Asthma caused by aerosols of sterilization agents


Occupations

  • Chemical industry
  • Cosmetics industry
  • Doctor
  • Hospital staff
  • Medical personnel
  • Nurse
  • Paper industry
Agents
Benzalkonium chloride, Chloramine t, Chlorhexidine, Ethylene oxide, Formaldehyde, Glutaraldehyde, Hexachlorophene, Isothiazolinone, Proteolytic enzymes, Quaternary ammonium compounds.
 
Incidence
Incidence: the number of reported cases is increasing. Atopy does not appear to play a role. No immunological mechanism has been demonstrated to date. Eczema symptoms following contact with chlorohexidine have been reported for many years, but they are not associated in all cases. Similarly, eczemas are frequently associated with isothiazolinone.
 
The incidence rate of contact eczemas due to benzalkonium is 5%. At present, 5 cases of asthma caused by quaternary ammonium compounds have been reported in the literature.
 
Conditions
All of these disinfectants can cause asthma e.g. usage of aerosols of chlorohexidine in alcohol as a cleaning agent for large surface areas. Glutaraldehyde is used in bronchoscopy suites and ethylene oxide is used to sterilize dialysis facilities. Some latex gloves are sterilised using ethylene oxide which can provoke additional sensitization. In addition these agents are used as developers and fixers in radiology and in certain installations of air conditioning. The exposure levels set by the OES for glutaraldehyde were reduced from 0.2 ppm to 0.05 ppm in 1998.
 
Quaternary ammonium compounds are well known for their ability to cause skin sensitisations. They can also cause asthma, particularly in the case of benzalkonium chloride. Proteolytic enzymes used in the disinfection of endoscopy equipment can induce IgE-dependent sensitisations.
 
Symptoms
Rhinitis, sporadic coryza and conjunctivitis are often associated with coughing. Breathing difficulties and asthma may also occur.
In the case of benzalkonium chloride, swelling of the joints may also develop.
 
Diagnostic methods
Bronchial provocation test with raw materials (in hospital).
 
No skin tests or immunological dosage CAP/RAST for chroramine T and ethylene oxide and glutaraldehyde are possible, but rarely give a positive result. The use of tryptase or ECP assays and measurement of ECP levels in nasal lavage fluid could be a novel approach.

References

  1. Allergy 2001,56:1186 - Palczynski C. et al.
  2. INRS 2000 DMT 84 Rosenberg
  3. Int. Arch. Occup. Environ. Health 2000,73:423 Purohit A. et al.
  4. Monaldi Arch. Chest Dis. 1998,53:50 - Di Stephano F. et al.
  5. Thorax 1997,52:746 - Bourke S.J et al.
  6. Occup. Med. 1997,47:249 - Moscato G. et al.
  7. Lancet 1995,346:1434
  8. Thorax 1995,50:156
  9. Respiratory Medicine 1995,89:693
  10. Rev. Fr. Allergol. 1991,31:41
  11. Presse Med. 1991,20,30:1455
  12. J. Allergy Clin. Immunol. 1993,91(5):974
  13. Br. J. Ind. Med. 1992,49:523
  14. Br. Med. J. 1989,298:929

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.