Ja. Bernstein et al., A COMBINED RESPIRATORY AND CUTANEOUS HYPERSENSITIVITY SYNDROME INDUCED BY WORK EXPOSURE TO QUATERNARY AMINES, Journal of allergy and clinical immunology, 94(2), 1994, pp. 257-259
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.