A review of 4652 exposures to liquid laundry detergent capsules reported to the United Kingdom National Poisons Information Service 2008–2018

Abstract

Introduction: Liquid laundry detergent capsules contain concentrated liquid laundry detergent in a water-soluble polyvinyl alcohol membrane. Objective: To review 4652 exposures reported to the United Kingdom National Poisons Information Service (NPIS) and to assess the impact of regulatory changes on potential toxicity. Methods: Telephone enquiries to the NPIS and returned questionnaires for these products were analyzed for the period January 2008 to December 2018. Results: Data on 4652 exposures were reported by telephone or questionnaire, of which 95.4% involved children aged 5 years. Overall, 1738 of 4594 patients remained asymptomatic (Poisoning Severity Score [PSS] 0), 2729 developed minor (PSS 1) features, 107 suffered moderate features (PSS 2), 19 were graded as severe (PSS 3) and one died. Ingestion was involved in most exposures (n ¼ 4175): vomiting occurred in 46.5%, coughing occurred in 4.3% and central nervous system depression in 3.2%. Nine (0.2%) children were intubated and ventilated. The eye was exposed in 646 cases: 371 (59.8%) suffered conjunctivitis or eye irritation and 21 (3.4%) had keratitis/corneal damage, which persisted in one patient for 9 d. The skin was involved in 364 cases; in 127 (35.5%) minor dermal features developed including erythema, irritation and rash. The most commonly reported features in the 127 cases with PSS !2 were vomiting (n ¼ 75), stridor (n ¼ 34), CNS depression (n ¼ 22), keratitis/corneal damage (n ¼ 21), coughing (n ¼ 18), conjunctivitis (n ¼ 13), hypersalivation (n ¼ 12), foaming from the mouth (n ¼ 11) and hypoxemia (n ¼ 11). However, respiratory features (stridor, hypoxemia, bronchospasm, respiratory distress, dyspnea, pulmonary aspiration and tachypnea) were the reason for grading 56 of 127 cases as PSS !2. Conclusions: This large data set of 4652 exposures is reassuring in that 97.2% of exposures resulted in no or only minor features, only 107 patients suffered moderate features (PSS 2) and 19 severe (PSS 3) features; one patient died.

Risks of exposure to liquid laundry detergent pods compared to traditional laundry detergents in dogs

“…1,11 This is in contrast to the results of the current study, in which no corrosive or ulcerative lesions were noted on physical examination. Endoscopic or bronchoscopic exams were not performed on any of the patients in the current study, so it is possible that some lesions were 2 Smith et al found that although ingestion of pod detergent may cause some esophageal injury, none of their patients had oral erythema, ulcers, or swelling that indicated the need for endoscopy. 15 Altogether, the research evidence might best be understood as indicating little or no effect of pod detergent on the stomach and intestines, although clearly more research is needed into this possibility.…”

“…In Europe, these liquid detergents most commonly contain anionic surfactants (20-35% per capsule), non-ionic surfactants (10-20%), propylene glycol (8-20%), and ethanol (2-5%) and have a pH of 7 to 9. 2,3 Based on various Safety Data Sheets (SDS) in the United States, the pod detergent compositions are similar to those in Europe. [4][5][6] After pods were launched in Europe, pediatric patients were reported to develop more severe reactions from oral exposure to these pods as opposed to traditional laundry detergent.…”

Detergent pods and children: a health hazard on the rise

“…Several exposure routes exist in the context of detergents and children, including ingestion, skin contact, and ocular exposure. Ingestion of detergent may lead to numerous systemic features including dyspnea, vomiting, diarrhea, and central nervous system depression [ 1 ]. Severe reactions may lead to pneumonitis, pharyngeal swelling, and upper airway inflammation requiring intensive care.…”

“…Skin contact may result in rashes, blisters, and burns. The face is most commonly involved, followed by the hands and fingers [ 1 ].…”

“…Enhanced warning icons, opaque packages, and child-proof lids have been implemented by some manufacturers. However, it is unclear whether the rates of adverse exposures to laundry detergent pods after such interventions have decreased at a population level [ 1 ]. This is exacerbated by the fact that off brand and generic laundry detergent pods often do not engage in child-proof packaging and manufacturing.…”