Bernstein J A, Stauder T, Bernstein D I, Bernstein I L
Department of Internal Medicine, University of Cincinnati Medical Center, OH 45267-0563.
J Allergy Clin Immunol. 1994 Aug;94(2 Pt 1):257-9. doi: 10.1016/0091-6749(94)90048-5.
The quaternary amine, benzalkonium chloride, has been associated with cutaneous and mucosal delayed hypersensitivity reactions and with paradoxical bronchoconstriction after use of aerosolized asthma medications. Until now, quaternary amines have not been reported to cause occupational asthma. We describe a case of occupational asthma caused by prolonged exposure to a cleaning solution containing benzalkonium chloride in the workplace. Single-blind, placebo-controlled, open-room challenges were performed to determine the specific agent responsible for the patient's symptoms. Pulmonary function and epicutaneous challenge tests were also performed. The patient had positive responses to challenges 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 responsible for occupational asthma induced by quaternary amines remain unknown; however, this case emphasizes the importance of recognizing reactive chemicals as possible causes.
季铵盐苯扎氯铵与皮肤和黏膜迟发型超敏反应有关，且在使用雾化哮喘药物后会出现矛盾性支气管收缩。到目前为止，尚未有季铵盐导致职业性哮喘的报道。我们描述了一例因在工作场所长期接触含苯扎氯铵的清洁溶液而引起的职业性哮喘病例。进行了单盲、安慰剂对照、开放环境激发试验，以确定导致患者症状的具体因素。还进行了肺功能和皮肤点刺试验。患者对含苯扎氯铵的液体马桶清洁剂激发试验呈阳性反应，但对其他测试试剂无反应。脱离工作场所后症状完全缓解。季铵盐引起职业性哮喘的确切机制尚不清楚；然而，该病例强调了认识到反应性化学物质可能是病因的重要性。
