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

  TOC \o "1-3" \h \z \u    HYPERLINK \l "_Toc127791271"  0.0
INTRODUCTION	  PAGEREF _Toc127791271 \h  3  

  HYPERLINK \l "_Toc127791272"  1.0 	INCIDENT REPORT DATA ASSOCIATED
WITH HEALTH EFFECTS	  PAGEREF _Toc127791272 \h  3  

  HYPERLINK \l "_Toc127791273"  1.1	OPP’s Incident Data System (IDS)	 
PAGEREF _Toc127791273 \h  4  

  HYPERLINK \l "_Toc127791274"  1.2	California Data - 1982 through 2003	
 PAGEREF _Toc127791274 \h  4  

  HYPERLINK \l "_Toc127791275"  1.3 	National Pesticide
Telecommunications Network (NPTN)	  PAGEREF _Toc127791275 \h  4  

  HYPERLINK \l "_Toc127791276"  1.4 	Incident Reports Associated with
Acute Toxic Effects of Quats Published in Scientific Literature.	 
PAGEREF _Toc127791276 \h  4  

  HYPERLINK \l "_Toc127791277"  2.0 	SUMMARY AND CONCLUSION	  PAGEREF
_Toc127791277 \h  5  

  HYPERLINK \l "_Toc127791278"  3.0 	REFERENCES	  PAGEREF _Toc127791278
\h  8  

 

0.0	INTRODUCTION tc \l1 "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 Quats. 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 that are involved in
each incident.  Therefore, in preparing this report, all the quats are
going to be discussed together.  

1.0 	INCIDENT REPORT DATA ASSOCIATED WITH HEALTH EFFECTS

The following databases have been consulted for the poisoning incident
data on the 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.

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 hazards are published in the scientific literature.

1.1	OPP’s Incident Data System (IDS) tc \l2 "1.1 	OPPs 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 reactions.  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). A summary table
describing each incident is attached in Attachment 1.  As summarized in
Table 1, symptoms associated with the 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, and 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) tc \l2 "1.4 
National Pesticide Telecommunications Network (NPTN) 

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

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

There are several incidents that have been published outlining the
problems associated with the use of quats.  Most of the reported
incidents are associated with irritation type reactions (Preller et al.,
1996).  Some incidents are associated with allergic type reactions
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 reports 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 reactions have also been reported in some incidents.  

Although risks associated with eye exposure are not assessed in the risk
assessment process, symptoms associated with the eyes are the most
commonly reported symptoms associated with quats exposure.  The most
common symptoms reported for cases of ocular exposure were eye
irritation/burning, eye pain, conjunctivitis, swelling of the eye and
swelling of the 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, and 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.

 tc \l2 "1.5 	Incident Reports Associated with Acute Toxic Effects of
Hydantoins Published in Scientific Literature. 

Table 1.  Cases Due to Quaternary Ammonium Compound Exposure in
California Reported by Type of Illness and Year, 1982-2003

Year	Illness Type

	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 includes 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.  Before 1991, there is no clear
medical description of all the related symptoms for all the related
incidents.Table 2:  

Number of Persons Disabled (taking time off work) or Hospitalized for
Indicated Number of Days after Quaternary Ammonium Compound 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.

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 Conjunctivitis from synthetic detergents 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. Disinfectant 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.

 tc \l2 "1.5 	Incident Reports Associated with Toxic Effects of phenols
Published in Scientific Literature. 

Attachment 1

Case Reports Received by the California Pesticide Illness Surveillance
Program,

1982 - 2003

In Which Health Effects Were Definitely, Probably, or Possibly
Attributed to

Exposure to Quaternary Ammonium Compounds (Quats) 

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