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BACKGROUND: Systemic contact dermatitis (SCD) is an allergic inflammatory skin disease. We report that 3 family members developed SCD after exposing to laundry detergent containing benzalkonium chloride, which is rare. SCD caused by benzalkonium chloride has been reported. However, Similar symptoms in the whole family caused by it have not been reported yet. In our case, a 36-year-old man was diagnosed as SCD, and his symptoms had not controlled after 7 days treatment, until he stopped dressing the clothes washed by the laundry detergent containing benzalkonium chloride. It was interesting that both his wife and the daughter developed SCD successively, and they have not exposed to any haptens besides the benzalkonium chloride in the laundry detergent. METHODS: Dermoscopic examination showed bright-red background, focal branching vessels and white scales. HE staining from the lesion revealed hyperkeratosis and parakeratosis, focal subcorneal microabscess, ocal hyperkeratosis, koilocyte in the epidermis, and erythrocyte extravasation, fibroplasia, hyaline degeneration and scattered aggregates of lymphocytes in the dermis. Then path test was performed 1 month after recovery with benzalkonium chloride 0.05% and 0.1% in petrolatum. RESULTS: Stop the laundry detergent containing benzalkonium chloride. The symptoms had controlled after they stopped the laundry detergent containing benzalkonium chloride. CONCLUSION: The case highlights that benzalkonium chloride with very low concentration and repeated exposure may be an active agent of SCD. It is of the utmost importance to pay close attention to patients presenting with similar symptoms within the family. A thorough examination of the medical history is essential to determine the underlying cause.
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Compuestos de Benzalconio , Detergentes , Humanos , Masculino , Adulto , Compuestos de Benzalconio/efectos adversos , Detergentes/efectos adversos , Femenino , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiologíaRESUMEN
are that the contents of this article are their own original unpublished findings. Title: Comparison of potential contact allergens in best-selling adult and baby cleansers Authors: Jayden Galamgam1 MD, Sasan D Noveir2 BA, Carol E Cheng1 MD Affiliations: 1Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA, 2 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA Corresponding Author: Jayden Galamgam MD, Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, Email: jgalamgam@mednet.ucla.edu.
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Alérgenos , Humanos , Alérgenos/efectos adversos , Dermatitis Alérgica por Contacto/etiología , Adulto , Lactante , Detergentes/efectos adversosRESUMEN
Toilet cleaner containing hydrochloric acid is a common item found in households all over the world. Due to the availability of the substance, it becomes one of the main contributors to corrosive damage to the gastrointestinal system. This study reports a case of a female in her 50s with an alleged history of ingestion of toilet cleaner an empty bottle of which was found together with a suicide note at the incident site. During the autopsy, the forensic expert made an intriguing observation regarding the dispersion of ingested acid to other organs without gastric perforation. Despite the absence of gastric perforation, the corrosive effects of the ingested acid were evident in various organs, including the liver and spleen. This phenomenon suggests a unique mechanism by which the acid is able to disperse and cause damage beyond the stomach, leading to widespread organ involvement. However, through a comprehensive analysis of the detailed history, typical macroscopic autopsy findings, and chemical analysis reports, it is possible to establish that the cause of death is corrosive acid poisoning. In such cases, further investigation is warranted to gain a better understanding of the underlying mechanisms responsible for the dispersion of the acid and its clinical implications. By delving deeper into these aspects, we can enhance our knowledge and contribute to the field of forensic medicine.
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Autopsia , Humanos , Femenino , Persona de Mediana Edad , Ácido Clorhídrico/efectos adversos , Ácido Clorhídrico/envenenamiento , Cáusticos/envenenamiento , Cáusticos/toxicidad , Quemaduras Químicas/patología , Quemaduras Químicas/etiología , Detergentes/envenenamiento , Detergentes/efectos adversos , Suicidio Completo , Patologia ForenseRESUMEN
Exposure to disinfectants and cleaning products (DCPs) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCPs and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCPs. In contrast to other agents, the incidence of WRA due to DCPs has increased over time. The use of DCPs in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCPs remain poorly studied; however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic workup based on clinical assessment accompanied by evaluation of lung function and immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms, and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCPs.
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Detergentes , Exposición Profesional , Humanos , Exposición Profesional/efectos adversos , Detergentes/efectos adversos , Asma Ocupacional/diagnóstico , Desinfectantes/efectos adversos , Enfermedades Profesionales/diagnósticoRESUMEN
Many baby cleansers are promoted as hypoallergic products; however, these claims are not typically validated. This study assessed the 50 best-selling baby cleansers from online retailer Amazon for potential allergens. We found that the presence of most marketing claims, including "hypoallergenic" or "allergy-tested," did not correlate with the number of potential allergens in a cleanser. Furthermore, the total number of marketing claims of a cleanser was positively correlated with the number of allergens, highlighting the discordance between marketing claims and allergen content in baby cleansers.
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Alérgenos , Humanos , Alérgenos/efectos adversos , Lactante , Prevalencia , Dermatitis Alérgica por Contacto/etiología , Detergentes/efectos adversos , Cuidado del Lactante/métodosRESUMEN
BACKGROUND: Epithelial barrier impairment is associated with many skin and mucosal inflammatory disorders. Laundry detergents have been demonstrated to affect epithelial barrier function in vitro using air-liquid interface cultures of human epithelial cells. METHODS: Back skin of C57BL/6 mice was treated with two household laundry detergents at several dilutions. Barrier function was assessed by electric impedance spectroscopy (EIS) and transepidermal water loss (TEWL) measurements after the 4 h of treatments with detergents. RNA sequencing (RNA-seq) and targeted multiplex proteomics analyses in skin biopsy samples were performed. The 6-h treatment effect of laundry detergent and sodium dodecyl sulfate (SDS) was investigated on ex vivo human skin. RESULTS: Detergent-treated skin showed a significant EIS reduction and TEWL increase compared to untreated skin, with a relatively higher sensitivity and dose-response in EIS. The RNA-seq showed the reduction of the expression of several genes essential for skin barrier integrity, such as tight junctions and adherens junction proteins. In contrast, keratinization, lipid metabolic processes, and epidermal cell differentiation were upregulated. Proteomics analysis showed that the detergents treatment generally downregulated cell adhesion-related proteins, such as epithelial cell adhesion molecule and contactin-1, and upregulated proinflammatory proteins, such as interleukin 6 and interleukin 1 beta. Both detergent and SDS led to a significant decrease in EIS values in the ex vivo human skin model. CONCLUSION: The present study demonstrated that laundry detergents and its main component, SDS impaired the epidermal barrier in vivo and ex vivo human skin. Daily detergent exposure may cause skin barrier disruption and may contribute to the development of atopic diseases.
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Detergentes , Piel , Humanos , Ratones , Animales , Detergentes/efectos adversos , Detergentes/química , Detergentes/metabolismo , Ratones Endogámicos C57BL , Piel/metabolismo , Epidermis/metabolismo , Inflamación/metabolismoRESUMEN
BACKGROUND: Detergent is a chemical product commonly used in people's daily life. Contact with detergent solutions can damage the human skin barrier and cause skin diseases. Skin surface lipids (SSLs) play a decisive role in skin barrier function. This study aimed to observe the changes of SSLs in young adults after exposure to detergent solutions to explore the underlying mechanism of skin barrier function damage. METHODS: A self-controlled study on youth adults was conducted in Zhengzhou, China, in November 2020. The study lasted for a total of 1 week, and skin barrier function was assessed by trans-epidermal water loss (TEWL) values. The changes of SSLs before and after exposure to the detergent with subjects were measured using ultra-performance liquid chromatography quadrupole time of flight mass spectrometry. RESULTS: The skin barrier function of subjects' hands was impaired after exposure to detergent (TEWL value increased, p < 0.001). A total of 520 SSLs were detected, divided into 6 main categories. The average relative abundance of these 6 major lipids decreased after exposure. Sphingolipids (mainly ceramides), free fatty acids (mainly long-chain fatty acids), cholesterol lipids, and glycerophospholipids are the most severely damaged lipids. CONCLUSION: Detergent solutions can damage the skin barrier function and SSLs of young hands; interventions targeting SSLs to eliminate detergent damage to human skin may be of value.
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Detergentes , Lipidómica , Humanos , Adulto Joven , Adolescente , Detergentes/efectos adversos , Detergentes/análisis , Piel , Epidermis/química , Agua , Lípidos/análisis , Lípidos/química , Lípidos/farmacologíaRESUMEN
OBJECTIVE: Health care workers are at risk for work-related asthma, which may be affected by changes in cleaning practices. We examined associations of cleaning tasks and products with work-related asthma in health care workers in 2016, comparing them with prior results from 2003. METHODS: We estimated asthma prevalence by professional group and explored associations of self-reported asthma with job-exposure matrix-based cleaning tasks/products in a representative Texas sample of 9914 physicians, nurses, respiratory/occupational therapists, and nurse aides. RESULTS: Response rate was 34.8% (n = 2421). The weighted prevalence rates of physician-diagnosed (15.3%), work-exacerbated (4.1%), and new-onset asthma (6.7%) and bronchial hyperresponsiveness symptoms (31.1%) were similar to 2003. New-onset asthma was associated with building surface cleaning (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.10-3.33), use of ortho-phthalaldehyde (OR, 1.77; 95% CI, 1.15-2.72), bleach/quaternary compounds (OR, 1.91; 95% CI, 1.10-3.33), and sprays (OR, 1.97; 95% CI, 1.12-3.47). CONCLUSION: Prevalence of asthma/bronchial hyperresponsiveness seems unchanged, whereas associations of new-onset asthma with exposures to surface cleaning remained, and decreased for instrument cleaning.
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Asma , Enfermedades Profesionales , Exposición Profesional , Médicos , Humanos , Exposición Profesional/efectos adversos , Personal de Salud , Asma/epidemiología , Ocupaciones , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Detergentes/efectos adversosRESUMEN
PURPOSE OF REVIEW: The prevalence and incidence of allergic disease have been rising in Westernized countries since the twentieth century. Increasingly, evidence suggests that damage to the epithelium initiates and shapes innate and adaptive immune responses to external antigens. The objective of this review is to examine the role of detergents as a potential risk factor for developing allergic disease. RECENT FINDINGS: Herein, we identify key sources of human detergent exposure. We summarize the evidence suggesting a possible role for detergents and related chemicals in initiating epithelial barrier dysfunction and allergic inflammation. We primarily focus on experimental models of atopic dermatitis, asthma, and eosinophilic esophagitis, which show compelling associations between allergic disease and detergent exposure. Mechanistic studies suggest that detergents disrupt epithelial barrier integrity through their effects on tight junction or adhesion molecules and promote inflammation through epithelial alarmin release. Environmental exposures that disrupt or damage the epithelium may account for the increasing rates of allergic disease in genetically susceptible individuals. Detergents and related chemical compounds represent possible modifiable risk factors for the development or exacerbation of atopy.
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Asma , Dermatitis Atópica , Esofagitis Eosinofílica , Humanos , Detergentes/efectos adversos , InflamaciónRESUMEN
INTRODUCTION: Epidemiological studies demonstrated that cleaning work and frequent use of cleaning products are risk factors for asthma. Laundry detergents have been reported to have epithelial barrier-opening effects. However, whether laundry detergents directly induce airway inflammation and its mechanisms in vivo remain to be elucidated. METHODS: Two commercial laundry detergents and two commonly used surfactants for cleaning and cosmetics (sodium lauryl sulfate and sodium dodecyl benzene sulfonate) were intranasally administered to mice. Lungs were analyzed using flow cytometry, histology, ELISA, and quantitative PCR. Human bronchial epithelial cells were stimulated with laundry detergents and analyzed using quantitative PCR and western blotting. Involvement of oxidative stress was assessed using an antioxidant. Dust samples from homes were analyzed to determine their detergent content by measuring their critical micelle concentration (CMC). RESULTS: The administered laundry detergents and surfactants-induced eosinophilic airway inflammation accompanied by increased IL-33 expression and activation of group 2 innate lymphoid cells (ILC2s). Detergent-induced eosinophilic airway inflammation was significantly attenuated in Rag2-/- Il2rg-/- , Il33-/- mice, and also in wild-type mice treated with NAC. Detergent-induced IL-33 expression in airways was attenuated by NAC treatment, both in vivo and in vitro. CMCs were found in all of the tested dust extracts, and they differed significantly among the homes. CONCLUSION: The laundry detergents and surfactants-induced eosinophilic airway inflammation in vivo through epithelial cell and ILC2 activation. They induced IL-33 expression in airway epithelial cells through oxidative stress. Furthermore, detergent residues were present in house dust and are presumably inhaled into the airway in daily life.
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Detergentes , Inmunidad Innata , Humanos , Ratones , Animales , Detergentes/efectos adversos , Tensoactivos/efectos adversos , Linfocitos , Interleucina-33/farmacología , Polvo , InflamaciónRESUMEN
OBJECTIVES: This study investigated occupational risk factors and exposure-response relationships for airway disease among health workers (HWs) exposed to cleaning agents in two tertiary hospitals in South Africa and Tanzania. METHODS: In this cross-sectional study, 697 participants completed questionnaire interviews while 654 underwent fractional exhaled nitric oxide (FeNO) testing. Asthma Symptom Score (ASS) was computed based on the sum of answers to five questions on asthma-related symptoms in the past 12 months. For exposure-response analyses, cleaning agent-related self-reported exposure variables were categorised into three levels (cleaning product not used; use of a cleaning product for up to 99 min per week and use of a cleaning product for ≥100 min per week). RESULTS: Asthma-related outcomes (ASS and FeNO) demonstrated positive associations with medical instrument cleaning agents (orthophthalaldehyde and enzymatic cleaners) and tasks (instruments precleaning and changing sterilisation solutions) as well as patient care activities (disinfection prior to procedures and disinfecting wounds). A particularly pronounced dose-response relationship was observed between work-related ocular-nasal symptoms and medical instrument cleaning agents (orthophthalaldehyde, glutaraldehyde, enzymatic cleaners, alcohols and bleach) (OR range: 2.37-4.56) and tasks (OR range: 2.92-4.44). A strong association was also observed between ASS and use of sprays for fixed surface cleaning (mean ratio 2.81; 95% CI 1.41 to 5.59). CONCLUSIONS: Specific agents for medical instrument disinfection for example, orthophthalaldehyde and enzymatic cleaners, patient care activities and use of sprays are important occupational risk factors for airway disease among HWs.
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Asma , Enfermedades Profesionales , Exposición Profesional , Trastornos Respiratorios , Humanos , Asma/diagnóstico , Estudios Transversales , Detergentes/efectos adversos , Enfermedades Profesionales/inducido químicamente , Enfermedades Profesionales/complicaciones , Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Factores de Riesgo , Centros de Atención TerciariaRESUMEN
BACKGROUND: Household cleaning and personal care products (HC&PCPs) are irreplaceable in most daily routines. However, data are sparse on chemical burns caused by HC&PCPs. METHODS: We queried the National Electronic Injury Surveillance System (NEISS) from 2012 to 2021 to characterize chemical burns caused by HC&PCPs as well as the most common causative categories of HC&PCPs responsible for chemical burns. RESULTS: We found 2729 total emergency department (ED) visits due to chemical burn injuries within the years 2012-2021 due to HC&PCPs. Chemical burns disproportionally affect children ages four and under, accounting for 36.4% of all patients. Within this subpopulation, boys were more frequently affected by chemical burns and the eyes were the most affected area. The most common HC&PCPs involved in chemical burns in individuals ages one to four were laundry soaps and detergents (22.0%) and bleaches (21.3%). CONCLUSION: Children ages four and under are disproportionately affected by chemical burns due to non-intentional exposure of HC&PCPs, with laundry detergents and bleaches being the most common causative agents. Adequate storage of all HC&PCPs and improved parental supervision are paramount in preventing chemical burns in this age group.
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Quemaduras Químicas , Detergentes , Masculino , Niño , Humanos , Detergentes/efectos adversos , Quemaduras Químicas/epidemiología , Quemaduras Químicas/etiología , Estudios Transversales , Jabones , Servicio de Urgencia en HospitalRESUMEN
Purpose Detergent pod-related aerodigestive/ocular chemical burns/ingestion poisoning injuries are a group of injuries of concern to parents/guardians of young children as well as oral healthcare professionals. Each year detergent pod injuries result in thousands of emergency department (ED) visits and significant oral, eye, airway, and digestive trauma. The purpose of this study was to investigate trends in detergent pod injuries resulting in ED visits in children ages >0 to <18 years from 2016-2020.Methods This cross-sectional study used data collected from the National Electronic Injury Surveillance System (NEISS). A secondary data analysis was performed on the NEISS data from 2016-2020 for children ages >0 to <18 years. Injuries were identified as detergent pod-related oral-aerodigestive/ingestion poisonings, detergent pod-related ocular injuries, or other product-related injuries among children. Time trends and demographic characteristics were analysed by age, sex, and race.Results There were an estimated 13,176 detergent pod-related oral-aerodigestive injuries/ingestion poisonings and 8,654 detergent pod-related ocular injuries with ED visits during 2016 - 2020. In adjusted logistic regression, white children were more likely to have oral-aerodigestive injuries/ingestion poisonings than black children (p=0.0006). Time trend (p=0.4358), and sex (p=0.3905) failed to reach significance. Children, ages 5 to<18 years, were less likely to have ED visits for oral-aerodigestive injuries/ingestion poisonings, or any detergent pod-related injury than younger children. Children, ages 3 to ≤5 years, were more likely to have detergent pod-related ocular injuries than younger or older children.Conclusion Time trends for detergent-pod related injuries requiring ED visits remained unchanged from 2016-2020 for oral-aerodigestive injuries/ingestion poisonings. Given the significant health risks associated with detergent pods and the fact that the injuries have not declined, there is a need for improved parent/guardian education and practices in safeguarding detergent pods from children. Dental hygienists are well positioned to provide anticipatory guidance on this safety issue.
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Detergentes , Personal de Salud , Niño , Humanos , Adolescente , Preescolar , Detergentes/efectos adversos , Estudios Transversales , EscolaridadRESUMEN
BACKGROUND: Glove occlusion might enhance skin sensitivity to a subsequent detergent challenge (occlusion effect). Thus, some skin protection creams (PC) claim to protect against this effect of occlusion, and are recommended to be used before wearing liquid-proof gloves. OBJECTIVES: To evaluate the effect of PC applied prior to glove occlusion on the 'occlusion effect'-refers to increased susceptibility of the skin to a model detergent. METHODS: One hundred and eleven volunteers were enrolled in a single-blind, randomized study. Seven PCs were applied before glove occlusion over 7 days (D1-D7). After sodium lauryl sulphate (SLS) challenge, we compared the irritation between the areas treated with PC and occlusion alone. Clinical scoring and bioengineering methods (capacitance, transepidermal water loss [TEWL], and colourimetry [erythema]) were used to quantify the irritant reactions. RESULTS: After 1 week of occlusion and PC application, we did not observe significant changes in TEWL, nor in erythema, whereas skin hydration raised in three cream-treated areas. On day 10, after a challenge with SLS, some products significantly aggravated the skin irritation as compared to occlusion alone. CONCLUSIONS: The 'occlusion effect'-shown as higher skin susceptibility to a model detergent-was not mitigated by PCs when applied prior to glove occlusion. On the contrary, some PCs might have negative effects on skin barrier function and augment such sensitivity.
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Dermatitis Alérgica por Contacto , Dermatitis Irritante , Humanos , Dermatitis Irritante/etiología , Dermatitis Irritante/prevención & control , Método Simple Ciego , Detergentes/efectos adversos , Piel , Dodecil Sulfato de Sodio/efectos adversos , Eritema/inducido químicamente , Eritema/prevención & control , Emolientes , Agua , Pérdida Insensible de AguaRESUMEN
BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic allergic disease associated with type 2 inflammation and epithelial barrier dysfunction. The etiology is unknown, however, genetic heritability studies suggest environmental factors play a key role in pathogenesis. Detergents, such as sodium dodecyl sulfate (SDS), are common ingredients in household products such as dish soap and toothpaste. We hypothesized detergent exposure decreases epithelial barrier function and induces esophageal inflammation. METHODS: Immortalized esophageal epithelial cells (EPC2) were cultured in air-liquid interface (ALI) and exposed to SDS. Barrier function/activity was assessed by transepithelial electrical resistance (TEER), FITC-dextran flux, and RT-PCR. Additionally, SDS-treated mouse esophageal organoids were evaluated for morphology. To investigate the effects of SDS in vivo, mice were treated with 0.5% SDS in drinking water for 14 days. Esophagi were assessed by gross morphology, histopathology, protein expression, and bulk RNA sequencing. RESULTS: When EPC2 cells were exposed to SDS (5 µg/ml) for 96 h, TEER decreased (p = 0.03), and FITC-dextran flux increased (p = 0.0002). mRNA expression of IL-33 increased 4.5-fold (p = 0.02) at 6 h and DSG1 decreased (p < 0.0001) by 72 h. Disrupted epithelial integrity was noted in SDS-treated esophageal organoids. When mice were exposed to SDS, they showed increased esophageal width, chemokine, and metalloprotease levels. Mice treated with SDS also showed increased IL-33 protein expression, basal zone hyperplasia, CD4+ cell infiltration, and esophageal eosinophilia. RNA sequencing revealed upregulation of immune response pathway genes. CONCLUSION: Exposure to SDS decreases esophageal barrier integrity, stimulates IL-33 production, and promotes epithelial hyperplasia and tissue eosinophilia. Detergents may be a key environmental trigger in EoE pathogenesis.
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Detergentes , Esofagitis Eosinofílica , Animales , Ratones , Detergentes/efectos adversos , Células Epiteliales/metabolismo , Hiperplasia/patología , Inflamación/metabolismo , Interleucina-33/metabolismoRESUMEN
Cocamidopropyl betaine (CAPB) is an amphoteric surfactant. It has several functions, including producing effervescence and washing effects, and thus, it is used in many cleansing products, such as shampoo and liquid body cleansers. Recently, it has become clear that some impurities that arise during the manufacturing process can have sensitizing effects. Herein, we report a case of allergic contact dermatitis caused by detergents containing CAPB, in which an impurity was determined to be the possible causative agent by patch testing and chemical analysis.A 64-year-old Japanese female developed a skin rash on the hairlines of her forehead and nuchal region one month before her first visit to our clinic. Later, the rashes, which were composed of desquamative erythema, expanded to her face, neck, upper back, and chest. Patch tests produced positive results for a shampoo and liquid body cleanser (1% aq.) that she had used as well as for CAPB (1% aq.); lauramidopropyl betaine (LAPB) (1% aq.); and lauramidopropyl dimethylamine (LAPDMA) (0.05% aq.), which is an impurity of CAPB. The rashes resolved completely after we instructed her to use products without CAPB and LAPB. When issuing such instructions, clinicians should have correct knowledge about surfactants, such as the differences between cosmetic ingredient names and quasi-drug ingredient names.
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Betaína , Dermatitis Alérgica por Contacto , Humanos , Femenino , Persona de Mediana Edad , Betaína/efectos adversos , Detergentes/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Pruebas del Parche/efectos adversos , Pruebas del Parche/métodos , TensoactivosRESUMEN
BACKGROUND: Transfusion-related acute lung injury (TRALI) is a severe complication of plasma transfusion, though the use of solvent/detergent pooled plasma (SDP) has nearly eliminated reported TRALI cases. The goal of this study was to investigate the incidence of TRALI in intensive care units (ICU) following the replacement of quarantined fresh frozen plasma (qFFP) by SDP. STUDY DESIGN AND METHODS: A retrospective multicenter observational before-after cohort study was performed during two 6-month periods, before (April-October 2014) and after the introduction of SDP (April-October 2015), accounting for a washout period. A full chart review was performed for patients who received ≥1 plasma units and developed hypoxemia within 24 h. RESULTS: During the study period, 8944 patients were admitted to the ICU. Exactly 1171 quarantine fresh frozen plasma (qFFP) units were transfused in 376 patients, and respectively, 2008 SDP units to 396 patients after implementation. Ten TRALI cases occurred during the qFFP and nine cases occurred during the SDP period, in which plasma was transfused. The incidence was 0.85% (CI95%: 0.33%-1.4%) per unit qFFP and 0.45% (CI95%: 0.21%-0.79%, p = 0.221) per SDP unit. One instance of TRALI occurred after a single SDP unit. Mortality was 70% for patients developing TRALI in the ICU compared with 22% in patients receiving at least one plasma transfusion. CONCLUSION: Implementation of SDP lowered the incidence of TRALI in which plasma products were implicated, though not significantly. Clinically diagnosed TRALI can still occur following SDP transfusion. Developing TRALI in the ICU was associated with high mortality rates, therefore, clinicians should remain vigilant.
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Lesión Pulmonar Aguda Postransfusional , Transfusión de Componentes Sanguíneos/efectos adversos , Estudios de Cohortes , Detergentes/efectos adversos , Humanos , Incidencia , Unidades de Cuidados Intensivos , Plasma , Estudios Retrospectivos , Solventes , Lesión Pulmonar Aguda Postransfusional/epidemiologíaRESUMEN
BACKGROUND: Increased hand hygiene measures during the COVID-19 pandemic have led to an increased quantum of hand eczema (HE). OBJECTIVES: To examine the effects of varying washing frequencies using current mild cleansing agents-alongside with the effect of a rehydrating cream-on the epidermal barrier function and inflammatory processes of the stratum corneum(SC). METHODS: Standardized skin washings on the volar aspects of the lower arms of skin-healthy volunteers were performed using the automated cleansing device either 5 or 11 times within 4 h for 60 s each with a standard cleanser, a lipid-containing syndet, or a lipid-containing syndet followed by one-time application of a rehydrating cream. Skin bioengineering parameters (transepidermal water loss, SC hydration, erythema, and SC pH) and biochemical/immunological parameters (interleukin-1α, interleukin-1α receptor antagonist and natural moisturizing factor) of SCsamples collected by tape stripping were assessed. RESULTS: All applied washing procedures provided comparable, mild effects on the epidermal barrier function and skin inflammation. CONCLUSION: Occupational skin cleansers seem to have improved regarding skin barrier damaging effects. To further corroborate this, a study design, modified on the basis of our findings, applying longer washing periods for consecutive days seems desirable.