Contact Sensitizations to Disinfectants Containing Alcohols or Quaternary Ammonium Compounds Contact Dermatitis

TAKE-HOME MESSAGE

• The patch test results of 145 patients with suspected contact allergy to disinfectants were retrospectively evaluated to determine if ethanol, 1-propanol, and isopropanol could represent relevant allergens. There were no strong positive reactions but 8 patients reacted positively to one of these components. Each of the patients testing positive to any of the alcohols underwent repetitive open application tests (ROATs) and only 1 had a positive ROAT to 1-propanol. In addition, 85 of these patients underwent patch testing with didecyldimethylammonium chloride (DDAC) 0.03% and DDAC 0.05%. Additionally, none of the positive DDAC patch tests were deemed clinically relevant.

• Alcohols and DDAC are rarely implicated in allergic contact dermatitis in disinfectants and testing for other potential allergens should be pursued in these cases. The authors recommend ROATs to confirm positive patch test results given that disinfectants can also lead to irritant skin reactions.

–  Alex Noble, MD

Written by

Christen Maria Mowad MD

Disinfectants have been used daily in the medical field. The COVID-19 pandemic has made the use of disinfectants ubiquitous in society as well as we all try and adhere to important infection-control recommendations. Frequent use of these products can result in clinical findings that could be allergic or irritant contact dermatitis. By nature of the compounds, irritant contact dermatitis is likely part of the process. This study investigated allergic contact dermatitis to these disinfectants in a retrospective manner. The authors evaluated 145 patients with suspected allergic contact dermatitis to disinfectants. The patients were tested to different alcohols: ethanol, 1-propanol, and isopropanol, as well as didecyldimethylammonium chloride (DDAC), a quaternary ammonium compound used for disinfection. The authors point out that optimal patch test concentrations have not been determined and that no commercially available patch test for DDAC is available. Only 1 patient had a possible allergy to 1-propanol. Only 1 patient reacted to DDAC, but it had no clinical relevance. The authors concluded that DDAC and alcohols are rare allergens. Irritant contact dermatitis, as well as other allergens, including fragrances, emollients, and preservatives, should be considered when evaluating possible causes for clinical findings upon exposure to disinfectants. Patch testing should be considered in these situations; however, this study concludes that the alcohols and the DDAC compounds are rarely the problem.

Abstract

BACKGROUND

The use of disinfectants is part of the everyday life of people, especially in the medical profession. During the coronavirus disease 2019 (COVID-19) pandemic, the use of disinfectants continues to increase and is of fundamental importance in infection control.

OBJECTIVES

To determine the frequency of sensitization and the value of patch testing to didecyldimethylammonium chloride (DDAC) and the alcohols ethanol, 1-propanol, and isopropanol.

METHODS

Clinical patch test data of 145 patients with suspected contact allergy to disinfectants were retrospective analysed.

RESULTS

Among the 145 patients patch tested with the different alcohols, only one nurse was detected with a possible allergy to 1-propanol. Additional patch testing in 84 patients with DDAC 0.05% resulted in five patients with weakly positive reactions only, without clinical relevance. Patch testing with DDAC 0.03% showed no positive reactions at all on day 3 readings.

CONCLUSIONS

DDAC and alcohols are rarely responsible for allergic contact dermatitis. The accused products of the patients should be checked for other allergens and further additives with skin-irritating properties. Individual susceptibility and mishandling of the disinfectants should be considered.

Contact Dermatitis

Contact Sensitizations to Disinfectants Containing Alcohols or Quaternary Ammonium Compounds Are Rarely of Clinical Relevance

Contact Derm 2021 Mar 24;[EPub Ahead of Print], K Kreipe, S Forkel, KE Heinemann, K Amschler, T Fuchs, J Geier, T Buhl