Infant; D008875:Middle Aged; D010476:Perfume / Q000506:poisoning*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects; D013997:Time Factors; D006113:United Kingdom
chemical_list: D010476:Perfume
keywords: 3-methoxy-3-methyl-1-butanol; Dipropylene glycol methyl ether acetate; dipropylene glycol monomethyl ether; dipropylene glycol n-butyl ether; ethanol; isopropanol; petroleum distillates; propylene glycol monobutyl ether