![]() Methanol toxicity as a result of ingestion, as well as from inhalation and transdermal absorption is not a new entity. In the past month in Dubai, six ABHRs of 102 tested have been removed from the market because of the presence of methanol. Other regions such as the UK also permit methanol to be used in some trade-specific formulations of denatured alcohol. Worldwide, particularly in low income settings, methylated spirits products frequently contain methanol and are readily available. However, a recent Australian alert issued earlier this year described a patient who presented with methanol toxicity having ingested the contents of methylated spirits which was found to contain more than 60% methanol. Whilst in recent years in Australia, the formulation of methylated spirits has largely changed from including methanol (wood alcohol) to other safer denaturants such as denatonium benzoate, there are still some formulations of methylated spirits containing methanol available for purchase - admittedly often at a low concentration of 2% (e.g. Of potential concern is where ‘methylated spirits’ (also known as denatured alcohol) is substituted for ethanol or isopropyl alcohol. Several of these formulas use unvalidated methods and are from non-qualified sources. Unsurprisingly, the shortage of commercially available ABHRs has also led to a multitude of home ‘Do-It-Yourself” (DIY) hand sanitiser recipes circulating online. Glycerol is a safe, relatively inexpensive humectant that acts as an emollient to increase the tolerability of the product and protect skin from contact dermatitis with repeated use. The low concentration of hydrogen peroxide within the WHO formulations is intended to eliminate any bacterial spores present in the formulation and is not considered part of the antisepsis. Benzalkonium chloride, an antiseptic used in some hand sanitisers, appears to have less reliable activity against coronaviruses than either ethanol or isopropyl alcohol and for this reason is not recommended first line for use against SARS-CoV-2. Ethanol and isopropyl alcohol are chosen due to their marked viricidal effect by denaturing proteins and inactivating enveloped SARS-CoV, MERS-CoV - and more recently both formulations have been shown to be effective against SARS-CoV-2. The WHO’s recommended formulations utilise either ethanol 80% v/v (Formulation 1) or isopropyl alcohol 75% v/v (Formulation 2) each with glycerol 1.45% v/v, hydrogen peroxide (H 2O 2) 0.125% v/v and sterile distilled or boiled cold water. ![]() The magnitude and speed in response is commendable in this era of unprecedented demand, but may also carry some potential risks. Consequently, there has been a surge in production of large quantities of ABHR by various businesses, including pharmacies and alcohol distilleries. In the UK and USA, local businesses are allowed to produce hand sanitizer adhering to WHO formulations, however the alcohol used must be denatured prior to production of the ABHR. The Australian Therapeutic Goods Administration (TGA) currently allows for hand sanitizer to be produced without the requirement of TGA approval or notification, provided one of the two formulations developed by the WHO are used. Several countries including the United States of America (USA), Australia and the United Kingdom (UK) have relaxed legislation to make it easier for local businesses to rapidly produce ABHRs. Whilst hand washing with soap and water remains the effective method to reduce transmission of the virus, ABHRs provide a convenient, effective and relatively low cost alternative worldwide. The COVID-19 (SARS-CoV-2) pandemic, declared by the World Health Organization (WHO) on 11th March 2020 has led to a global shortage in commercially available alcohol-based hand rubs (ABHRs).
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