J Korean Med Sci.  2004 Apr;19(2):289-290. 10.3346/jkms.2004.19.2.289.

Anaphylaxis Caused by Benzalkonium in a Nebulizer Solution

• Kim SH
• Ahn Y

• KMID: 1733491
• DOI: http://doi.org/10.3346/jkms.2004.19.2.289

Abstract

Benzalkonium chloride (BAC) is commonly used as a bactericidal preservative in nebulizer solutions, and can cause paradoxical onchoconstriction following nebulizing therapy in some asthmatics. We describe a case of anaphylactic shock in a 23-yr-old asthmatic woman following an intradermal skin test with a salbutamol solution containing BAC. Since she complained of cough and dyspnea after inhalation therapy with a nebulizer solution, we conducted an intradermal skin test using the same solution, which contained BAC. About 10 min later, the patient reported dizziness, palpitations, and dyspnea. On examination, tachycardia, tachypnea, and hypotension were found. She was resuscitated with a subcutaneous injection of epinephrine and an infusion of saline. One month later, we conducted a bronchial provocation test with BAC, and she showed a positive response.

Keyword

Anaphylaxis; Preservatives, Pharmaceutical; Skin Tests; Adrenergic beta-agonist

MeSH Terms

Adult
Anaphylaxis/*chemically induced
Anti-Asthmatic Agents/administration & dosage
Anti-Infective Agents, Local/*adverse effects
Asthma/*drug therapy
Benzalkonium Compounds/*adverse effects
Female
Human
Nebulizers and Vaporizers
Support, Non-U.S. Gov't

Reference

1. Asmus MJ, Barros D, Liang J, Chesrown SE, Hendeles L. Pulmonary function response to EDTA, an additive in nebulized bronchodilators. J Allergy Clin Immunol. 2001. 107:68–72.

2. Bernstein JA, Stauder T, Berstein DI, Bernstein IL. A combined respiratory and cutaneous hypersensitivity syndrome induced by work exposure to quaternary amines. J Allergy Clin Immunol. 1994. 94:257–259.

3. Purohit A, Kopferschmitt-Kubler MC, Moreau C, Popin E, Blaumeiser M, Pauli G. Quaternary ammonium compounds and occupational asthma. Int Arch Occup Environ Health. 2000. 73:423–427.

4. Read GW, Kiefer EF. Benzalkonium chloride: selective inhibitor of histamine release induced by compound 48/80 and other polyamines. J Pharmacol Exp Ther. 1979. 211:711–715.

5. Miszkiel KA, Beasley R, Rafferty P, Holgate ST. The contribution of histamine release to bronchoconstriction provoked by inhaled benzalkonium chloride in asthma. Br J Clin Pharmacol. 1988. 25:157–163.