Every year, the largest toxicology conference of the world–the North American Congress of Clinical Toxicology–brings together toxicologists from around the globe to learn from each other and present research that impacts all of us. At this year’s conference, three fascinating abstracts on laundry pods.  If not interested in the study details, scroll down to “My take home points from these three abstracts” at the bottom of the blog.

Abstract 1:

Trends in Liquid Laundry Detergents Packet Exposures in Children Reported to Poison Centers from 2012 – 2015. Authors Lucas, Reynolds, Banner and Green

The authors compared the number of unit dose laundry packets sold with national exposure data aggregated by poison centers across the country. They found that laundry pod unit sales increased by over 60% from 2012 to 2015; in that same time period, pediatric poisoning exposures to pods increased by 50% – less than the increasing units sold share would predict. They conclusion was that over the four-year period, the rate of pediatric exposure per 1,000,000 units sold declined about 20%. The rate of pediatric exposure was almost three exposures per 1,000,000 unit packets sold in 2015.

Abstract 2:

Four year trend analysis of childhood exposures to liquid laundry detergent packs in the U.S. Authors Colvin, Yin, Rylander and Vaunia

This study used data from a representative cohort of U.S. poison centers enrolled in a prospective study supported by Proctor & Gamble. The participating poison centers recorded just over 10,700 laundry pod exposures to liquid laundry detergent packets in a four-year period. Unlike the previous abstract, the authors had access to the poison centers’ charts, coding and reported effects from laundry pods. When analyzing the rate by units sold, they found a rate of 1.24 exposures per 1,000,000 units sold in 2012 and a decline to 0.78 exposures per 1,000,000 units sold (37% decrease) in 2015. During the same time period, exposures with serious medical outcomes declined by 58%. Interestingly, they found that single compartment packets had more serious outcomes than multi-compartment packets.

Abstract 3:

SUDS (single-use detergent sacs) Exposures reported to a statewide poison control system:  Impact of Packaging and Labeling Changes. Authors Phan, Ta, Fenik and Vohra

This study was out of California, which has four poison centers serving 38 million Californians. The authors analyzed the four centers’ absolute numbers but did not correct for market share or unit doses sold in order to calculate an exposure rate, which would have been a more useful number to know. They found that soon after Proctor & Gamble changed the packaging of its Tide laundry pod product to be more child resistant, pediatric exposures to that product dropped. The poison centers then saw a gradual increase in calls compared to the baseline. Without a correction for rate, it is hard to know if the increase was due to an increase in product sales or a failure in the packaging. Interestingly, the authors concluded that the brand All Mighty Pacs was statistically associated with moderate or severe poisoning compared to other brands.

My take-home points from these three abstracts:

• The rate of exposures to these products may have decreased since 2012, but the overall volume of pediatric exposures reported to poison centers remains high, as sales of these products have increased greatly since 2012;
• Single compartment unit doses may be associated with worse toxicity when compared to multi-compartment packets; and
• All Mighty Pacs is a single compartment packet, and in the study out of California, it had a statistically significant increase in severity of clinical effects in pediatric poisoning patients compared to other brands.

In the first study, the authors most likely did not have brand names available to them. In the second study, the authors had brand names available but opted to keep the information generic and instead break out the difference between single compartment and multi-compartment products. In the final article, the authors decided to name names – specifically, in their data set, there is a product that is associated with injury more than the others.

Til next time . . .