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Contact Dermatitis. 2008 Jun;58(6):359-63. doi: 10.1111/j.1600-0536.2008.01327.x.

Is the irritant benzalkonium chloride a contact allergen? A contribution to the ongoing debate from a clinical perspective.

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Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-N├╝rnberg, D-91054 Erlangen, Germany.



Benzalkonium chloride (BAC) is a well-recognized irritant. However, doubts exist that it is also a contact allergen.


Analysis of clinical patch test data addressing the reaction profile and synchronous reproducibility of BAC 0.1% in petrolatum (pet.) and possible increases in risk of BAC contact allergy in certain (occupationally exposed) subgroups. PATIENTS /METHODS: Data of 42 898 patients tested with BAC 0.1% in pet. in 3 different series (topical drugs, ophthalmics, and disinfectants) in the departments of the Information Network of Departments of Dermatology ( between 1996 and 2006 was analysed.


Overall, morphologically 'positive' reactions were rare, 0.6-1.5%, with a total of 41 stronger positive reactions. Concordance, assessed in 3322 patients tested in duplicate, was low (kappa coefficient 0.15, 95% CI: 0-0.31). Positive test reactions were observed significantly more often in the disinfectants series compared with the 2 other series, indicating that suspected exposure to disinfectants may be associated with sensitization. However, variation of stronger BAC test positivity across potentially relevant (occupational) groups was non-significant.


This analysis of routine clinical data and a number of previous reports add further, if weak, evidence to the notion that BAC is a contact allergen, albeit a very rare one.

[Indexed for MEDLINE]

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