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Competing Interests: Conflict of interest: None declared.

Abstract: Lymphomatoid contact dermatitis (LCD) is a rare, benign pseudolymphoma with clinicopathologic features of both allergic contact dermatitis and cutaneous T-cell lymphoma (CTCL). In this article, we report a fascinating case of LCD secondary to chronic baby wet wipe use with clinical features of allergic contact dermatitis and histopathologic changes of mycosis fungoides, a subtype of CTCL. We argue that LCD should be added to the list of mimickers of mycosis fungoides, a subtype of CTCL., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Differences in patterns of allergic contact dermatitis (ACD) among underrepresented minority populations are not well studied., Objective: The aim of the study was to investigate patterns of ACD in African American and White patch-tested patients in a distinct metropolitan area over a 10-year period., Methods: We conducted a retrospective review of 297 ACD patients patch tested from 2009 to 2019. Differences in allergen frequency, relevance, and sources of exposure were evaluated. Fisher exact test analyses were performed to examine these differences., Results: Among 297 patients, 215 were White and 47 were African American. The most common sensitizers differed between the 2 groups. African American patients also reacted with statistically significant greater frequency to disperse dye blue (P = 0.019) and textile dye mix (P = 0.001). The most common source of positive patch tests for all patients was personal care products (72%). Occupational allergy was greater in African American male patients, and personal care product exposure was greater in White male patients (P = 0.009)., Conclusions: Our study highlights the differing patterns of sensitization seen in African American and White patients. This is likely due to differences in personal care product use or occupational allergy. Additional studies with larger sample sizes are needed to expand upon these differences., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2021 American Contact Dermatitis Society. All Rights Reserved.)

Background: Preservatives are used widely in cosmetic, household, and industrial products to prevent microbial growth and spoiling of the products. There has been a recent epidemic of contact allergy to methylisothiazolinone (MI)., Objectives: To establish emerging trends in preservative contact allergy as MI is replaced., Methods: We performed a retrospective study on consecutively patch-tested patients at our center from January 2011 to December 2019., Results: A total of 7846 consecutively patch-tested patients were included who were patch tested between January 2011 and December 2019. The prevalence of allergy to MI fell from a peak of 9.39% in 2013 to 1.98% in 2019. MI/methylchloroisothiazolinone (MCI) followed a similar trend, with a peak prevalence of 7.85% in 2014 and falling to 1.39% in 2018. The prevalence of contact allergy to benzisothiazolinone (BIT) has increased steadily increased in 2014 from 0.26% (confidence interval [CI] 0.03-0.93) to 3.42% (CI 2.43-4.66) in 2019., Conclusions: Our data show a significant increase in the prevalence of contact allergy to BIT over the last 6 years, probably as a consequence of increased use in household products. It is essential to continue to look for emerging trends in contact allergy to enable prompt preventative measures to be taken., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Colophonium (rosin) can cause allergic contact dermatitis, mainly due to autoxidation of abietic acid (AbA). Products containing ≥0.1% colophonium should be labeled with EUH208 - "Contains rosin; colophony. May produce an allergic reaction." How should this be measured?, Objective: To compare the results from different strategies for estimating colophonium levels in consumer products: (a) from AbA, and (b) the sum of all major resin acids. To investigate the ratio of 7-oxodehydroabietic acid (7-O-DeA)/AbA as indication of autoxidation., Methods: Resin acids were extracted from consumer products, derivatized, and then separated by gas chromatography/mass spectrometry (GC/MS)., Results: Resin acids were detected in 9 of 15 products. No product contained colophonium ≥0.1%. Estimation based on AbA resulted in underestimation of the colophonium levels in four of nine products. For three products, the obtained levels from this strategy were only one of two compared to when estimating from the sum of all resin acids. The ratio 7-O-DeA/AbA varied from 74% to 1.4%., Conclusions: We propose to measure colophonium based on the sum of all detectable major resin acids, including 7-O-DeA. The ratio of 7-O-DeA/AbA should be used as a marker of autoxidation, indicating an increased risk of sensitization. The presented analytical method is simple to use and suitable for further screening studies., (© 2021 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Baby wipes are a commonly used cleansing method for infants. A literature review has been performed to assess if using baby wipes is beneficial or harmful compared to water and cloth in terms of nappy rash. This includes a detailed analysis of baby wipe ingredients, as many skin irritants as well as allergens are identified. MedLine, Embase and PubMed were searched and after 420 titles and abstracts were screened, 21 studies remained for inclusion. Baby wipes are deemed as superior to water and cloth in the majority of the literature. However, no definitive conclusion can be drawn as many studies are also industry funded. The most notable allergens identified are fragrances, such as linalool, cocamidopropyl betaine (surfactant), formaldehyde-releasing preservatives and other preservatives, including methylisothiazolinone and methylchloroisothiazolinone. As not all allergens are listed on the label accurately, this can be misleading for the consumer., (© 2021 The Australasian College of Dermatologists.)

Burns are a common cause of pediatric injury and represent significant morbidity and mortality in this age group. In children, most burns are thermal, resulting from exposure to a hot surface, liquid, or fire. Cyanoacrylate is a liquid compound commonly found in households, mainly in "superglue" and nail glue. This compound solidifies through an exothermic reaction that is magnified when in contact with certain fibers that act as catalysts, such as cotton. In these circumstances, intense heat is produced in the contact area, potentially causing severe thermal burns. Despite its widespread availability, there is a paucity of safety information about cyanoacrylate and its role as a cause for burns. In the literature, only 18 cases of cyanoacrylate burns are reported in children. We present two cases of pediatric burns with cyanoacrylate and a review of the literature., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Nail glue often consists of a mixture of alcohol, cyanoacrylate, or photo-bonded methacrylate. Ocular exposures to nail glue may result in potentially serious clinical effects, and patients may be treated at healthcare facilities. The objective of this study was to characterize ocular nail glue exposures treated at United States emergency departments., Methods: Data were obtained from the National Electronic Injury Surveillance System, a database of consumer product-related injuries collected from approximately 100 United States hospital emergency departments. Ocular nail glue exposures reported during 2000-2019 were identified by reviewing all records with product code 0909 (Adhesives) and with "nail" and "glue" or "nail" and "adhesive" in the Narrative field., Results: A total of 498 ocular nail glue exposures were identified, resulting in a national estimate of 18,402 exposures. Of the estimated exposures, the age distribution was 14.1% 0-5 years, 15.1% 6-12 years, 14.3% 13-19 years, and 56.6% 20 years or older; 87.5% of the patients were female. The nail glue was mistaken for eye drops in 20.8% of the cases, splashed into the eye in 15.0% cases, and rubbed into the eye in 3.3% cases. The most commonly reported clinical effects were 41.8% foreign body, 33.8% corneal abrasion, and 11.0% conjunctivitis., Conclusion: The most common circumstance leading to ocular nail glue exposures treated at United States emergency departments involved nail glue being mistaken for eye drops. The most frequently reported clinical effects were the presence of a foreign body, corneal abrasion, and conjunctivitis.

Background: Fragrances are widely used in scented products used in daily life with the potential to induce skin sensitization., Objective: To evaluate exposure to scented products and to explore associations between exposure and fragrance contact allergy., Methods: A cross-sectional study on individuals from 18 to 74 years of age, who were randomly selected from the general population in five European countries. A random sample (N = 3119) was patch tested and interviewed on exposure to scented products., Results: Female participants were strongly associated with exposure to scented products relative to male participants. Participants age 40 years and older showed an inverse association with exposure to scented products. Compared to Sweden, The Netherlands followed by Germany showed the highest overall exposure to scented products. Sensitive skin was associated with exposure to scented products and with fragrance allergy. In univariable regression analysis, exposure to leave-on products and to specific scented product subgroups was significantly associated with fragrance allergy., Conclusion: Exposure to scented products depends primarily on sex and age. Female sex and sensitive skin are relevant indicators for developing fragrance allergy. Because aggregate exposure, especially to scented leave-on products, may enhance the prevalence of contact allergy to fragrances, further investigations into exposure amounts and frequencies is warranted., (© 2021 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Introduction: Occupational use of cleaning chemicals has been related to asthma in adults. However, little information is available on the effect of non-occupational use of cleaning products during pregnancy on childhood asthma. This study examines the association between prenatal exposure to cleaning and scented products with childhood asthma, asthma symptoms, and mental and developmental comorbidities among low-income families in Karachi, Pakistan., Methods: Four hundred children from the Koohi Goth Women's Hospital were included in the study. Parents' or guardians reported current asthma, asthma-related symptoms, mental health problems, and behavioral problems among the children. Multivariable logistic regression analysis was used to examine the association between the use of cleaning and scented products during pregnancy and seven different outcome variables., Results: The odds of nocturnal cough were significantly elevated among children whose mothers reported the use of cleaning products ( OR: 2.23, 95% CI: 1.15-4.31) or scented products (OR: 2.15, 95% CI: 1.22-3.77) during pregnancy. Mental health comorbidities were threefold elevated (OR: 3.05, 95% CI: 1.74-5.35) among children whose mothers reported using scented products during pregnancy. There was no statistically significant association of the prenatal use of cleaning or scented products with current asthma status or nocturnal symptoms of wheezing, shortness of breath, and chest tightness among children., Conclusions: The study results indicate prenatal exposure to cleaning and scented products is associated with nocturnal cough among children. The study also suggests an association between prenatal use of scented products and mental health comorbidities among children.

Background: Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) contact dermatitis is a severe problem. The high concentrations of these substances and other isothiazolinones such as benzisothiazolinone (BIT) and octylisothiazolinone (OIT) contained in cleaning products may cause allergic contact dermatitis in sensitized patients., Objectives: To evaluate the exposure to isothiazolinones contained in cleaning products on the market and from sensitized patients, and to verify the accuracy of labeling., Methods: A total of 34 cleaning products were collected (17 supplied by sensitized patients and 17 bought randomly). Analysis was made of the concentrations of MI, MCI, BIT, and OIT using liquid chromatography tandem mass spectrometry (LC-MS/MS)., Results: MI and BIT were the components most frequently detected. Of all the products analyzed, 76.5% contained at least one isothiazolinone. Twelve products had an MI concentration above the permitted level for rinse-off cosmetics. Most of them were coming into direct contact with the skin in daily use. Mislabeling occurred in eight products., Conclusions: Some cleaning products with high concentrations of isothiazolinones may cause cutaneous symptoms in sensitized patients, especially in spray form. The labeling should be correct, also regarding the use of each article., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Chemicals in textile manufacturing and laundering products are important sources of allergens triggering allergic contact dermatitis. Allergens corresponding to the textile production process have been well recognized. However, there is limited information regarding potential allergens in laundering products., Objective: The aim is to investigate the presence and prevalence of potential allergens in commonly used laundering products., Methods: An Internet-based search was performed to identify the current best-selling laundering products in the United States. Subsequent inquiry of common allergens for each product was collected through a review of ingredients listed by manufacturers., Results: Sixty-five laundering products were examined: 30 laundry detergents, 10 fabric softeners, 8 dryer sheets, and 17 stain removers. Ten common allergens were identified: benzisothiazolinone, benzyl benzoate, cocamidopropyl betaine, decyl glucoside, "fragrances," lauryl glucoside, methylisothiazolinone, methylchloroisothiazolinone, phenoxyethanol, and propylene glycol. Fragrances and essential oils are the top allergens in laundry detergents (66.7%), fabric softeners (90%), dryer sheets (75%), and stain removers (58.8%). Laundry detergents labeled as "baby safe" and "free and gentle" contained common allergens, with methylisothiazolinone being the most prevalent, in 80% and 57.1%, respectively., Conclusions: Textile dermatitis can negatively impact quality of life and function. Aside from textile dyes and finishing resins, laundering products should also be considered.

In Japan, the use of methanol, trichloroethylene, and tetrachloroethylene in aerosol household products is banned under the Act on the Control of Household Products Containing Harmful Substances. As the official analytical methods for testing for these substances have not been revised for over 35 years, several issues have been pointed out. Thus, we developed a new method to revise the official method in our previous study. In this study, validation of the proposed method for detecting the target substances was conducted using two aerosol-product samples (A and B), which contained methanol, trichloroethylene, and tetrachloroethylene. Sample A comprised regulated values of these compounds, while sample B comprised one-tenth of the regulated amounts. They also contained several volatile compounds that served as interfering substances. Subsequently, the samples were analyzed using head space/gas chromatography-mass spectrometry, and it was confirmed that the three target substances were separated from the other chemicals on chromatograms. Validation tests were conducted at seven laboratories to evaluate the proposed method using the prepared samples. In one laboratory, the recovery of trichloroethylene and tetrachloroethylene in sample B was slightly higher at 120%, while the recoveries obtained from the other tests were between 70% and 120%. Relative standard deviation at each laboratory was less than 10%. Furthermore, the relative standard deviations between the validation tests with respect to each chemical were less than 15%. Therefore, the method validated in this study was considered to be effective as a revised method for testing for methanol, trichloroethylene, and trichloroethylene in household aerosol products.

Limonene is a fragrance widely used in cosmetics and household products. Until recently, contact allergy to limonene was considered rare because positive patch tests to it were infrequently observed. In recent years, however, it has been demonstrated that exposure of limonene to oxygen (air) results in the formation of a number of oxidation products, of which the hydroperoxides have a far stronger sensitizing potency than the pure compound. By routine testing of patients suspected of contact dermatitis with hydroperoxides of limonene, high frequencies of positive reactions were found, indicating that these chemicals are important fragrance allergens. It should be realized, however, that a number of "positive" reactions may well be false-positive, irritant responses.

We report the case of a 59-year-old man with a history of type 2 diabetes, hypertension and chronic kidney disease who presented with symptomatic severe hypercalcaemia (calcium 15.8 mg/dL) and acute kidney injury. Evaluation revealed that the hypercalcaemia was not mediated by parathyroid hormone (PTH), PTH-related peptide or 1,25-hydroxyvitamin D. Adrenal insufficiency was subsequently diagnosed and was initially thought to be the aetiology of the hypercalcaemia. He was treated with intravenous fluid, pamidronate and started on hydrocortisone with resolution of his hypercalcaemia. Over the next several months, despite adherence to hydrocortisone therapy, the patient continued to have recurrent severe hypercalcaemia requiring hospitalisation. Additional laboratory evaluation showed similar results to the initial evaluation. On further questioning, the patient admitted to routinely ingesting the household cleaning product Comet, which contains a large amount of calcium. Psychiatric assessment confirmed the diagnosis of pica. The patient eventually discontinued ingestion of Comet with resolution of his hypercalcaemia., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Exposure to cleaning products has been associated with adverse respiratory outcomes. This study aimed to investigate the medically reported incidence, trends in incidence and occupational determinants of work-related respiratory disorders attributed to cleaning agents and to explore the role of 'Quantitative Structure Activity Relationships' (QSAR) in corroborating the identification of chemical respiratory sensitisers., Methods: Respiratory diagnoses attributed to cleaning agents were extracted from The Health and Occupation Research (THOR) surveillance network, 1989-2017. Incidence, trends in incidence and incidence rate ratios by occupation were investigated. Agents were classified by chemical type and QSAR hazard indices were determined for specific organic chemicals., Results: Approximately 6% (779 cases) of the (non-asbestos) THOR respiratory cases were attributed to cleaning agents. Diagnoses were predominantly asthma (58%) and inhalation accidents (27%) with frequently reported chemical categories being aldehydes (30%) and chlorine/its releasers (26%). No significant trend in asthma incidence (1999-2017) was observed (annual average change of -1.1% (95% CI -4.4 to 2.4)). This contrasted with a statistically significant annual decline in asthma incidence (-6.8% (95% CI -8.0 to -5.6)) for non-cleaning agents. There was a large variation in risk between occupations. 7 of the 15 organic chemicals specifically identified had a QSAR generated hazard index consistent with being a respiratory sensitiser., Conclusion: Specific occupations appear to be at increased risk of adverse respiratory outcomes attributed to cleaning agents. While exposure to agents such as glutaraldehyde have been addressed, other exposures, such as to chlorine, remain important. Chemical features of the cleaning agents helped distinguish between sensitising and irritant agents., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Triclosan (2,4,4'-trichloro-2'-hydroxy-diphenyl ether) is widely used in personal care and household products. Previous in vitro and in vivo studies showed that triclosan may affect female reproductive health. However, evidence from human studies is scarce., Objectives: To assess the potential effects of triclosan on women's reproductive health., Methods: A prospective cohort study recruited 1,182 couples who planned to conceive and presented to preconception care clinics for physical examination in Shanghai, China, between 2013 and 2015. These couples were then prospectively followed every 2 months for 12 months. Triclosan was quantified in preconception urine samples at enrollment. The outcomes of interest included menstruation and fecundity. Normal menstruation was defined as a woman who had normal cycle duration between 21 and 35 days, duration of menstrual bleeding between 3 and 7 days, and self-reported normal amount of menstrual bleeding., Results: A total of 698 women were included in the analysis on the association between triclosan and menstruation. Compared with low triclosan levels, high triclosan levels were associated with increased risks of abnormal menstruation [adjusted odds ratio (OR) = 1.47; 95% confidence interval = 1.05, 2.06] and prolonged menstrual cycle (OR = 2.08; 95% confidence interval = 1.00, 2.31). In the analysis on the association between triclosan and fecundability, 648 women were included. Compared with the lowest tertile of triclosan level (<1.1 ng/mL), the highest level (>4.5 ng/mL) was associated with a 23% of reduction in fecundability and there tended to be a dose-response pattern., Conclusion: Our findings suggest that triclosan may affect menstruation and reduce female fecundity.

Background: Little is known regarding the characteristics of patients with negative patch test (NPT) results., Objective: To characterize patients with NPT results., Methods: Retrospective cross-sectional analysis of 34,822 patch tested patients. NPT results were defined as negative or irritant final interpretations of all North American Contact Dermatitis Group screening allergens and no relevant allergens on supplemental series., Results: Almost one-third of patients (n = 10,888 [31.3%]) had NPT results. Patients with NPT results were significantly more likely to be male (P < .0001), be age 40 years or younger (P = .0054), be nonwhite (P = .0005), and have dermatitis primarily having a scattered generalized distribution (P = .0007) or primarily located on the lips (P = .0214) or eyelids (P = .0364). However, the absolute differences in age, race, and site were small and may not be clinically meaningful. Patients with NPT results were significantly less likely to have occupationally related skin disease (P < .0001). Overall, 8.3% of patients with NPT results had occupationally related skin disease, with precision production worker/machine operator (28.5%), health care worker (17.0%), and mechanic/repairer (7.5%) being the most commonly related occupations. In all, 22.9% of patients with NPT results had relevant irritants and 41.6% of irritants were occupationally related; cosmetics/health care products and soaps were common sources for both occupationally related and non-occupationally related irritants., Limitations: Retrospective cross-sectional study of tertiary referral population., Conclusions: Patients with NPT results have distinct characteristics., (Published by Elsevier Inc.)

The prevalence of the asthmatic symptoms among children increases globally over the time. Reduced exposure to pathogens in early childhood and increased exposure to anthropogenic irritants result in increased risk of wheezing in children, and all of this may be related to the usage of household chemicals. Objective of this analysis thus was to study the potential effects of overall exposure to home chemicals in the early life on the phenotypes of wheezing from birth until five years of age. 3411 mother-infant pairs from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ) participated in the study. The exposure was estimated by the composite household chemical score from 18 chemical-based products. Social, medical and environmental factors were taken into account as covariates in multivariable multinomial logistic regression using phenotypes of wheezing as a study outcome. We were able to determine the association between several wheezing childhood phenotypes and the frequent usage of household chemicals in the fully adjusted model. Statistically significant odds ratios (OR) for increasing exposures per 1 SD of exposure score were obtained for the intermediate onset transient (OR 1.27, 95% CI 1.10-1.47), intermediated onset persistent (OR 1.23, 95% CI 1.03-1.46), and early onset persistent phenotypes (OR 1.36, 95% CI 1.04-1.77) in comparison to never wheezing children. Moreover, the persistent phenotypes were significantly associated with school age asthma. Our study has shown the negative role of the increased household chemicals usage on the respiratory outcomes in children up to five years of age. Overall evaluation of the household chemical exposure may be useful tool for any large epidemiological studies., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Formaldehyde is a common preservative and strong sensitizer., Objective: The aim of the study was to evaluate the release of formaldehyde from baby/toddler wet wipes using the chromotropic acid method (CAM)., Methods: An online search of best-selling baby wipes was conducted. None declared formaldehyde or formaldehyde-releasing preservatives. Standard CAM procedures were used: a 1 × 1-in square of fresh wipe was placed in a bottle with an open vial of 4 mg/1 mL of chromotropic acid and sulfuric acid solution, sealed, and stored for 48 hours. Formalin and water served as controls. A blinded investigator graded color change (negative, indeterminate, mild, moderate, or strong). For quality control, 20% of all samples as well as all positives were retested., Results: Fifty-one popular and highly reviewed baby and toddler wet wipe products were tested using CAM. Twelve wipes (24%) released formaldehyde (8 mild, 4 moderate/strong). Chromotropic acid method testing of 9 wipes (18%) was indeterminate and 30 (59%) were negative., Conclusions: Almost one quarter of baby/toddler wet wipes released formaldehyde when evaluated with CAM. Patients and clinicians should be aware of this potentially undeclared source of this common allergen.

Purpose: To investigate the epidemiology of ocular exposures reported to poison control centers in the United States., Methods: A retrospective analysis of ocular exposures from 2000 to 2016 was conducted using National Poison Data System data., Results: United States poison control centers received 1,436,683 reports of ocular exposures during 2000-2016, averaging 7,043 exposures per month. The annual frequency of ocular exposures declined significantly by 37.2% from 2006 to 2016. The ocular exposure rate per 10,000 US residents was highest among children < 6 years of age (10.7), particularly among 2-year-olds (20.5), and was lowest among adults ≥ 20 years of age (1.9). The majority of the exposures resulted in minor effects (51.4%). Among exposed individuals, 23.0% were treated and released and 0.3% were admitted to a healthcare facility. Household cleaning products (22.2%), cosmetics/personal care products (15.7%), and pesticides (7.4%) were the most common substance categories associated with exposures, but exposures to building and construction products (18.1%), industrial cleaners (14.9%), and chemicals (14.1%) resulted in a higher percentage of moderate or major effects. In addition, exposures to alkaline substances had a higher percentage of moderate or major effects., Conclusion: Although the annual frequency of ocular exposures declined during the last decade, the number of exposures remains high, particularly among young children. The commonly associated substance categories identified in this study represent important preventable sources of morbidity.

Synthetic musk compounds are extensively used in personal care and cosmetic products around the world. Because they are not completely removed in sewage treatment plants, they eventually end up in aquatic environments. The aim of this review was to summarize published information on effects of polycyclic musks on aquatic organisms and to discuss whether the experimental design of toxicological studies involving these substances could influence the results obtained. With the exception of one study run in a flow-through system, all published toxicological studies on synthetic polycyclic musks have been conducted in semi-static or even static systems. Based upon data in the literature and our own results, we conclude that in toxicological tests with semi-static set-ups, concentrations of polycyclic musks decrease with time between bath exchanges, and, as a result, tested organisms are not being exposed to stable concentrations but rather to concentration pulses. The duration and character of these pulses are influenced mainly by aeration of experimental baths, as polycyclic musks have a tendency to volatilize from water baths. Under semi-static conditions, tested organisms may be subjected to lower concentration of the tested substance for relatively long periods. Those levels may even fall below the limits of quantification. During these periods, some level of detoxification and/or elimination (depuration) of the toxicant may reduce toxic effect of the previous exposures. Consequently, toxicity of polycyclic musk substances for aquatic organisms obtained under these conditions may be underestimated. Based upon existing data in the literature, therefore, it is very difficult to correctly estimate risk of polycyclic musks to aquatic organisms., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To present data on chemical ocular burns in children seen at a single tertiary care facility resulting from accidental eye exposure to the contents of laundry detergent pods., Methods: All emergent pediatric ophthalmology consultations specific for chemical ocular burns at a level I trauma center were included as part of a prospective quality improvement investigation over a 13-month period. Age, causative agent, and examination findings at presentation and final follow-up were recorded and analyzed., Results: A total of 12 children with chemical ocular burns were seen during the study period. All patients were ≤5 years of age. Most chemical ocular burn consultations (n = 8) were specific to ocular exposure of laundry detergent pod contents; the remainder were associated with conventional cleaning agents or pesticides (n = 4). There was a significant association between laundry detergent pod as causative agent and a patient age of 2-5 years, compared to <2 years and any other agent (P = 0.018 [Fisher exact test])., Conclusions: In our study, laundry detergent pods were the most frequent cause of chemical ocular burns in children. Additionally, preschoolers may be at a higher risk of sustaining these injuries. Increased public awareness, product safety improvements, and/or regulation may be advisable to decrease the ocular hazards associated with laundry detergent pods., (Copyright © 2018 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

The NanoAptamer assay is a bisphenol A (BPA) quantification method that uses magnetic beads, quantum dot nanoparticles, and a BPA-specific aptamer. In this study, screening of various consumer and household products for BPA was demonstrated utilizing the NanoAptamer assay. First, the experimental conditions suitable for BPA detection using the NanoAptamer assay were examined in terms of incubation time, temperature, and buffer composition. The range of BPA quantification via the NanoAptamer assay was determined to be 0.005-1000 ng/mL of BPA. The selectivity was confirmed by detecting BPA in an analog mixture containing bisphenol S and bisphenol F. Finally, a leaching experiment using 20 consumer and household products classified into 4 categories was performed to demonstrate the capability of the NanoAptamer assay for BPA detection. The experiment was validated by high-performance liquid chromatography analysis (correlation coefficient, r = 0.99)., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Pressure cookers are common kitchen appliances with a good safety record and only rare associated explosions., Case Report: Here we present a case of unintentional pressure cooker explosion leading to polytrauma with injuries including pneumothorax, intracranial hemorrhage, open skull fracture, and multiple facial fractures. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Extreme forces and temperatures are involved in pressure cooking. Given the infrequent but real risk of mechanical failure and the increasing use of such devices to create intentional explosions, emergency physicians should be aware of the potentially significant blast injuries that can be associated with them., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Consumers regularly use household care and personal care products (HC&PCPs). Isothiazolinones are included in HC&PCPs as preservatives and are being held responsible for an epidemic rise in allergic contact dermatitis (ACD). The objective of this study was to assess the origin and extent of dermal exposure in order to evaluate the risk of ACD from isothiazolinones in HC&PCP. Individual-based aggregate dermal exposure to four isothiazolinones was estimated using the newly proposed Probabilistic Aggregated Consumer Exposure Model-Kinetic, Dermal (PACEM-KD) by combining the reported individual use patterns for HC&PCP in Switzerland (N = 669 (558 adults), ages 0-91) with isothiazolinone concentrations measured in products used by the individual person. PACEM-KD extends the original PACEM by considering exposure duration, product dilution and skin permeability. PACEM-KD-based higher-tier exposure on palms (99th percentile) was 15.4 ng/cm 2 , 1.3 ng/cm 2 , 0.9 ng/cm 2 , and 0.08 ng/cm 2 for the isothiazolinones 1,2‑Benzisothiazol‑3‑(2H)‑one (BIT), 2‑Octyl‑3(2H)‑isothiazolinone (OIT), 2‑Methylisothiazolin‑3(2H)‑one (MI), and 5‑Chloro‑2‑methyl‑4‑isothiazolin‑3‑one (CMI), respectively. Major sources of exposure to BIT included all-purpose cleaners, dishwashing detergent, and kitchen cleaner, while exposure to OIT mainly stems from a fungicide. For MI, the main contributors were dishwashing detergent and all-purpose wet wipes, and for CMI all-purpose cleaner. A Quantitative Risk Assessment (QRA) for BIT using Sensitization Assessment Factors (SAFs) indicates that around 1% of the Swiss population is at risk to be sensitized by BIT in cosmetics and household chemicals. For isothiazolinones in general the presented higher-tier modelling approach suggests that household cleaners are currently more important sources of exposure than cosmetics., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Water pollution are among the most critical problems in China and emerging contaminants in surface water have attracted rising attentions in recent years. There is great interest in China's future environmental quality as the national government has committed to a major action plan to improve surface water quality. This study presents methodologies to rank the importance of socioeconomic and environmental drivers to the chemical concentration in surface water during 2000-2030. A case study is conducted on triclosan, a home and personal care product (HPCP) ingredient. Different economic and discharge flow scenarios are considered. Urbanization and wastewater treatment connection rates in rural and urban areas are collected or projected for 2000-2030 for counties across China. The estimated usage increases from ca. 86 to 340 t. However, emissions decreases from 76 to 52 t during 2000-2030 under a modelled Organisation for Economic Co-operation (OECD) economic scenario because of the urbanization, migration and development of wastewater treatment plants/facilities (WWTPs). The estimated national median concentration of triclosan ranges 1.5-8.2 ng/L during 2000-2030 for different scenarios. It peaks in 2009 under the OECD and three of the Intergovernmental Panel on Climate Change (IPCC), A2, B1 and B2 economic scenarios, but in 2025 under A1 economic scenario. Population distribution and surface water discharge flow rates are ranked as the top two drivers to triclosan levels in surface water over the 30 years. The development of urban WWTPs was the most important driver during 2000-2010 and the development of rural works is projected to be the most important in 2011-2030. Projections suggest discharges of ingredients in HPCPs - controlled by economic growth - should be balanced by the major expenditure programme on wastewater treatment in China., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to assess the prevalence of multiple chemical sensitivities (MCS), its co-occurrence with asthma and fragrance sensitivity, and effects from exposure to fragranced consumer products., Methods: A nationally representative cross-sectional population-based sample of adult Americans (n = 1137) was surveyed in June 2016., Results: Among the population, 12.8% report medically diagnosed MCS and 25.9% report chemical sensitivity. Of those with MCS, 86.2% experience health problems, such as migraine headaches, when exposed to fragranced consumer products; 71.0% are asthmatic; 70.3% cannot access places that use fragranced products such as air fresheners; and 60.7% lost workdays or a job in the past year due to fragranced products in the workplace., Conclusion: Prevalence of diagnosed MCS has increased over 300%, and self-reported chemical sensitivity over 200%, in the past decade. Reducing exposure to fragranced products could help reduce adverse health and societal effects.

Use of quantitative risk assessment (QRA) for assessing the skin sensitization potential of chemicals present in consumer products requires an understanding of hazard and product exposure. In the absence of data, consumer exposure is based on relevant habits and practices and assumes 100% skin uptake of the applied dose. To confirm and refine the exposure, a novel design for in vitro skin exposure measurements was conducted with the preservative, methylisothiazolinone (MI), in beauty care (BC) and household care (HHC) products using realistic consumer exposure conditions. A difference between measured exposure levels (MELs) for MI in leave-on versus rinse-off BC products, and lower MELs for MI in HHC rinse-off compared to BC products was demonstrated. For repeated product applications, the measured exposure was lower than estimations based on summation of applied amounts. Compared to rinse-off products, leave-on applications resulted in higher MELs, correlating with the higher incidences of allergic contact dermatitis associated with those product types. Lower MELs for MI in rinse-off products indicate a lower likelihood to induce skin sensitization, also after multiple daily applications. These in vitro skin exposure measurements indicate conservatism of default exposure estimates applied in skin sensitization QRA and might be helpful in future risk assessments., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Wet wipes are a significant allergen source for anogenital allergic contact dermatitis., Objective: The aim of the study was to calculate the frequency of potentially allergenic ingredients in personal hygiene wet wipes., Methods: Ingredient lists from brand name and generic personal hygiene wet wipes from 4 large retailers were compiled., Results: In the 54 personal hygiene wet wipes evaluated, a total of 132 ingredients were identified (average of 11.9 ingredients per wipe). The most common ingredients were Aloe barbadensis (77.8%), citric acid (77.8%), fragrance (72.2%), sorbic acid derivatives (63.0%), tocopherol derivatives (63.0%), glycerin (59.3%), phenoxyethanol (55.6%), disodium cocoamphodiacetate (53.7%), disodium ethylenediaminetetraacetic acid (EDTA) (42.6%), propylene glycol (42.6%), iodopropynyl butylcarbamate (40.7%), chamomile extracts (38.9%), sodium benzoate (35.2%), bronopol (22.2%), sodium citrate (22.2%), lanolin derivatives (20.4%), parabens (20.4%), polyethylene glycol derivatives (18.5%), disodium phosphate (16.7%), dimethylol dimethyl hydantoin (DMDM) (14.8%), and cocamidopropyl propylene glycol (PG)-dimonium chloride phosphate (11.1%). Of note, methylisothiazolinone (5.6%) was uncommon; methylchloroisothiazolinone was not identified in the personal hygiene wet wipes examined., Conclusions: There are many potential allergens in personal hygiene wet wipes, especially fragrance and preservatives.

Benzalkonium chloride is a quaternary ammonium cationic detergent present in a number of household products, which can act as a major skin irritant. We present the case of six children who developed granular parakeratosis after exposure to benzalkonium chloride in laundry rinse aids, presenting as a brightly erythematous, tender but minimally pruritic, intertriginous eruption followed by superficial desquamation. The eruptions resolved over 3-4 weeks after cessation of exposure., (© 2016 The Australasian College of Dermatologists.)

Background: An alarming increase in the prevalence of sensitization to the preservative methylisothiazolinone (MI), alone or in combination with methylchloroisothiazolinone (MCI), has recently been reported, mainly in Northern Europe. Prevalence data from Southern Europe are scanty., Methods: We evaluated the prevalence of contact allergy to MI and MCI/MI among 1392 patients consecutively patch tested in 2012-2013 at the Clinica Dermatologica of San Martino Hospital, Genoa, Italy. The patients were patch tested with 2000 ppm MI aq. in addition to the Italian baseline series. The MOAHLFA Index (Male, Occupation, Atopic Dermatitis, Hand, Legs, Face, Age above 40 years) was registered for all patients. Relevant exposures to MI and/or MI/MCI were determined and the patients' clinical outcome after isothiazolinones avoidance was evaluated., Results: The prevalence of sensitization to MI showed a steep increase of prevalence from 2.3% in 2012 to 6.9% in 2013 while sensitization to MI/MCI rose from 6.76% in 2012 to 9.04% in 2013. Hand and face dermatitis were significantly prevalent in MI allergic patients. Cosmetics, followed by household products, were the most common sources of relevant exposure to both MI and MI/MCI. Clinical improvement after avoidance of isothiazolinones containing products was reported by 85.3% of followed up patients., Conclusions: In Italy the prevalence of MI and MI/MCI contact allergy is alarmingly high and it is increasing.

Competing Interests: Competing interests: None declared.

Endocrine disrupting chemicals, a group of exogenous chemicals that can interfere with hormone action in the body, have been implicated in disrupting endocrine function, which negatively affects human health and development. Endocrine disrupting chemicals are ubiquitously detected in consumer products, foods, beverages, personal care products, and household cleaning products. Due to concerns about their negative effects on human health, several professional health provider societies have recommended the reduction of common endocrine disrupting chemical exposures. The purpose of this review is to provide a brief overview of common endocrine disrupting chemicals (bisphenol A, phthalates, triclosan, polybrominated ethers, and parabens) and potential effects on child development and health. In addition, we aim to provide guidance and resources for pediatricians and other health care providers with counseling strategies to help patients to minimize exposures to common endocrine disrupting chemicals., (Copyright © 2017 Mosby, Inc. All rights reserved.)

Background and Objective: Inhalation exposure to household chemicals can result in serious health problems, although the long-term outcomes are unclear. We evaluated the changes in lung function after home humidifier disinfectant (HD) exposure., Methods: This post hoc analysis of a prospective nationwide cohort involved patients with inhalation lung injury due to HD. Patients underwent spirometric measurements at onset and annually thereafter., Results: Forty subjects met the eligibility criteria. Overall, mean forced vital capacity (FVC) increased significantly during the first 3 years from 2.10 ± 0.74 to 3.06 ± 1.08 L. Mean forced expiratory volume in 1 s (FEV 1 ) also rose from 1.84 ± 0.63 to 2.62 ± 0.88 L. Both variables then stabilized. However, in 19 (48%) patients, the FVCs did not normalize. Compared to subjects with an FVC at onset of <2.5 L, subjects with onset FVC ≥2.5 L exhibited significantly more improvement in percent predicted FVC over time (group × time interaction: P < 0.001). Patients with lower exposure also exhibited increasing percent predicted FVC over time, whereas more exposed patients showed a plateau starting at year 1. On multivariate analysis, onset FVC < 2.5 L associated significantly with <80% predicted FVC at year 4 (adjusted OR: 20.33; 95% CI: 1.10-376.53; P = 0.04)., Conclusion: Half of the patients with inhalation injury exhibited stabilization of lung function within several years of onset. However, lung function was impaired in the remaining patients. This impairment associated with lung function at onset and exposure intensity., (© 2016 Asian Pacific Society of Respirology.)

Exposure to chemicals in consumer products has been gaining increasing attention, with multiple studies showing that near-field exposures from products is high compared to far-field exposures. Regarding the numerous chemical-product combinations, there is a need for an overarching review of models able to quantify the multiple transfers of chemicals from products used near-field to humans. The present review therefore aims at an in-depth overview of modeling approaches for near-field chemical release and human exposure pathways associated with consumer products. It focuses on lower-tier, mechanistic models suitable for life cycle assessments (LCA), chemical alternative assessment (CAA) and high-throughput screening risk assessment (HTS). Chemicals in a product enter the near-field via a defined "compartment of entry", are transformed or transferred to adjacent compartments, and eventually end in a "human receptor compartment". We first focus on models of physical mass transfers from the product to 'near-field' compartments. For transfers of chemicals from article interior, adequate modeling of in-article diffusion and of partitioning between article surface and air/skin/food is key. Modeling volatilization and subsequent transfer to the outdoor is crucial for transfers of chemicals used in the inner space of appliances, on object surfaces or directly emitted to indoor air. For transfers from skin surface, models need to reflect the competition between dermal permeation, volatilization and fraction washed-off. We then focus on transfers from the 'near-field' to 'human' compartments, defined as respiratory tract, gastrointestinal tract and epidermis, for which good estimates of air concentrations, non-dietary ingestion parameters and skin permeation are essential, respectively. We critically characterize for each exposure pathway the ability of models to estimate near-field transfers and to best inform LCA, CAA and HTS, summarizing the main characteristics of the potentially best-suited models. This review identifies large knowledge gaps for several near-field pathways and suggests research needs and future directions., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Introduction: A suicide trend that involves mixing household chemicals to produce hydrogen sulfide or hydrogen cyanide, commonly referred to as a detergent, hydrogen sulfide, or chemical suicide is a continuing problem in the United States (U.S.). Because there is not one database responsible for tracking chemical suicides, the actual number of incidents in the U.S. is unknown. To prevent morbidity and mortality associated with chemical suicides, it is important to characterize the incidents that have occurred in the U.S., Methods: The author analyzed data from 2011-2013 from state health departments participating in the Agency for Toxic Substances and Disease Registry's National Toxic Substance Incidents Program (NTSIP). NTSIP is a web-based chemical incident surveillance system that tracks the public health consequences (e.g., morbidity, mortality) from acute chemical releases. Reporting sources for NTSIP incidents typically include first responders, hospitals, state environmental agencies, and media outlets. To find chemical suicide incidents in NTSIP's database, the author queried open text fields in the comment, synopsis, and contributing factors variables for potential incidents., Results: Five of the nine states participating in NTSIP reported a total of 22 chemical suicide incidents or attempted suicides during 2011-2013. These states reported a total of 43 victims: 15 suicide victims who died, seven people who attempted suicide but survived, eight responders, and four employees working at a coroner's office; the remainder were members of the general public. None of the injured responders reported receiving HazMat technician-level training, and none had documented appropriate personal protective equipment., Conclusion: Chemical suicides produce lethal gases that can pose a threat to responders and bystanders. Describing the characteristics of these incidents can help raise awareness among responders and the public about the dangers of chemical suicides. Along with increased awareness, education is also needed on how to protect themselves., Competing Interests: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.

Background: Previous studies have shown that children as young as 18 months can open a microwave and remove its contents causing sometimes severe scalds. Although this mechanism may be uniquely preventable by an engineering fix, no national estimate of this type of child burn injury has been reported., Methods: We analyzed the Consumer Product Safety Commission's National Electronic Injury Surveillance System data on emergency department-treated microwave-related burn injuries from January 2002 through December 2012 in children aged 12 months to 4 years. Based on the narrative description of how the injury occurred, we defined a case as a burn with a mechanism of either definitely or probably involving a child himself or herself opening a microwave oven and accessing the heated contents. National estimates of cases and their characteristics were calculated., Results: During the 11 years studied, an estimated 10,902 (95% confidence interval, 8,231-13,573) microwave-related burns occurred in children aged 12 months to 4 years. Of these, 7,274 (66.7%) (95% confidence interval, 5,135-9,413) were cases of children burned after accessing the contents of the microwave themselves. A total of 1,124 (15.5%) cases required hospitalization or transfer from the treating emergency department. Narratives for children as young as 12 months described the child himself or herself being able to access microwave contents. The most commonly burned body parts were the upper trunk (3,056 cases) and the face (1,039 cases). The most common scalding substances were water (2,863 cases), noodles (1,011 cases), and soup (931 cases)., Conclusion: The majority of microwave-related burns in young children occur as a result of the child himself or herself accessing the microwave and removing the contents. More than 600 young children are treated in US emergency departments annually for such burns. Children as young as 12 months sustained burns caused by this mechanism of injury. These burns could be prevented with a redesign of microwaves to thwart young children from being able to open the microwave oven door., Level of Evidence: Epidemiologic study, level III.

Background: Bleach is widely used for household cleaning. Although it is recognized that occupational use of bleach may have adverse respiratory health effects, it is unknown whether common domestic use of bleach may be a risk factor for asthma., Aim: To assess whether the domestic use of bleach for home cleaning is associated with asthma and other respiratory outcomes., Methods: Questionnaire-based information on respiratory symptoms and cleaning habits and data from skin prick-tests, bronchial responsiveness challenge and white blood cells were analyzed in 607 women participating in the follow-up of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA). Bleach use was evaluated in 3 categories (<1 day/week; 1-3 days/week; 4-7 days/week "frequent")., Results: Overall, 37% of the women reported using bleach weekly. Women using bleach frequently (11%) were more likely to have current asthma as compared to non-users (adjusted Odds-Ratio (aOR) = 1.7; 95% Confidence Interval (95%CI) 1.0-3.0). Among women with asthma, frequent use of bleach was significantly associated with higher blood neutrophil cell counts. Bleach use was significantly associated with non-allergic asthma (aOR 3.3; 95%CI 1.5-7.1), and more particularly with non-allergic adult-onset asthma (aOR 4.9; 95%CI 2.0-11.6). Consistently, among women without allergic sensitization, significant positive associations were found between use of bleach and bronchial hyperresponsiveness, asthma like-symptoms and chronic cough. No association was observed for allergic asthma., Conclusions: Frequent use of bleach for home-cleaning is associated with non-allergic adult-onset asthma, elevated neutrophil counts and lower-airway symptoms in women., (Copyright © 2016 Elsevier Ltd. All rights reserved.)