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754 exposures to reed diffusers reported to the United Kingdom National Poisons Information Service 2010–2014

Abstract Objective: The objective of this study is to review the reported toxicity of reed diffuser fragrance liquid which, in addition to essential oils, commonly contains glycol ethers but other ingredients and/or alternatives are 3-methoxy-3-methyl-1-butanol, petroleum distillates, ethanol and isopropanol. Methods: We analysed retrospectively enquiries to the United Kingdom National Poisons Information Service between 1 January 2010 and 31 December 2014. Results: 754 patients were exposed to reed diffusers; the majority (n = 712) were children < 5 years. Ingestion was the most common route of exposure (706 of 754 patients) and involved the liquid alone (n = 570), water beads alone (n = 84), sucking on the reeds (n = 31) or ingesting the liquid and water beads (n = 21). The reported amount of fragrance liquid ingested was known in only 76 of 591 cases (12.9%), with a median (IQR) volume of 20.0 (IQR = 10–40) mL. The WHO/IPCS/EC/EAPCCT Poisoning Severity Score (PSS) was known in 702 of 706 sole ingestions: in 574 (81.3%), the PSS was 0 (asymptomatic); in 117 (16.6%) patients, the PSS was 1 (minor toxicity); in 11 (1.6%), the PSS was 2 (moderate toxicity); there were no patients with features graded PSS 3 (severe toxicity). Significantly (p = 0.008) more patients became symptomatic (PSS 1 and PSS 2) following the ingestion of a reed diffuser containing 3-methoxy-3-methyl-1-butanol than propylene glycol monobutyl ether, though there was no significant difference when compared with those containing dipropylene glycol monomethyl ether (p = 0.181). The most common features following ingestion of fragrance liquid were nausea and vomiting (n = 53), coughing (n = 17) and CNS depression (n = 9). Seven patients suffered eye exposure alone: two developed eye pain and four conjunctivitis. Dermal exposure alone was reported in six patients, two of whom developed skin irritation. Conclusions: The majority of patients in our study developed no features or only minor symptoms following ingestion of reed diffuser fragrance liquid.