**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](#introduction)

[1.0 INCIDENT REPORT DATA ASSOCIATED WITH HEALTH EFFECTS
3](#incident-report-data-associated-with-health-effects)

[1.1 OPP's Incident Data System (IDS) 4](#opps-incident-data-system-ids)

[1.2 California Data - 1982 through 2003
4](#california-data---1982-through-2003)

[1.3 National Pesticide Telecommunications Network (NPTN)
4](#national-pesticide-telecommunications-network-nptn)

[1.4 Incident Reports Associated with Acute Toxic Effects of Quats
Published in Scientific Literature.
4](#incident-reports-associated-with-acute-toxic-effects-of-quats-published-in-scientific-literature.)

[2.0 SUMMARY AND CONCLUSION 5](#summary-and-conclusion)

[3.0 REFERENCES 8](#references)

# 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)]{.underline}** - 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]{.underline}** -
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**)]{.underline} -
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]{.underline}** - Some incident reports
associated with quats related human health hazard are published in the
scientific literature.

## 1.1 [OPP's Incident Data System (IDS)]{.underline}

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]{.underline}

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)]{.underline}

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.]{.underline}

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**

+----------+----------+------+-------+----------+-------------+-------+
| Year     | Illness  |      |       |          |             |       |
|          | Type     |      |       |          |             |       |
+==========+==========+======+=======+==========+=============+=======+
|          | Systemic | Eye  | Skin  | Res      | Combination | Total |
|          | ^a^      |      | ^b^   | piratory | ^c^         |       |
+----------+----------+------+-------+----------+-------------+-------+
| 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    | 48       | 567  | 205   | 50       | 40          | 856   |
|          |          |      |       |          |             |       |
| (19      |          |      |       |          |             |       |
| 91-2003) |          |      |       |          |             |       |
+----------+----------+------+-------+----------+-------------+-------+
| Total    | \-       | \-   | \-    | \-       | -\`         | 1105  |
|          |          |      |       |          |             |       |
| (18      |          |      |       |          |             |       |
| 82-2003) |          |      |       |          |             |       |
+----------+----------+------+-------+----------+-------------+-------+

^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.

**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      **Number of Persons
                           Disabled**               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                        \-

  **Unknown^b^**           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 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.