• Journal of Environmental Health Sciences
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• v.46 no.5
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• pp.481-494
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• 2020

Objectives: No study has been conducted to review characteristics of humidifier disinfectants (HD) products, such as real numbers, levels and types of HD substances contained, or the volume marketed. We aimed to review the characteristics of HD through a literature review. Methods: We collected literature reporting the names, numbers, and ingredients of HD and discussed them with a focus on the number of HD products and the chemicals used as a disinfectant. Results: A total of eight publications has reported the names of HD brands or types of disinfectants from 2011 to 2020. To date, a total of 40 HD products have been used, excluding four products. Eight HD products used polyhexamethylene guanidine phosphate (PHMG) and 14 used a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) as disinfectants. Benzalkonium chloride (BKC) and sodium dichloroisocyanurate (NaDCC) were also used as a disinfectant in several HD products. A total of 19 HD products were associated with the development of HD associated lung injury (HDLI). The Oxy Saksak HD product containing PHMG showed the highest number of HD associated health effects. The type of disinfectant from a total of 14 HD products has not been identified. Conclusions: A total of 40 HD products have been marketed in South Korea since 1994. Further studies should be conducted to identify the association of product characteristics, including type of HD ingredients, with health effects.

• Journal of Environmental Health Sciences
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• v.43 no.5
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• pp.349-359
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• 2017

The objective of this study is to review the safety and health information displayed on containers of humidifier disinfectants (HD). We summarized not only general characteristics related to the marketing and manufacturing of HD, such as the duration sold and the name of the company, but also the safety and health information, such as identification of disinfectants, recommended use volume, and precautions. All of this information was reviewed by HD brand. We collected safety and health information from 31 HD brands. We found that companies that sold and manufactured HD brands differ. Two companies were found to sell their HD without permission after 2011 when the health effects caused by HD were widely known. The name of the disinfectants were not identified on the container of HD. The recommended volumes were found not to be based on toxicological evidence and set without consideration of the level of susceptibility of users. Most companies displayed phrases such "this HD is safe for humans, even children" on the front of the container. No inhalation and skin toxicity precautions were provided. In conclusion, most HD did not properly display information related to safety and health to protect the health of HD users. There has been no official investigation to evaluate the risks posed by HD, such as the sales volume by HD, identification of chemical disinfectants, or their concentration, nor have there been actions to control the chemical quality of HD. In addition, government actions to punish the malicious practices of companies that manufactured and sold HD were found to inappropriate.

• Clinical and Experimental Pediatrics
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• v.63 no.7
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• pp.251-258
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• 2020

Exposure to environmental factors can cause interstitial lung diseases (ILDs); however, such types of ILDs are rare. From 2007 to 2011, an ILD epidemic occurred in South Korea owing to inhalational exposure to toxic chemicals in humidifier disinfectants (HDs). HD-associated ILDs (HD-ILDs) are characterized by rapidly progressing respiratory failure with pulmonary fibrosis and a high mortality rate of 43.8%-58.0%. Although 18.1%-31.1% of the general population used HDs, only a small proportion of HD users were diagnosed with HD-ILDs. This finding suggests that investigation of the pathophysiologies underlying HD-ILDs is needed in addition to the identification of susceptibility to HD-ILDs. Further, there have been several concerns regarding the diverse health effects of exposure to toxic chemicals in HDs, including those that have not been identified, and long-term prognoses in terms of pulmonary function and residual pulmonary lesions observed on follow-up chest images. In this review, we summarize the clinical features, pathologic findings, and changes in radiologic findings over time in patients with HD-ILDs and the results of previous experimental research on the mechanisms underlying the effects of toxic chemicals in HDs. Studies are currently underway to identify the pathophysiologies of HD-ILDs and possible health effects of exposure to HDs along with the development of targeted therapeutic strategies. The experience of identification of HD-ILDs has encouraged stricter control of safe chemicals in everyday life.

• Journal of Environmental Health Sciences
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• v.48 no.3
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• pp.183-194
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• 2022

Background: No study has examined the regulatory factors associated with fatal health problems due to the use of humidified disinfectants (HD) in South Korea. Objectives: This study aimed to identify and discuss the deficiencies and limitations found in the Toxic Chemical Control Acts (TCCA) that failed to prevent the health risk of chemicals in HD products. Methods: The South Korean TCCA was reviewed focusing on acts in operation from 1994 through the end of 2011, the period when HD was allowed in manufacturing and marketing. Results: The TCCA was the act intended to regulate the toxicity of chemicals in HD products. We found the TCCA to lack three key legal clauses which would have been essential to controlling the health risk of HD. First, there was the exemption of toxic and hazard testing for existing chemicals, including chloromethylisothiazolinone (CMIT), methylisothiazolinone (MIT), and benzalkonium chloride (BKC). Secondly, there were no articles requiring industry to provide animal inhalation test result for polymers such as polyhexamethylene guanidine (PHMG) and Oligo(2-)ethoxyethoxyethyl guanidine chloride (PGH). Finally, there was a lack of articles on examining the risk of products as well as on addressing changes in the usage of products. These articles were found to be generally provided in the US Toxic Substance Chemical Act (TSCA) and the EU Registration, Evaluation and Authorization of Chemicals (REACH). Conclusions: In conclusion, the Ministry of Environment of South Korea had not updated key articles for regulating hazardous chemicals, causing large-scale health problems due to HD which had been fundamentally addressed in chemical-related acts in other countries.

• Journal of Environmental Health Sciences
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• v.42 no.6
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• pp.365-374
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• 2016

Objectives: Studies are needed to examine the characteristics of health effects reported by people who used humidifier disinfectant (HD), including the distribution of victims. Methods: We analyzed the distribution of health effects including lung injury that were asserted by a total of 699 individuals who registered with the first through third national programs to determine health effects associated with the use of HD. Results: We found that HD-associated lung injury (HDLI) occurred every year from 2002 through 2011, and in 2011 for 37.2% (n=96) of the total of 258 clinically evaluated HDLI victims. More than half of the victims responded that they were victimized between 2010 and 2011. This was consistent among all classifications by sex, age, HD brand and HD chemical ingredient. Conclusion: This study assumed that the major reason for the outbreak of the health effect between 2010 and 2011 could be the variations in concentrations and physical properties related to polyhexamethylene guanidine (PHMG). Further studies are necessary to examine if some factors related to the chemical disinfectants contained in HD brands may have caused the massive outbreak of health effects including HDLI.

• Journal of Environmental Health Sciences
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• v.47 no.4
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• pp.310-319
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• 2021

Background: Humidifier disinfectant exposure is an ongoing issue, and there is still considerable related controversy. Various approaches are needed to secure scientific evidence on the extent of the victims' damages and for the determination of appropriate compensation. Objectives: The purpose of this study was to assess the association between humidifier disinfectant (HD) use and academic achievement in Korean children. Methods: This study used data from the 8th Panel Study on Korean Children in 2015. For the final study, 1,598 cases were used. T-tests and multiple linear regression analyses were conducted to determine whether the use of humidifier disinfectant is a factor that affects academic ability. Results: Children in groups using humidifier disinfectant showed statistically significantly lower scores in all areas of language, including reading, speaking and writing, and statistically lower scores in all areas of mathematics, including counting, addition and subtraction. In the multiple regression analysis results, which control for the effects of various demographic/social variables, the use of humidifier disinfectants showed statistically significant beta coefficients (β: -0.357, p<0.001), negatively affecting children's language ability. As for the 'math' variable, which was created by combining counting, addition, and subtraction scores, the use of humidifier disinfectants as independent variables also showed statistically significant beta coefficients (β: -0.200, p<0.001), negatively affecting children's math ability. Conclusions: The results of the study showed that depending on whether or not humidifier disinfectants were used, there are differences in children's language abilities, such as reading, speaking, and writing, as well as in their mathematical abilities, such as counting, adding, and subtracting numbers. These findings are thought to serve as a scientific basis for extending the perspective from health effects to more diverse areas of demographic and social impact related to humidifier disinfectant damage and compensation.

• Journal of Environmental Health Sciences
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• v.47 no.6
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• pp.513-520
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• 2021

Background: Benzalkonium chloride (BKC) has been extensively used as a preservative in industrial products and in hygiene, medical, and cosmetic applications. Humidifier disinfectant (HD) products containing BKC have been used in South Korea. Objectives: This study was aimed to review types of products containing BKC, to summarize the regulations in the US, EU, Japan, and South Korea, and to review the health effects associated with the use of HD. Methods: We reviewed and summarized documents which were searched through PubMed and Google Scholar with the key words: BKC and asthma/contact dermatitis, humidifier disinfectant-associated lung injury (HDLI), and more. Results: Regulations in most countries including South Korea do not allow its use as disinfectants in spray-type of products for medicine, cosmetics, and household products. Two types of HD containing BKC (800~1,270 ppm) were marketed in South Korea from 1996~2003. Health effects reported from people who used products containing BKC were allergic contact dermatitis, erythema, and respiratory disease, including asthma. Two people who responded as HD users containing BKC only were confirmed to have developed asthma. HD-associated lung injury (HDLI) was reported by consumers who used both HD containing polyhexamethylene guanidine (PHMG) and HD containing BKC. Conclusions: In conclusion, the use of BKC as a biocide has to be controlled considering the route and pattern of exposure. Products containing BKC as preservatives were reviewed with exposure routes and sites in the human body such as skin, eyes, and the respiratory tract. HD containing BKC was clinically evaluated to be associated with asthma.

• Journal of Environmental Health Sciences
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• v.49 no.3
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• pp.159-168
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• 2023

Background: An ongoing environmental exposure assessment of humidifier disinfectants (HDs) has been conducted since November 2011 among individuals who experienced HD exposure-related adverse health effects. It is being performed in order to determine and quantify exposure to humidifier disinfectants in victims and their families. To date, the assessment has encompassed Cycles I-to-V. There is no report summarizing the characteristics of the subjects from the overall cycles. Objectives: We intended to examine the individual characteristics related to demographics, HD usage, and HD exposure using integrated data from Cycles I-to-V of the environmental exposure assessment of HDs and the changes with the cycles. Methods: We included 7,543 individuals who participated in Cycles I-to-V of the environmental exposure assessment of HDs. We summarized the participants' characteristics regarding their demographics (e.g., sex, education level, and age), HD usage history (e.g., product name, ingredient, and frequency of HD use), and HD exposure (e.g., daily time of HD use, cumulative time of HD use, and exposure intensity). In addition, their characteristics were compared across the cycles of the exposure assessment. Results: Among the 7,543 participants from Cycles I-to-V, there were more male participants than females (51.05% overall), except for Cycles I and III. Across all cycles, a higher proportion of survivors was observed than deceased individuals. While PHMG was the most prevalent ingredient in HDs throughout all the cycles, its proportion gradually decreased over the course of the examination cycles. Participants in Cycle I reported longer daily times of HD use compared to those in the subsequent cycles. On the other hand, cumulative time of HD use was shorter in the earlier cycles than in the later cycles. Conclusions: Using the integrated data from the full cycles of the environmental exposure assessment, this study identified changes in demographic characteristics as well as the HD exposure characteristics between the participants across different cycles.

• Journal of Environmental Health Sciences
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• v.42 no.3
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• pp.141-146
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• 2016

In South Korea, many cases of humidifier disinfectant-associated lung injury (HDLI) have been reported among people who used humidifier products containing humidifier disinfectant (HD). The objectives of this study are to estimate both airborne HD concentration in the room where HD was used and the amount of humidifier disinfectant absorbed into the respiratory system. Information and data on the HDs were collected using a structured questionnaire and home environmental investigations include the volume of HD (ml) and hours used per day, concentration of disinfectants contained in the HD brand (${\mu}g/ml$), volume of the room ($m^3$), assumed ventilation rate ($m^3/hr$) and breathing rate assumed ($m^3/hr$). We used children aged under five years old as a sample and estimated both airborne HD concentrations and amount of HD absorbed into the respiratory system. The estimated airborne concentration of HD in the room ranged from 68 to $369{\mu}g/m^3$ for PHMG (polyhexamethylene guanidine phosphate) and from 16 to $239{\mu}g/m^3$ for PGH (oligo (2-(2-ethoxy) ethoxyethyl guanidine). The amount of HD absorbed in the respiratory system per day was estimated to range from 227 to $1,225{\mu}g$ for PHMG and from 53 to $794{\mu}g$ for PGH. In conclusion, a great amount of HD was likely absorbed into respiratory system, likely beyond the level of the capacity of the immune system to remove the HD absorbed.

• Journal of Environmental Health Sciences
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• v.46 no.3
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• pp.312-323
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• 2020

Objective: This study aimed to summarize the physiochemical properties, toxicity, and legal regulation of chloromethylisothiazolinone (CMIT) and/or methylisothiazolinone (MIT), review the health effects caused by exposure to CMIT/MIT, and evaluate the individual association of lung injury with the use of humidifier disinfectants (HD) containing a mixture of CMIT and MIT. Method: A literature review was conducted by searching keywords such as CMIT, MIT, health effect, dermatitis, asthma, and lung injury, either singly or combined. Results: Both CMIT and/or MIT were found to be associated with the development of several types of adverse health effects. In particular, respiratory diseases including asthma, nasal symptoms, cough, and rhinitis were caused by the use of products including CMIT or/and MIT. The mixture of CMIT/MIT has been banned in cosmetics. As of the end of 2017, nine patients who were confirmed to have HD associated lung injury (HDLI) were found to have used only an HD brand containing CMIT and MIT. Their responses regarding the name of the HD used could be trustworthy based on the short duration of HD use (less than six months) before the onset of HDLI and frequent use of HD per day. Conclusion: According to the toxicity and HDLI cases, the use of HD containing CMIT and /or MIT can cause fatal lung injury. Further study with manufacturers' assistance is necessary in order to obtain more clear evidence on the causal relationship since HDLI cases are being reported continuously.