INCIDENT
REPORTS
ASSOCIATED
WITH
Quaternary
Ammonium
Compounds
(
Quats)

February
15,
2006
U.
S.
Environmental
Protection
Agency
Office
of
Pesticide
Programs
Antimicrobials
Division
TABLE
OF
CONTENTS
0.0
INTRODUCTION................................................................................................................................................
3
1.0
INCIDENT
REPORT
DATA
ASSOCIATED
WITH
HEALTH
EFFECTS
...............................................
3
1.1
OPP'S
INCIDENT
DATA
SYSTEM
(
IDS)...................................................................................................................
4
1.2
CALIFORNIA
DATA
­
1982
THROUGH
2003.............................................................................................................
4
1.3
NATIONAL
PESTICIDE
TELECOMMUNICATIONS
NETWORK
(
NPTN)......................................................................
4
1.4
INCIDENT
REPORTS
ASSOCIATED
WITH
ACUTE
TOXIC
EFFECTS
OF
QUATS
PUBLISHED
IN
SCIENTIFIC
LITERATURE.
...........................................................................................................................................................
4
2.0
SUMMARY
AND
CONCLUSION....................................................................................................................
5
3.0
REFERENCES
.....................................................................................................................................................
8
0.0
INTRODUCTION
Quaternary
ammonium
compounds
(
Quats)
are
widely
used
industrial
chemicals.
The
purpose
of
this
chapter
is
to
review
the
evidence
of
health
effects
in
humans
resulting
from
exposure
to
QAC.
As
stated
in
the
PR
Notice
88­
1
(
February
26,
1988),
the
Agency
has
clustered
Quats
into
four
categories:

Group
I.
Alkyl
or
hydroxyalkyl
(
straight
chain)
substituted
quats;
Group
II
Non­
halogenated
benzyl
substituted
quats;
Group
III.
Di­
and
tri­
chlorobenzyl
substituted
quats;
and
Group
IV.
Quats
with
unusual
substituents
However
for
the
available
incident
information,
it
is
difficult
to
differentiate
the
specific
members
of
the
Quats
the
involved
in
each
incident.
Therefore,
in
preparing
this
reports,
all
the
quats
are
going
to
discussed
together.

1.0
INCIDENT
REPORT
DATA
ASSOCIATED
WITH
HEALTH
EFFECTS
The
following
databases
have
been
consulted
for
the
poisoning
incident
data
on
the
active
ingredient
quats
Incident
Data
System
(
IDS)
­
The
Incident
Data
System
of
The
Office
of
Pesticide
Programs
(
OPP)
of
the
Environmental
Protection
Agency
(
EPA)
contains
reports
of
incidents
from
various
sources,
including
registrants,
other
federal
and
state
health
and
environmental
agencies
and
individual
consumers,
submitted
to
OPP
since
1992.
Reports
submitted
to
the
Incident
Data
System
represent
anecdotal
reports
or
allegations
only,
unless
otherwise
stated.
Typically
no
conclusions
can
be
drawn
implicating
the
pesticide
as
a
cause
of
any
of
the
reported
health
effects.
Nevertheless,
sometimes
with
enough
cases
and/
or
enough
documentation
risk
mitigation
measures
may
be
suggested.
And
California
Department
of
Pesticide
Regulation
­
California
has
collected
uniform
data
on
suspected
pesticide
poisonings
since
1982.
Physicians
are
required,
by
statute,
to
report
to
their
local
health
officer
all
occurrences
of
illness
suspected
of
being
related
to
exposure
to
pesticides.
The
majority
of
the
incidents
involve
workers.
Information
on
exposure
(
worker
activity),
type
of
illness
(
systemic,
eye,
skin,
eye/
skin
and
respiratory),
likelihood
of
a
causal
relationship,
and
number
of
days
off
work
and
in
the
hospital
are
provided.

National
Pesticide
Telecommunications
Network
(
NPTN)
­
NPTN
is
a
toll­
free
information
service
supported
by
OPP.
A
ranking
of
the
top
200
active
ingredients
for
which
telephone
calls
were
received
during
calendar
years
1984­
1991,
inclusive,
has
been
prepared.
The
total
number
of
calls
was
tabulated
for
the
categories
human
incidents,
animal
incidents,
calls
for
information,
and
others.

Published
Incident
Reports
­
Some
incident
reports
associated
with
quats
related
human
health
hazard
are
published
in
the
scientific
literature.

1.1
OPP's
Incident
Data
System
(
IDS)

There
are
1,584
incidences
that
have
been
reported
in
the
OPP
incident
data
system
associated
with
quats
exposure.

Dermal,
ocular
and
inhalation
are
the
primary
routes
of
exposure.
Most
of
the
incidences
are
related
to
irritation
type
reaction.
The
most
common
symptoms
reported
for
cases
of
dermal
exposure
were
skin
irritation/
burning,
rash,
itching,
skin
discoloration/
redness
and
blistering.
Some
allergic
type
reactions
including
hives
and
allergic
contact
dermatitis
have
also
been
reported..
The
most
common
symptoms
reported
for
cases
of
ocular
exposure
were
eye
irritation/
burning,
eye
pain
and
swelling
of
eyes.

The
most
common
symptoms
reported
for
cases
of
inhalation
exposure
were
respiratory
irritation/
burning,
irritation
to
mouth/
throat/
nose,
coughing/
choking,
shortness
of
breath,
dizziness,
flu
like
symptoms,
and
headache.

1.2
California
Data
­
1982
through
2003
There
are
1,105
incidences
that
have
been
reported
in
the
California
Pesticide
Surveillance
Program
Database
(
1982­
2003)
as
definitely
,
probably,
or
possibly
related
to
quats
(
Mehler,
2005).
As
summarized
in
Table
1,
symptoms
associated
with
eyes
are
the
primary
reported
illness
(
over
50%)
in
all
the
associated
incidences.

Nausea,
headache,
and
sore
throat
are
the
primary
systemic
effects
that
have
been
reported.
The
primary
dermal
effects
that
have
been
reported
are
rash,
burning
sensation,
numbness,
itching,
As
summarized
in
Table
2,
although
there
are
some
people
who
were
unable
to
work
after
exposure
for
a
certain
period
of
time,
no
one
was
hospitalized.

1.3
National
Pesticide
Telecommunications
Network
(
NPTN)

There
are
no
incident
reported
in
the
NPTN
database
related
to
quats
exposure.

1.4
Incident
Reports
Associated
with
Acute
Toxic
Effects
of
Quats
Published
in
Scientific
Literature.

There
are
several
incidents
have
been
published
outlining
the
problems
associated
with
the
use
of
quats.
Most
of
the
reported
incidents
are
associated
with
irritation
type
reaction
(
Preller
et
al,
1996).
Some
incidents
are
associated
with
allergic
type
reaction
through
dermal
exposure
(
Dibo
and
Brasch,
2001;
Shmunes
and
Levy,
1972)
or
eye
exposure
(
Orlandini,
et
al.
1990).

2.0
SUMMARY
AND
CONCLUSION
There
are
many
incident
reported
associated
with
exposure
to
end­
use
products
containing
quats.
Dermal,
ocular
and
inhalation
are
the
primary
routes
of
exposure.
Most
of
the
incidences
are
related
to
irritation.
Allergic
type
reaction
is
also
been
reported
in
some
incidents.

Although
risk
associated
with
eye
exposure
is
not
assessed
in
the
risk
assessment
process,
symptoms
associated
with
eye
are
most
commonly
reported
associated
with
quats
exposure.
The
most
common
symptoms
reported
for
cases
of
ocular
exposure
were
eye
irritation/
burning,
eye
pain,
conjunctivitis,
swelling
eye
and
swelling
of
eyelid
The
most
common
symptoms
reported
for
cases
of
inhalation
exposure
were
respiratory
irritation/
burning,
irritation
to
mouth/
throat/
nose,
coughing/
choking,
chest
pain,
disorientation,
dizziness,
shortness
of
breath.

The
most
common
symptoms
reported
for
cases
of
dermal
exposure
were
skin
irritation/
burning,
rash,
itching,
and
blistering.
Allergic
type
reactions
including
hives
and
allergic
contact
dermatitis,
have
also
been
reported..

Although
oral
exposure
is
considered
a
minor
route
of
exposure
for
quats
use,
irritation
to
mouth/
throat/
nose,
vomiting/
nausea/
abdominal
pain,
dizziness,
and
headache
have
been
reported
in
the
cases
of
ingestion.
Table
1.
Cases
Due
to
Quaternary
Ammonium
Compounds
Exposure
in
California
Reported
by
Type
of
Illness
and
Year,
1982­
2003
Illness
Type
Year
Systemic
a
Eye
Skin
b
Respiratory
Combination
c
Total
1982
ND
ND
ND
ND
ND
2
1983
ND
ND
ND
ND
ND
4
1984
ND
ND
ND
ND
ND
3
1985
ND
ND
ND
ND
ND
2
1986
ND
ND
ND
ND
ND
2
1987
ND
ND
ND
ND
ND
23
1988
ND
ND
ND
ND
ND
53
1989
ND
ND
ND
ND
ND
67
1990
ND
ND
ND
ND
ND
86
1991
1
53
22
4
­
81
1992
4
40
14
3
3
71
1993
4
54
16
1
3
79
1994
3
62
21
1
2
88
1995
4
61
18
5
­
89
1996
2
43
20
1
1
67
1997
2
53
14
6
3
75
1998
3
43
16
6
3
66
1999
4
32
11
5
4
47
2000
2
25
17
3
1
46
2001
1
30
8
2
3
36
2002
4
22
10
6
4
39
2003
14
49
18
7
13
72
Total
(
1991­
2003
)
48
567
205
50
40
856
Total
(
1882­
2003
)
­
­
­
­
­ 
1105
a
Category
include
cases
where
nausea,
sore
throat,
dizziness,
headache
and
other
systemic
effects
occurred.
b
Category
includes
burning
sensation,
numbness,
itching,
and
discolored
(
white/
brownish)
skin.
c
Category
includes
combined
effects
to
eye,
skin,
respiratory
and/
or
systemic
effects.
d
ND
=
No
available
information.
Before1991,
there
is
no
clear
medical
description
of
all
the
related
symptoms
for
all
the
related
incidents.
7
Table
2:
Number
of
Persons
Disabled
(
taking
time
off
work)
or
Hospitalized
for
Indicated
Number
of
Days
after
Quaternary
Ammonium
Compounds
Exposure
in
California,
1982­
2003.

Number
of
Persons
Disabled
Number
of
Persons
Hospitalized
One
day
89
1
Two
days
54
1
3­
5
days
44
1
6­
10
days
17
­

11
 
15
days
6
­

More
than
15
days
5
­

Indefinite
a
6
­

Unknownb
24
1
Note:
(
a)
An
entry
of
indefinite
indicates
the
event
occurred,
but
the
time
period
is
not
known.
(
b).
An
entry
of
unknown
indicates
no
information
was
provided.
8
3.0
REFERENCES
Dibo,
M.
and
Brasch,
J.
2001.
Occupational
allergic
contact
dermatitis
from
N,
N­
bis93­
aminoprpyl)
dodecylamine
and
dimethyldidecylammonium
chloride
in
two
hospital
staff.
Contact
Dermatitis.
45(
1):
40.

Mehler,
L.
2005.
Personal
Communication.
California
Department
of
Pesticide
Regulation
Oriandini,
A.;
Viotti,
G.
Martinoli,
C;
and
Magno,
L.
1990.
Allergic
Contact
Conjunctivities
from
synthetic
detergenets
in
nurse.
Contact
Dermatitis.
23:
376­
377.

Preller,
L.;
Doekers,
G.;
Heederik,
D.;
Vermulen,
R.;
Vogelzang,
P.
F.
J,
and
Boleij,
J.
S.
M.
1996.
Disinfinfectant
use
as
a
risk
factor
for
atopic
sensitization
and
symptoms
consistent
with
asthma:
an
epidemiological
study.
European
Respiratory
Journal:
9
(
7)
1407­
1413.

Shmunes,
E.
and
Levy,
E.
J.
1972.
Quaternary
ammonium
compound
contact
dermatitis
from
deodorant.
Arch
Dermatol.
105(
1)
91­
93.
