A COMBINED RESPIRATORY AND CUTANEOUS HYPERSENSITIVITY SYNDROME INDUCED BY WORK EXPOSURE TO QUATERNARY AMINES

The quaternary amine, benzalkonium chloride, has been associated with cutaneous and mucosal delayed hypersensitivity reactions and with para doxical bronchoconstriction after use of aerosolized asthma medication s. Until now, quatenary amines have not been reported to cause occupat ional asthma. We describe a case of occupational asthma caused by prol onged exposure to a cleaning solution containing benzalkonium chloride in the workplace. Single-blind, placebo-controlled, open-room challen ges were performed to determine the specific agent responsible for the patient's symptoms. Pulmonary function and epicutaneous challenge tes ts were also performed. The patient had positive responses to challeng es with a liquid toilet bowl cleaner containing benzalkonium chloride but was unreactive to other agents tested. Removal from the workplace resulted in complete resolution of symptoms. The exact mechanisms resp onsible for occupational asthma induced by quaternary amines remain un known; however, this case emphasizes the importance of recognizing rea ctive chemicals as possible causes.