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After the deadliest terrorist attack on American soil on September 11, 2001, the 107th Congress passed the Aviation and Transportation Security Act on November 19, 2001, and established the Transportation Security Administration (TSA) to oversee all modes of transportation, including air travel. Subsequently, after a liquid explosives threat in 2006, the restrictions further tightened so that travelers could carry liquids onto airplanes only in conformance with the “3-1-1 liquids rule,” ie, in containers no larger than 3.4 ounces (100 mL) in a 1-quart plastic bag. Then in 2010, after the attempted bombing of a flight from Amsterdam to Detroit, the Explosives Trace Detection Test (ETDT) was implemented, a screening process that involves “swabbing” for explosive materials. The TSA prohibits items on airplanes such as explosives and/or flammables, firearms, food items, self-defense items, sharp objects, sporting goods, and tools; however, items of all types are subject to scrutiny. The final decision whether to allow an item onto an airplane rests with the individual TSA agent.1
Security issues are not unknown to oncodermatology patients. The literature reports that at least 3 patients with grade 2 or 3 hand-foot syndrome, who had lost their fingerprints secondary to capecitabine treatment, were either detained at airport security or unable to process government papers or perform banking procedures.2-4 We report a patient–airline passenger who encountered heightened TSA scrutiny of an ammonium lactate–containing moisturizer at 3 different airports in both checked and carry-on luggage.
Report of a Case
A woman with cancer was receiving antiestrogen therapy, which caused dry skin and associated erythema and pruritus. When traveling, she carried her prescribed 385-mL bottle of ammonium lactate, 12%, cream in the standard 1-quart plastic bag, clearly labeled with the appropriate prescription information. Nonetheless, at an airport, the bottle was removed from her carry-on bag following x-ray screening for examination by a TSA agent, and the patient underwent ETDT on her hands.
She was flagged again on another flight when the bottle was spotted in the x-ray machine, and that second screening involved a full body pat-down in addition to the ETDT performed on the bottle and her hands. In addition, a sample was taken from the ammonium lactate moisturizer for analysis.
Before a third domestic flight, the patient placed the ammonium lactate container in her checked luggage with a TSA-approved lock, hoping to avoid delays. However, after arriving at her destination and opening her checked luggage, the patient discovered a printed card saying that the TSA had opened her bag and performed an ETDT.
Ammonium is the salt form of the base ammonia, and for it to exist in stable form, it must be chemically combined with an acid. In the case of ammonium lactate, the acid is lactic acid, the compound forming one of thousands of harmless ammonium salts that are used extensively in cosmetics and everyday household items. However, the most common explosive form of ammonia is the nitrate salt ammonium nitrate. It is the combination with nitrate that is responsible for its explosive property and is the target of TSA scrutiny.
The active ingredient in ammonium lactate, 12%, cream consists of lactic acid neutralized with ammonium hydroxide forming the stable salt ammonium lactate. Lactic acid is an α-hydroxy propionic acid, a hygroscopic humectant that reduces excessive epidermal keratinization to serve as an efficient moisturizer.5 Ammonium lactate is mixed with many other neutral ingredients6 to form the cream (ingredients listed in the Box).
Light mineral oil
Polyethylene glycol (PEG)-100 stearate
Polyoxyl 40 stearate
Magnesium aluminum silicate
Methyl and propyl parabens
Clarification of the differences between related chemical agents is key for maximum security efficiency during transportation. We advise physicians to educate their patients and reassure them that their moisturizer is not dangerous. Current procedures direct patients to alert TSA prior to their travel date and obtain approved labeling to minimize discomfort and stress. Alternatively, patients may arrange to have their ammonium lactate prescribed and ordered at a pharmacy in their destination city.
Corresponding Author: Mario E. Lacouture, MD, Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, MSK 60th St Outpatient Center, Ste 302, 16 E 60th St, New York, NY 10022 (LacoutuM@mskcc.org).
Published Online: August 3, 2016. doi:10.1001/jamadermatol.2016.2665.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported in part by P30 Cancer Center Support Grant P30 CA008748. Work at the Organic Synthesis Core Facility and the Research Pharmacy Core is partially funded through core grant P20 CA008748-48 from the National Cancer Institute.
Role of the Funder/Sponsor: The funding institutions had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Zarbo A, Ouerfelli O, Klang M, Lacouture ME. Increased Airport Scrutiny by the Transportation Security Administration of a Patient-Passenger Carrying Ammonium Lactate–Containing Moisturizer. JAMA Dermatol. 2016;152(9):1054–1055. doi:10.1001/jamadermatol.2016.2665
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