Mast Cell disorders mean that you can have an allergy-like reaction to basically everything.
In my case, this has meant I spent several months trying to figure out why I kept getting hives in a Very Sensitive Area. I finally figured out that my toilet paper was the culprit.
Finding a toilet paper that I didn’t react to took longer, although fortunately I received several suggestions from friends with MCAS who also had this particular flavor of uncomfortable reaction.
Some of the toilet papers that worked for my friends didn’t work for me. Mast Cell triggers can unfortunately vary a great deal.
I’ve spent a lot of time thinking about what my specific toilet paper related triggers are, in an attempt to be able to predict whether toilet paper is going to give me hives.
This isn’t to say I’ve identified every possible toilet paper related trigger. But here are my best guesses:
1. Texture
Rough toilet paper is going to be more rough on my delicate mucus membranes.
When skin is damaged, it provokes an immune response. This immune response is the first part of how your body repairs damage. Mast cells are involved in this immune response.
My mast cells tend to keep the immune response going long after it’s actually helpful.
Rough or scratchy toilet paper is more likely to cause problems for me.
Additionally, I tend to have trouble with “waffle” textured toilet paper, or anything with a lot of ridges. I find “quilted” toilet paper tends to be more smooth.
Some toilet paper seems to “shed” small particles of paper fairly easily. I also find this tends to cause more irritation for me.
For me this means I’m looking for:
✅ soft paper
✅ smooth paper (quilted)
❌ rough paper
❌ textured paper (waffle)
❌ toilet paper that “sheds”
2. Fragrances
Not everyone with MCAS has a reaction to fragrances. “Fragrances” can also include a wide variety of different chemical compounds (both synthetic and naturally occuring).
I’m sure some company somewhere has made intentionally scented toilet paper.
However, toilet paper can also absorb scents from the surroundings area. In the grocery store, toilet paper is often stocked near cleaning supplies. It can absorb the fragrances from nearby scented products.
In public bathrooms, toilet paper can absorb fragrances from the cleaners used in the bathroom, from air fresheners, and potentially from other people’s perfume/cologne.
Toilet paper can also absorb fragrances from the warehouse where it’s stored. Some companies appear to add a fragrance to their packaging.
Toilet paper can also absorb fragrances from your home or your neighbors apartment.
I tend to store my toilet paper in a sealed container, to prevent accidental fragrance transfer.
Toilet paper can potentially absorb VOCs from plastic packaging. I typically try to get plastic free toilet paper where possible.
It’s hard to predict if toilet paper is going to have bonus fragrances.
There are some companies that only sell toilet paper, and ship it directly to you. In my experience, these are less likely to have bonus fragrances.
I have also generally had good luck ordering toilet paper from Thrive Market (a US based company).
It’s also possible to air out some of the fragrances. For example, one could place the toilet paper in a sealed container with a paper bag of activated charcoal. Activated charcoal can bind to some of the fragrances.
For me this means:
✅ toilet paper shipped from a dedicated toilet paper company
✅ home toilet paper stored in sealed container
✅ toilet paper packaged in paper
✅ activated charcoal to absorb fragrances (if needed)
❌ toilet paper stored near fragranced items (eg cleaning supplies)
❌ toilet paper packaged in plastic
3. Chemical treatments
“Chemicals” are not necessarily bad.
Even potentially harmful chemicals can often be ok in very low doses. There’s a saying in science: “the dose makes the poison.”
Unfortunately, my tolerance for potentially harmful chemicals seems to be lower than the average person.
There are two potentially harmful chemicals frequently used in making toilet paper which may cause problems with my own MCAS.
One is formaldehyde. Formaldehyde is used to make toilet paper softer in the US. I have found one case study identifying toilet paper as a possible cause of chronic vulvar irritation.
(Formaldehyde is also sometimes used in clothing manufacturing as well, especially “wrinkle free” and “easy care” clothing.)
In my experience, there are three ways to find formaldehyde free toilet paper:
- Rough, scratchy toilet paper
- Bamboo toilet paper (typically soft and durable without the need for formaldehyde)
- Eco friendly toilet paper that advertises it’s made “without harsh chemicals”
Note that there’s no set definition of “eco friendly toilet paper.” However, some companies specify exactly what they mean by “eco friendly.” Aside from emailing the manufacturer, I’ve found toilet paper advertised as “made without harsh chemicals” seems to work better for me.
I also seen to have problems with toilet paper whitened with chlorine bleach.
Chlorine evaporates fairly quickly, so it is unlikely that there is chlorine residue on the finished toilet paper products.
However, I do have another plausible explanation for this reaction. When wood pulp is exposed to chlorine bleach, this produces dioxins. Dioxins are a form of persistent organic pollutant (POP) with numerous harmful effects. Dioxins can also affect the immune system. I have yet to find a paper specifically studying the connections between dioxins and mast cells.
Again: the dose makes the poison. The amount of dioxin residue in toilet paper is very low (measured in “parts per trillion”). The greatest risk is to people working in paper mills, rather than the average toilet paper user.
However, I think it’s plausible that my threshold for trace amounts of dioxin is lower than the average person.
Fortunately, many “eco-friendly” toilet papers are made without chlorine bleach:
- Brown toilet paper
- “Whitened without the use of chlorine”
Toilet paper brands
I know from experience that when you’re dealing with MCAS, trying to find products is incredibly time consuming and hard.
So I’m going to share some products that meet some of the specifications above. Note that I live in the US, so these are brands sold in the US.
As a reminder: toilet paper can absorb fragrances, so it’s hard to say for sure if a brand will stay fragrance free. Buying directly from the manufacturer can sometimes help with this.
Chlorine free. Formaldehyde free. Soft. Smooth texture. Bamboo based. Plastic-free packaging.
Chlorine free. Formaldehyde free. Soft. Smooth texture. Bamboo based. Plastic-free packaging.
Everspring (Target store brand)
Chlorine free. Formaldehyde free. Smooth texture. Some lint. Recycled. Packaged in plastic. Relatively affordable.
Chlorine free. Formaldehyde free. Waffle texture. Soft. Bamboo. Plastic-free packaging.
Chlorine free. Formaldehyde free. Waffle texture. Soft. Bamboo. Plastic-free packaging.
Scott Professional Toilet Paper
Probably formaldehyde free (texture). Rough. Recycled. Plastic-free packaging. Didn’t give me a rash. Relatively affordable.
Marcal Professional Toilet Paper
Probably formaldehyde free (texture). Rough.Chlorine free. No added fragrances. Recycled. Plastic-free packaging. Didn’t give me a rash. Relatively affordable.
Note there are multiple product lines of Marcal Professional Toilet Paper. I have been on with each one I tried.
References
Anderson, Stacey E, and B Jean Meade. “Potential health effects associated with dermal exposure to occupational chemicals.” Environmental health insights vol. 8, Suppl 1 51-62. 17 Dec. 2014, doi:10.4137/EHI.S15258
Ito, Tomohiro et al. “TCDD exposure exacerbates atopic dermatitis-related inflammation in NC/Nga mice.” Toxicology letters vol. 177,1 (2008): 31-7. doi:10.1016/j.toxlet.2007.12.011
Keenan, R E. and M.M. Sauer, et al. “Assessment of potential health risks from dermal exposure to dioxin in paper products.” Chemosphere,
Volume 19, Issues 1–6, 1989, Pages 877-882, https://doi.org/10.1016/0045-6535(89)90425-6.
Majerovich, Jo Ann et al. “Chronic vulvar irritation: could toilet paper be the culprit?.” Canadian family physician Medecin de famille canadien vol. 56,4 (2010): 350-2.
Marshall, Nikki B, and Nancy I Kerkvliet. “Dioxin and immune regulation: emerging role of aryl hydrocarbon receptor in the generation of regulatory T cells.” Annals of the New York Academy of Sciences vol. 1183 (2010): 25-37. doi:10.1111/j.1749-6632.2009.05125.x
Liminal Nest 