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The aim of this study is to evaluate the potential hazard of naturally occurring radioactive material (NORM) added consumer products. Using the Monte Carlo method, the radioactive products were simulated with ICRP reference phantom and the organ doses were calculated with the usage scenario. Finally, the annual effective doses were evaluated as lower than the public dose limit of 1mSv y(-1) for 44 products. It was demonstrated that NORM-added consumer products could be quantitatively assessed for the safety regulation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to investigate the epidemiology of wire-bristle grill brush injury., Study Design and Setting: Cross-sectional analysis of national databases; literature review., Subjects and Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) was used to derive a national weighted estimate of emergency department visits for wire bristle injury from 2002 to 2014. Date, location of injury, demographics, and outcomes were analyzed. A literature search and a consumer-reported injury database (SaferProducts.gov) were interrogated to provide ancillary sources of data., Results: A total of 43 cases were found within the NEISS database, which extrapolated to an estimated 1698 (95% confidence interval, 1468-1927) emergency department visits nationwide. In the NEISS database, the mean age was 30 years, and the sex distribution of the patients was similar (21 males vs 22 females). The most common location of injury was the oropharynx in both the NEISS database (23 of 43, 53.4%) and the literature review (11 of 36, 30.5%). However, the oral cavity was the most frequent site in the consumer-reported SaferProducts.gov database (9 of 24, 37.5%). The majority of patients in the NEISS were treated in the emergency department (31 of 43, 69.7%). Raw case counts were highest in June, July, and August, with the highest number of events in the month of July., Conclusion: Injury from wire-bristle grill brush is uncommon but prevalent during certain seasons. Otolaryngologists play an important in the diagnosis and treatment of these injuries. Awareness among consumers and product manufacturers is necessary to promote safety., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)

Background: Bioethanol-fueled fireplaces are popular interior home decoration accessories. Although their safety is promoted frequently, actual presentations of severe burn injuries in our burn intensive care unit (ICU) have focused the authors on safety problems with these devices. In this article we want to explore the mechanisms for these accidents and state our experiences with this increasingly relevant risk for severe burn injuries., Materials and Methods: The computerized medical records of all burn intensive care patients in our burn unit between 2000 and 2014 were studied. Since 2010, 12 patients with bioethanol associated burn injuries were identified. Their data was compared to the values of all patients, except the ones injured by bioethanol fireplaces that presented themselves to our burn ICU between the years 2010 and 2014., Results: At time of admission the bioethanol patients had a mean ABSI-score of 4.8 (+/- 2.2 standard deviation (SD)). A mean of 17 percent (+/- 9.1 SD) body surface area was burned. Involvement of face and hands was very common. An operative treatment was needed in 8 cases. A median of 20 days of hospitalization (range 3-121) and a median of 4.5 days on the ICU (range 1-64) were necessary. No patient died. In most cases the injuries happened while refilling or while starting the fire, even though safety instructions were followed. In the control group, consisting of 748 patients, the mean ABSI-score was 5.6 (+/- 2.7 SD). A mean of 16.5 percent (+/- 10.1 SD) body surface area was burned. Treatment required a median of 3 days on the burn ICU (range 1-120). Regarding these parameters, the burden of disease was comparable in both groups., Conclusion: Bioethanol-fueled fireplaces for interior home decoration are a potential source for severe burn accidents even by intended use., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Background: The usage prevalence of ingredients in topical products is important to dermatologists and industry., Objective: To determine the prevalence of methylisothiazolinone (MI) in various types of consumer products, Methods: The Contact Allergy Management Program (CAMP) database was mapped and sorted in spreadsheet format to determine the prevalence of MI in various types of consumer products., Results: Methylisothiazolinone was found in 13.2% of 4660 total products in CAMP. High usage of MI was seen in dishwashing products (64%), shampoos (53%), bathroom/kitchen/all-purpose cleaners (47%), hair conditioners (45%), hair dyes (43%), laundry additives/fresheners/softeners (30%), soaps/cleansers (29%), and surface cleaners/disinfectants (27%). Of the products containing MI, MI alone (without methylchloroisothiazolinone) was most common in makeup products (100%), cleaning/dish/laundry products (>99%), moisturizers (82%), shaving products (78%), sunscreens (71%), and antiaging products (67%)., Conclusions: The American Contact Dermatitis Society's CAMP is a valuable tool to collect epidemiologic data on the incidence of specific ingredient usage in various types of topical products.

Background: Epidemiological studies show that cigarette smoking increase the risk of nasopharyngeal carcinoma (NPC), however, whether other common, potentially adverse household inhalants increase NPC risk remains uncertain., Methods: We conducted a large case-control study to explore the effects of household inhalants, such as incense, mosquito coil, cooking fumes, and wood combustion, on NPC risk. We recruited 1,845 cases and 2,275 controls from Guangdong province, a high-risk area for NPC in China, to obtain the demographic data and relevant exposure information through face-to-face interviews., Results: We found that incense burning was associated with NPC risk by comparing frequent incense use with never using incense [OR and 95% confidence interval (CI) = 1.73, (1.43, 2.09)]. Wood fuel use was also associated with NPC risk compared with non-wood fire use [OR and 95% CI = 1.95, (1.65, 2.31)]. More intriguingly, we observed a significant addictive interaction between frequent incense burning and heavy cigarette smoking on NPC risk [synergistic index (SI) = 1.67; 95% CI: 1.01, 2.76]. We also found a significant joint effect between wood fuel use and NPC family history for NPC risk (SI = 1.77; 95% CI: 1.06, 2.96). However, neither mosquito oil nor cooking fumes were associated with NPC risk., Conclusions: Our study shows that incense smoke is not only the potential independent risk factor but also co-contributes with cigarette smoking to NPC risk. Moreover, wood combustion is another potential environmental risk factor and exerts a joint effect with NPC family history on NPC.

Synthetic organic chemicals can be used in personal care and consumer products. Data on potential human health effects of these chemicals are limited-sometimes even contradictory-but because several of these chemicals are toxic in experimental animals, alternative compounds are entering consumer markets. Nevertheless, limited information exists on consequent exposure trends to both the original chemicals and their replacements. Biomonitoring (measuring concentrations of chemicals or their metabolites in people) provides invaluable information for exposure assessment. We use phthalates and bisphenol A-known industrial chemicals-and organophosphate insecticides as case studies to show exposure trends to these chemicals and their replacements (e.g., other phthalates, non-phthalate plasticizers, various bisphenols, pyrethroid insecticides) among the US general population. We compare US trends to national trends from Canada and Germany. Exposure to the original compounds is still prevalent among these general populations, but exposures to alternative chemicals may be increasing.

Asthma is a complex syndrome with significant consequences for those affected. The number of individuals affected is growing, although the reasons for the increase are uncertain. Ensuring the effective management of potential exposures follows from substantial evidence that exposure to some chemicals can increase the likelihood of asthma responses. We have developed a safety assessment approach tailored to the screening of asthma risks from residential consumer product ingredients as a proactive risk management tool. Several key features of the proposed approach advance the assessment resources often used for asthma issues. First, a quantitative health benchmark for asthma or related endpoints (irritation and sensitization) is provided that extends qualitative hazard classification methods. Second, a parallel structure is employed to include dose-response methods for asthma endpoints and methods for scenario specific exposure estimation. The two parallel tracks are integrated in a risk characterization step. Third, a tiered assessment structure is provided to accommodate different amounts of data for both the dose-response assessment (i.e., use of existing benchmarks, hazard banding, or the threshold of toxicological concern) and exposure estimation (i.e., use of empirical data, model estimates, or exposure categories). Tools building from traditional methods and resources have been adapted to address specific issues pertinent to asthma toxicology (e.g., mode-of-action and dose-response features) and the nature of residential consumer product use scenarios (e.g., product use patterns and exposure durations). A case study for acetic acid as used in various sentinel products and residential cleaning scenarios was developed to test the safety assessment methodology. In particular, the results were used to refine and verify relationships among tiered approaches such that each lower data tier in the approach provides a similar or greater margin of safety for a given scenario., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

A 4-year-old boy developed unilateral, total limbal stem cell deficiency (LSCD) following an acid injury. A stable ocular surface was achieved with autologous simple limbal epithelial transplantation (SLET), performed 4 months after the injury. Focal areas of conjunctivalisation were noted in the postoperative period. These were addressed using a novel modification of SLET. A very small piece of limbus from the healthy eye was split into multiple pieces, and applied to the bare corneal stroma with fibrin glue after pannus resection. The surface was covered with amniotic membrane. This resulted in a stable surface, and visual acuity improved to 20/50. The donor remained healthy despite two biopsies being harvested. This case demonstrates that early ocular surface reconstruction may be considered in children with LSCD if amblyopia is a concern. Customised SLET allows surgeons to tackle focal recurrences of LSCD effectively, using minimal limbal tissue from the donor site., (2015 BMJ Publishing Group Ltd.)

Background: Chemical burns account for a small proportion of total burns in children, but may require specific first aid and different modes of prevention., Methods: A retrospective study between 2006 and 2012 of children ≤16 years treated with chemical burns at a specialist paediatric burn centre. Data were extracted from a prospectively maintained database., Results: 56 episodes of chemical burns occurred during the study period. The majority (54%) occurred in boys. There were 39 (72%) patients <10 years and 17 (39%) ≥10 years. Median total body surface area burnt was 1% with nine (16%) patients requiring skin grafting. Only 24 (45%) had adequate first aid. The majority (n=46, 82%) of chemical burns occurred in the domestic setting, especially in the <10 years age group (P=0.052). Non-intentional exposure of chemicals by an unattended child accounted for half of all (n=22, 49%) chemical burns <10 years of age. Eight (47%) burns in patients ≥10 years resulted from self-harm. The most common aetiological agents were household cleaners and aerosols in the younger and older age groups respectively., Conclusion: Chemical burns remain infrequent but potentially preventable. These burns mainly occur in the domestic setting due to non-intentional exposure of household chemicals in children <10, and due to deliberate self-harm in children ≥10. The use of child-resistant packaging, similar to that used for medications, and improved parental practices could help decrease the incidence of burns in children <10., (Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.)

Developmental exposure to phthalates may be associated with adverse health outcomes but information on the variability and predictors of urinary phthalate metabolite concentrations during pregnancy is limited. We evaluated in Spanish pregnant women (n=391) the reproducibility of urinary phthalate metabolite concentrations and predictors of exposure. We measured mono-(4-methyl-7-hydroxyoctyl) phthalate (7-OHMMeOP), mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono-(2-carboxyhexyl) phthalate (MCMHP), mono-benzyl phthalate (MBzP), mono-ethyl phthalate (MEP), mono-iso-butyl phthalate (MiBP) and mono-n-butyl phthalate (MnBP) in two spot urine samples collected in the first and third pregnancy trimesters. Questionnaires on predictors and food-frequency questionnaires were administered in the first and/or third pregnancy trimesters. Using creatinine-adjusted phthalate metabolite concentrations (log10-trasformed) we calculated intraclass correlation coefficients (ICCs). Linear mixed and regression models assessed the associations between predictors and phthalate metabolites. The ICCs ranged from 0.24 to 0.07 and were higher for MBzP, MEP, MiBP, and lower for MEOHP and MEHHP. Overweight, lower education and social class, and less frequent consumption of organic food were associated with higher levels of some phthalate metabolites. The use of household cleaning products (bleach, ammonia, glass cleaners, oven cleaning sprays and degreasing products) at least once per week during pregnancy was associated with 10-44% higher urinary phthalate metabolites. Bottled-water consumption, consumption of food groups usually stored in plastic containers or cans, use of plastic containers for heating food and cosmetic use were not associated with increased concentrations of phthalate metabolites. This large study with repeated phthalate measurements suggests that, in this Spanish setting, sociodemographic and lifestyle factors and household cleaning product use are better predictors of phthalate exposure levels in pregnant women than average water and food consumption and use of plastic containers and cosmetics., (Copyright © 2014 Elsevier GmbH. All rights reserved.)

Air freshener could be one of the multiple sources that release volatile organic compounds (VOCs) into the indoor environment. The use of these products may be associated with an increase in the measured level of terpene, such as xylene and other volatile air freshener components, including aldehydes, and esters. Air freshener is usually used indoors, and thus some compounds emitted from air freshener may have potentially harmful health impacts, including sensory irritation, respiratory symptoms, and dysfunction of the lungs. The constituents of air fresheners can react with ozone to produce secondary pollutants such as formaldehyde, secondary organic aerosol (SOA), oxidative product, and ultrafine particles. These pollutants then adversely affect human health, in many ways such as damage to the central nervous system, alteration of hormone levels, etc. In particular, the ultrafine particles may induce severe adverse effects on diverse organs, including the pulmonary and cardiovascular systems. Although the indoor use of air freshener is increasing, deleterious effects do not manifest for many years, making it difficult to identify air freshener-associated symptoms. In addition, risk assessment recognizes the association between air fresheners and adverse health effects, but the distinct causal relationship remains unclear. In this review, the emitted components of air freshener, including benzene, phthalate, and limonene, were described. Moreover, we focused on the health effects of these chemicals and secondary pollutants formed by the reaction with ozone. In conclusion, scientific guidelines on emission and exposure as well as risk characterization of air freshener need to be established.

Background: R-Limonene is a common fragrance terpene found in domestic and industrial products. R-Limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. In a recent multicentre study, 5.2% (range 2.3-12.1%) of 2900 patients showed a positive patch test reaction to oxidized R-limonene., Objective: To study the exposure to limonene among consecutive dermatitis patients reacting to oxidized R-limonene in an international setting, and to assess the relevance of the exposure for the patients' dermatitis., Methods: Oxidized R-limonene 3.0% (containing limonene hydroperoxides at 0.33%) in petrolatum was tested in 2900 consecutive dermatitis patients in Australia, Denmark, the United Kingdom, Singapore, Spain, and Sweden. A questionnaire assessing exposure to limonene-containing products was completed., Results: Overall, exposure to products containing limonene was found and assessed as being probably relevant for the patients' dermatitis in 36% of the limonene-allergic patients. In Barcelona and Copenhagen, > 70% of the patients were judged to have had an exposure to limonene assessed as relevant., Conclusions: Oxidized R-limonene is a common fragrance allergen, and limonene was frequently found in the labelling on the patients' products, and assessed as relevant for the patients' dermatitis. A large number of domestic and occupational sources for contact with R-limonene were identified., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Concentrated laundry detergent packs are new products that may be more likely to cause adverse effects and serious medical outcomes among young children than traditional laundry detergent products., Objective: The intent of this study was to examine whether certain factors might be associated with the referral of pediatric laundry detergent pack exposures by poison centers., Methods: Cases were laundry detergent pack exposures involving patients age 5 years or younger reported to Texas poison centers during February 2012 to August 2013. The health care facility referral rate was calculated for selected factors., Results: Of 912 exposures, 720 were managed on site and 192 were referred to a health care facility. The referral rate was 16.1% for patients with not serious outcomes and 71.6% for serious outcomes. The referral rate was 32.0% for patients age younger than 1 year and 14.3% to 22.1% for the older age groups. 31.0% of Purex(TM), 25.5% of All(TM), and 19.3% of Tide(TM) product exposures were referred. The referral rate was 33.3% for ocular exposures, 19.4% for dermal contact, and 20.2% for ingestions. The most common clinical effects and their referral rates were vomiting (30.5%), cough or choke (45.1%), ocular irritation (34.6%), red eye (25.4%), nausea (25.4%), drowsiness or lethargy (67.5%), oral irritation (16.7%), and dermal edema (68.4%)., Conclusions: Pediatric exposures to laundry detergent packs were more likely to be referred to health care facilities if the laundry detergent pack brand was Purex(TM), the exposure was ocular, or particular ocular, respiratory, dermal, or neurologic clinical effects were present., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Laundry and dishwasher detergent "pods" were introduced to the United States market in 2010 and are sold by several manufacturers. They represent a high percentage of household cleaning product exposure in the United Kingdom. We present a consecutive case series of 10 children seen in a 9-month period with corneal injuries from exposure to liquid detergent pods., (Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Chlorinated volatile organic compounds (Cl-VOCs), including polychloromethanes, polychloroethanes and polychloroethylenes, are widely used as solvents, degreasing agents and a variety of commercial products. These compounds belong to a group of ubiquitous contaminants that can be found in contaminated soil, air and any kind of fluvial mediums such as groundwater, rivers and lakes. This review presents a summary of the research concerning the production levels and sources of Cl-VOCs, their potential impacts on human health as well as state-of-the-art remediation technologies. Important sources of Cl-VOCs principally include the emissions from industrial processes, the consumption of Cl-VOC-containing products, the disinfection process, as well as improper storage and disposal methods. Human exposure to Cl-VOCs can occur through different routes, including ingestion, inhalation and dermal contact. The toxicological impacts of these compounds have been carefully assessed, and the results demonstrate the potential associations of cancer incidence with exposure to Cl-VOCs. Most Cl-VOCs thus have been listed as priority pollutants by the Ministry of Environmental Protection (MEP) of China, Environmental Protection Agency of the U.S. (U.S. EPA) and European Commission (EC), and are under close monitor and strict control. Yet, more efforts will be put into the epidemiological studies for the risk of human exposure to Cl-VOCs and the exposure level measurements in contaminated sites in the future. State-of-the-art remediation technologies for Cl-VOCs employ non-destructive methods and destructive methods (e.g. thermal incineration, phytoremediation, biodegradation, advanced oxidation processes (AOPs) and reductive dechlorination), whose advantages, drawbacks and future developments are thoroughly discussed in the later sections., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Recently, cases of contact dermatitis that were related to the use of polyvinyl alcohol (PVA) cooling towels containing isothiazolinone preservatives were reported in Japan. The aim of this investigation was to analyze the concentrations of five different isothiazolinone compounds present in PVA towels and to assess the effectiveness of washing in removing the preservatives from new towels prior to being used for the first time. Twenty-seven PVA towels were used in this study. Two groups (i.e., laboratory-simulation and volunteer) of washing experiments were conducted to evaluate the effect of washing procedures. Qualitative and quantitative analyses were performed by LC/MS/MS, which detected 2-methyl-4-isothiazolin-3-one (MI) and 5-chloro-2-methyl-4-isothaizolin-3-one (CMI) in 23 samples (MI: 0.29-154 μg g-wet(-1), CMI: 2.2-467 μg g-wet(-1)), 2-n-octyl-4-isothiazolin-3-one (OIT) in one sample (478 μg g-wet(-1)). The compounds 4,5-Dichloro-2-n-octyl-4-isothiazolin-3-one (2Cl-OIT) and 1,2-benzisothiazolin-3-one (BIT) were not detected in all samples. We confirmed the presence of residual MI, CMI, and OIT in the washed towels, and the residual-to-original content ratio of OIT was higher than that of MI and CMI in PVA towels, due to the higher hydrophobicity of OIT than MI and CMI. A concern has been raised about the occurrence of contact dermatitis being caused by the use of PVA towels. It is suggested that a detailed description of isothiazolinone preservatives in PVA towels and an effective washing procedure for the removal of these preservatives should be provided by the manufacturer. Further, alternative non-sensitizing preservatives might be considered for the manufacture of PVA cooling towels in the future.

Background: Tea tree oil is used as a natural remedy, but is also a popular ingredient in household and cosmetic products. Oxidation of tea tree oil results in degradation products, such as ascaridole, which may cause allergic contact dermatitis., Objectives: To identify the optimal patch test concentration for ascaridole, and to investigate the relationship between a positive reaction to ascaridole and a positive reaction to oxidized tea tree oil., Patients/materials/methods: Three hundred and nineteen patients with eczema were patch tested with ascaridole 1%, 2%, and 5%, and 250 patients were patch tested with oxidized tea tree oil 5%. Readings were performed on D3 and D7 according to a patch test calibration protocol., Results: With an increasing ascaridole test concentration, the frequency of positive reactions increased: ascaridole 1%, 1.4%; ascaridole 2%, 5.5%; and ascaridole 5%, 7.2%. However, the frequencies of irritant and doubtful reactions also increased, especially for ascaridole 5%. A positive reaction to ascaridole was related to a positive reaction to tea tree oil., Conclusions: This study is in support of ascaridole being a sensitizer. We recommend patch testing with ascaridole at 2%. The finding that every positive reaction to oxidized tea tree oil is accompanied by a positive reaction to ascaridole suggests that ascaridole might be a contact allergen in oxidized tea tree oil., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lead-based paint and occupational lead hazards remain the primary exposure sources of lead in New York City (NYC) children and men, respectively. Lead poisoning has also been associated with the use of certain consumer products in NYC. The NYC Department of Health and Mental Hygiene developed the Intervention Model for Contaminated Consumer Products, a comprehensive approach to identify and reduce exposure to lead and other hazards in consumer products. The model identifies hazardous consumer products, determines their availability in NYC, enforces on these products, and provides risk communication and public education. Implementation of the model has resulted in removal of thousands of contaminated products from local businesses and continues to raise awareness of these hazardous products.

Background: The rate of contact allergy and allergic contact dermatitis caused by methylisothiazolinone (MI) is dramatically increasing throughout Europe., Objectives: To report on methylchloroisothiazolinone (MCI)/MI and MI allergy in Belgium., Patients and Methods: Between January 2010 and December 2012, the medical charts of 6599 patients of the Belgian Contact and Environmental Dermatitis Group were retrospectively reviewed for MCI/MI and MI sensitization by use of a standardized questionnaire. Available data on sensitization in 2081 patients tested in 2013 were also included., Results: In 2012, the sensitization rate for MCI/MI had increased to 4.5% and that for MI to 6.0%; the latter showed a further increase to 7.2% in 2013. The people mainly affected were women with a median age of 49 years with hand and/or facial dermatitis, most often resulting from the use of cosmetics. Simultaneous reactions to octylisothiazolinone were observed., Conclusion: A dramatic increase in the rate of contact allergy caused by MI in cosmetics is occurring in Belgium. Notwithstanding the recent recommendation to discontinue the use of MI in leave-on cosmetics, safer use concentrations should also be determined for rinse-off products. Close monitoring of MI sensitization in the near future will be necessary, and the highest test concentrations reported for MI and MCI/MI should be included in the baseline series., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Chronic hand dermatitis is often multifactorial but allergic causes are frequent and can complicate atopic dermatitis or irritant dermatitis. The management of patients affected by hand dermatitis includes detailed interrogation and a complete examination of the skin. Allergologic tests must be systematically realized if examination is suggestive of contact dermatitis or protein contact dermatitis, if an occupational origin is suspected but also in all patients in which treatment is ineffective. Skin tests include patch tests with the European standard series, specialized or additional series if necessary. Skin tests may also include personal items used by patients on a daily basis. If protein contact dermatitis is suspected skin tests include prick tests. Only complete and definitive eviction of allergens can allow a complete and definitive cure of chronic hand dermatitis., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: The preservative methylisothiazolinone (MI) is used in combination with methylchloroisothiazolinone (MCI), but the MCI/MI mixture has been identified as highly allergenic. MI is considered to be less allergenic, and since the mid-2000s has been widely used alone, but is now clearly identified as a contact allergen. The French Vigilance Network for Dermatology and Allergy of the Study and Research Group on Contact Dermatitis (REVIDAL-GERDA) added MI to its baseline patch testing series in 2010., Objective: To evaluate the change in the proportion of MI-positive tests in France between 2010 and 2012., Patients/materials/methods: We conducted a nationwide, multicentre, retrospective study of all MI-tested patients between 2010 and 2012., Results: Sixteen centres participated in the study (7874 patients were tested). Patch tests were performed mainly at a concentration of MI 200 ppm aq. We observed a significant increase in the proportion of MI-positive tests in 2012 and 2011 as compared with 2010 (5.6%, 3.3%, and 1.5%, respectively; p < 0.001)., Conclusions: We report a significant increase in the number of MI-positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other European countries., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Methylisothiazolinone (MI) is a preservative found in cosmetic, personal hygiene, and industrial products. It has been characterized as a moderate to strong sensitizer and is an emerging allergen in the pediatric population. We discuss a case of perianal dermatitis in a child caused by contact allergy to MI-containing wet wipes., (© 2014 Wiley Periodicals, Inc.)

Background: The toxic heavy metal lead continues to be a leading environmental risk factor, with the number of attributable deaths having doubled between 1990 and 2010. Although major sources of lead exposure, in particular lead in petrol, have been significantly reduced in recent decades, lead is still used in a wide range of processes and objects, with developing countries disproportionally affected. The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels and associated health outcomes in children, pregnant women and the general population., Methods/design: The databases MEDLINE, Embase and the Global Health Library (GHL) will be searched using a sensitive search strategy. Studies in English, German, French, Spanish, Italian or Afrikaans will be screened according to predefined inclusion and exclusion criteria. We will consider randomized and non-randomized studies accepted by the Cochrane Effective Practice and Organization of Care (EPOC) Group, as well as additional non-randomized studies. Screening of titles and abstracts will be performed by one author. Full texts of potentially relevant studies will be independently assessed for eligibility by two authors. A single author will extract data, with a second reviewer checking the extraction form. Risk of bias will be assessed by two researchers using the Graphical Appraisal Tool for Epidemiological studies, as modified by the Centre for Public Health at the UK National Institute for Health and Care Excellence. Any inconsistencies in the assessment of eligibility, data extraction or quality appraisal will be resolved through discussion. Where two or more studies report the primary outcome blood lead levels within the same population group, intervention category and source of lead exposure, data will be pooled using random effects meta-analysis. In parallel, harvest plots as a graphical method of evidence synthesis will be used to present findings for blood lead levels and secondary outcomes., Discussion: This systematic review will fill an important evidence gap with respect to the effectiveness of interventions to reduce lead in consumer products and drinking water in the context of new WHO guidelines for the prevention and management of lead poisoning. It will also contribute to setting a future research agenda.

Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a combination preservative used in personal care and household products and is a common cause of allergic contact dermatitis (ACD). Recently, MI alone, without MCI, has been increasingly used in consumer products in attempts to minimize allergic reactions. Wet wipes are extensively tested and traditionally believed to be innocuous. MI in wet wipes ("baby wipes") has not been previously reported to cause ACD in children in the United States. Only 1 previous report of ACD in a child in Belgium has been recently reported. We report 6 children with chronic, perianal/buttock, and facial eczematous dermatitis, refractory to multiple topical and oral antibiotics and corticosteroids. All tested positive to MCI/MI on patch testing. None wore diapers. All patients had been using wet wipes containing MI (without MCI) to affected areas. Discontinuation of wipes resulted in rapid and complete resolution. This is the first report of pediatric ACD to MI in wet wipes in the United States, and the largest series to date. ACD to MI in wet wipes is frequently misdiagnosed as eczema, impetigo, or psoriasis. Wet wipes are increasingly marketed in personal care products for all ages, and MI exposure and sensitization will likely increase. Dermatitis of the perianal, buttock, facial, and hand areas with a history of wet wipe use should raise suspicion of ACD to MI and prompt appropriate patch testing. Rapid resolution occurs after the allergen exposure is eliminated. All isothiozolinones should be avoided in personal care and household products for these patients.

IMPORTANCE Skin disorders are common in the general population, and they may be associated with significant disability. The use of daily skin products may affect the appearance and severity of skin conditions. OBJECTIVES To assess the prevalence of reported itchy rash lasting longer than 3 days among the general population and to evaluate lifetime avoidance of different types of consumer products because of skin problems. DESIGN, SETTING, AND PARTICIPANTS The European Dermato-Epidemiology Network (EDEN) Fragrance Study comprised a large descriptive epidemiological survey of the general population conducted in 6 European regions from August 20, 2008, to October 10, 2011. Participants were a random sample of individuals aged 18 to 74 years, based on electoral precincts. The participants were interviewed using a standardized questionnaire. EXPOSURES Lifetime exposure to products of common use was considered, including toiletry items that remained on the skin or were rinsed off and household and functional items. MAIN OUTCOMES AND MEASURES The 1-month, 1-year, and lifetime age-standardized prevalence rates of itchy rash that lasted longer than 3 days. RESULTS In total, 12 377 individuals (53.9% female; median age, 43 years) were interviewed. The overall prevalences of itchy rash were 19.3% (95% CI, 18.6%-20.0%) during the month preceding the interview, 31.8% (95% CI, 31.0%-32.6%) during the preceding year, and 51.7% (95% CI, 50.8%-52.6%) over a lifetime. In addition, the percentage of individuals who reported avoidance of any product varied from 37.0% for products intended to be left on the skin to 17.7% for household or functional products. CONCLUSIONS AND RELEVANCE Our findings confirmed the magnitude of skin problems among the general population reported in other surveys. Although itchy rash is a nonspecific manifestation, it may be considered in epidemiological surveys to reflect a constellation of skin conditions and to summarize the burden of these conditions on general health.

Chloromethylisothiazolinone (MCI) and methylisothiazolinone (MI) have been widely used as preservatives in cosmetics, household products and industrial products since the late 1970s. First cases of contact allergy to the MCI/MI combination were noted in 1980-1982 in Sweden. Then, a significant increase in the frequency of sensitization to these compounds was observed in many European centers. The increase has been stopped by the introduction of legislation on their maximum concentrations in consumer and industrial products in Europe and in some non-European countries. But approval of the use of MI alone without limits in industrial products (from 2000) and at a maximum concentration of 100 ppm in cosmetics (from 2005) resulted in an unprecedented increase in the number of individuals sensitized to this compound. Allergic contact dermatitis due to MI occurs in both adults and children. It is often manifested by severe symptoms, which may be also induced by airborne exposure. The most important sources of sensitization include cosmetic products and paints. To counteract the increasing problem of contact allergy epidemic to MI, the recommendations have been developed, suggesting the ban on the use of MI in "leave-on" cosmetics and maximum concentration of 15 ppm in "rinse-off" products. The recommendations are likely to be implemented in 2014.

Question: A 4-year-old girl was brought into the emergency department vomiting after having had ingested a laundry detergent capsule (LDC) from under the sink at her house. What is the risk of LDC poisoning? What can be done to treat these children?, Answer: Laundry detergent capsules are relatively new to supermarket shelves in North America, and there has been an emergence of case reports in the literature describing LDC poisoning, which is worse than poisoning from other laundry detergents. Very little is known about the mechanisms causing these severe reactions, which include airway compromise and esophageal perforation, but the attractive appearance of these capsules and easy access at home has governments and health officials concerned about an increase in poisoning. No residual problems have been associated with these cases to date; however, further research is needed to assess long-term effects.

Objective: Many household products contain fragrances. Little is known about exposure to fragrances on human health, particularly within the airways. This study aimed to evaluate how common household fragrance products (i.e. air fresheners, cleaning products) affect people with asthma, who frequently report sensitivity to these products. Many of these products have volatile organic compounds or semi-volatile organic compounds. This study evaluated nine fragrance materials in an aerosol formulation to assess effects on airway physiology, airway inflammation and symptom perception in normal controls and those with asthma., Methods: The effects of fragrances were evaluated in people without asthma, people with mild asthma and people with moderate asthma in a four-way crossover placebo-controlled study. Subjects were exposed twice to a fragranced aerosol and twice to a placebo aerosol (15 and 30 min each). Subjects completed a questionnaire for 29 symptoms during and up to 3 h after each exposure scenario. Spirometry was performed prior to and 3 h post-exposure; sputum induction was conducted 3 h post-exposure., Results: Nasal symptoms showed the greatest frequency of response in all three subject groups, and moderate asthmatics reported the greatest symptom severity and symptom types. No significant differences were noted in physiology or cellular inflammation., Conclusion: A trend for increased symptoms was noted in moderate asthmatics, suggesting that asthma severity may play a factor in fragrance sensitivity.

Two patients presented to the University of Illinois at Chicago Eye and Ear Infirmary within 1 year with penetrating eye injuries caused by similar collapsible cloth and wire laundry hampers. Penetrating eye injuries in children are relatively rare but can result in poor visual outcomes and multiple vision-threatening complications. Both injuries at the University of Illinois resulted in an eye laceration as well as retinal complications similar to those reported with a high velocity injury. This now represents a significant pattern of eye injury and suggests that there exists a nontrivial risk for all children in households with this type of collapsible laundry hamper. Parents should receive a warning of the risks of these hampers.

Purpose: To quantify and characterize eye injuries related to consumer products in the infant population (0-12 months) treated in United States hospital emergency departments during the period from 2001 to 2008., Methods: This study is a descriptive analysis of consumer-product related eye injury data derived from the National Electronic Injury Surveillance System, a probability sample of 100 hospitals nationwide with 24-hour emergency departments. Narrative data were used to assign each case with the consumer products (CPs) causing the eye injury. The proportions of eye injury visits were calculated by age, sex, diagnosis, disposition, locale of incident, and CP categories. We examined the US Consumer Product Safety Commission National Electronic Injury Surveillance System data for all nonfatal eye injuries (853 cases) in the infant population (0-12 months) treated in US emergency departments from 2001 to 2008. These data can be used to project national, annual, weighted estimates of nonfatal injury treated in US emergency departments., Results: There were an estimated 21,271 visits to US emergency departments by patients aged 0-12 months for CP-related eye injuries during the study period. Of these, 63% involved infants aged 9-12 months and 54% involved male patients; 78% of all injuries occurred at home. The CPs causing the most eye injuries belonged to the categories of chemical (46%) and household items (24%). Contusions and abrasions were the leading eye injuries diagnoses (37%)., Conclusions: This study suggests that most CP-related infant eye injuries in the United States occur at home and are predominantly caused by chemicals and household products., (Published by Mosby, Inc.)

Background: The isothiazolinones methylchloroisothiazolinone and methylisothiazolinone (MCI/MI) are the active ingredients in a frequently used preservative in cosmetic, household, and industrial products., Objectives: This study reviewed our department's cases of allergic contact dermatitis caused by MCI/MI, outlining their clinical presentation and possible sources of sensitization. The effect of changing the concentration of MCI/MI from 0.01% to 0.02% in the British Society for Cutaneous Allergy baseline series was also measured., Methods: A total of 964 patients were patch tested to the British Society for Cutaneous Allergy baseline series in our department over 4 years. Patients were tested either to 0.01% MCI/MI (697) or 0.02% MCI/MI (267)., Results: Twenty-one patients (2.2%) had positive reactions to MCI/MI. Of patients tested to 0.02% MCI/MI, 3.8% had a positive reaction compared with 1.6% of those tested to MCI/MI 0.01%. Ten patients (48%) had perianal dermatitis; of these, 50% had used moist toilet wipes., Conclusions: We highlight MCI/MI as important contact allergens found in moist toilet wipes and should be considered particularly in patients with facial, hand, and perianal allergic contact dermatitis. Patch testing to 0.01% MCI/MI may underestimate its allergenic potential, missing more than half of allergic cases compared with testing to 0.02%. To identify isothiazolinone allergy, we recommend that 0.02% MCI/MI should be used in baseline series.

Background: The ideal gentle cleansing product is one that effectively removes soils while minimizing damage to the skin. Thus, measuring physical abrasion caused by cleansing tissues is critical to the continued development of gentle cleansing products. Current analysis of cleansing materials for skin gentleness is time consuming and requires expensive human subject testing. This report describes the development of a rapid and inexpensive bench assay for the assessment of skin abrasion caused by wiping., Methods: Coefficient of friction (COF) evaluations using bench methods were compared with results from clinical studies of repeated wiping and with confocal visualizations of excised skin. A Monitor/Slip and Friction instrument (model 32-06; TMI, Amityville, NY, USA) was used to measure tissue friction on simulated skin (Vitro-Skin, N19-5X; IMS, Milford, CT, USA). Clinical data from a 4-day repetitive forearm wiping study measuring transepidermal water loss (TEWL) in 30 subjects was compared with results from the bench top assay. In addition, excised skin samples were also treated using the COF bench assay and examined using confocal microscopy to visualize stratum corneum damage caused by wiping., Results: Using the bench COF assay, we were able to distinguish between bath tissue codes by comparing average static friction value (ASFV) for the test codes, where lower ASFV indicated less abrasive tissue. The ASFV followed the same gentleness trend observed in the clinical study. Confocal microscopy of excised skin wiped with the same materials indicated stratum corneum damage consistent with the bench COF and clinical TEWL observations., Conclusion: We observed significant correlation between bench and clinical methods for measuring skin damage caused by wiping of skin with tissue. The bench method will facilitate rapid and inexpensive skin gentleness assessment of cleansing materials., (© 2012 John Wiley & Sons A/S.)

Ammonium bifluoride is one of the most corrosive acids that may produce severe chemical burns when in contact with skin. This hazardous chemical is widely used in household products. We report two pediatric cases of irritant contact dermatitis after exposure to a rust remover, which contained ammonium bifluoride., (© 2011 Wiley Periodicals, Inc.)

Identifying and characterizing sources of exposure to phthalates and bisphenol A (BPA) have proved challenging due to the presence of multiple co-exposures resulting from a wide variety of home environments and lifestyles. We hypothesized that the consistent lifestyle of an Old Order Mennonite (OOM) community would provide an ideal setting in which to characterize sources of exposure to BPA and phthalates. We obtained urine samples from ten mid-term pregnant OOM women (ages-21-39) to determine concentrations of 9 phthalate metabolites and BPA and collected a self-reported survey of participants' household environment, product use, and lifestyle within a 48-h period prior to urine collection. We compared their metabolite concentrations to pregnant women included in the National Health and Nutrition Examination Survey (NHANES 2007-2008). Although OOM participants reported some use of plastic and fragranced household products, concentrations of metabolites were lower and significantly less for BPA (p=0.002) and phthalate metabolites MEHP (p=0.0215), MiBP (p=0.0020) and MEP (p=0.021), when compared to NHANES pregnant women. Levels of other phthalate metabolites were also lower in this population. Our data suggest three practices that may contribute to these lower levels: (1) consuming mostly homegrown produce (ingestion), (2) no cosmetics and limited use of personal care products, and (3) transportation primarily by sources other than automobiles., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Context: In early 2012, concentrated laundry detergent packs began to be marketed in the United States. Around May 2012, poison centers began to notice that they were handling serious exposures among young children to these products., Objective: This investigation examined whether a surveillance algorithm might have identified the exposures to laundry detergent packs among young children., Methods: Cases were exposures reported to Texas poison centers during January-June in 2009, 2010, 2011, and 2012. The monthly number of exposures reported in 2012 was determined. The mean for the corresponding month in the preceding 3 years (2009, 2010, 2011) was calculated. If the 2012 monthly value was greater than the historic mean plus two standard deviations, then the 2012 value was considered to be elevated. The comparison was made for eight case definitions involving combinations of age (5 years or less), vomiting, and substance being laundry detergent., Results: When compared to historic values, in 2012 the monthly total exposures and all exposures involving young children were not elevated. Exposures among young children involving vomiting did not become elevated until June 2012. Exposures involving any laundry detergent became elevated in March and remained elevated through June., Discussion: Surveillance of total exposures, all exposures involving young children, and exposures involving vomiting would not have been effective for identifying the influx of calls due to exposures to laundry detergent packs involving young children. Surveillance of any laundry detergent exposures would have identified these calls almost immediately.

During May and early June 2012, the Carolinas Poison Center and the Poison Control Center at the Children's Hospital of Philadelphia received four reports of children with vomiting, mental status changes, and respiratory distress after ingesting the contents of laundry detergent pods. Laundry detergent pods are single-load capsules that contain concentrated liquid detergent within a water-soluble membrane that dissolves when in contact with moisture. Laundry detergent pods were introduced in the U.S. market in 2010, and multiple manufacturers now sell laundry detergent packaged in pods (2-4). On May 17, 2012, CDC and the American Association of Poison Control Centers (AAPCC) began tracking and characterizing reported exposures to laundry detergent from pods. During May 17-June 17, 2012, poison centers reported 1,008 laundry detergent exposures to the National Poison Data System (NPDS), of which 485 (48%) exposures involved laundry detergent pods. Age was recorded for 481 exposures, of which 454 (94%) exposures involved children aged ≤5 years. Among children aged ≤5 years, a significantly greater proportion of those exposed to laundry detergent from pods had gastrointestinal and respiratory adverse health effects and mental status changes compared with those with non-pod laundry detergent exposures. Parents and caregivers should keep laundry detergent pods, as well as other household cleaning products, out of reach and out of sight of children. Health-care providers should be aware that exposure to laundry detergent from pods might be associated with adverse health effects more often than exposure to non-pod laundry detergents.