Gulf War and Health Volume 2: Insecticides and Solvents (2003) / Chapter Skim
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9. Additional Health Effects
9. Additional Health Effects
Pages 484-530
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From page 484... ...
Epidemiologic Studies of Aplastic Anemia and Exposure to Insecticides Several studies have examined the risk factors for aplastic anemia in relation to exposure to insecticides and pesticides. in response to concerns about possible high rates of aplastic anemia in Thailand, a population-based, case-control study began in Bangkok in 1989 and was expanded in 1991 to include two rural regions of Thailand (~:ssaragnsi!
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From page 485... ...
Risk of aplastic anemia was not consistently elevated for occupational exposure to insecticides (n = ~ 8) compared with hospitalized controls (odds ratio [OR]
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From page 486... ...
Neighbor control comparison 4 0.4 (0.1-1.3) Epidemiologic Studies of Aplastic Anemia and Exposure to Organic Solvents Most of the relevant research on aplastic anemia has focused on exposure to benzene; a few studies have examined other specific solvents or solvent mixtures.
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From page 487... ...
The hypothesis of an association with benzene exposure raised by the case reports has been confirmed by several epidemiologic studies, although most of the population-based studies have focused on the relationship between exposure to benzene and hematopoletic cancers (see Chapter 6~. As early as ~ 897, the deaths of four workers at a Swedish bicycle-tire factory were attributed to aplastic anemia associated with exposure to high concentrations of benzene (cited in Aksoy, 19851.
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From page 488... ...
I, 95% CT = 1.~9.2~. However, for the purposes of this review, the inferences Dom the study are limited by the fact that 41°/0 of the patients with aplastic anemia were under 20 years old at diagnosis and would not have had substantial occupational exposures.
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From page 489... ...
Using interviews with the case and control subjects, the researchers examined several risk factors for aplastic anemia. For the cases and controls drawn from Bangkok hospitals, there was a strong association with a history of solvent exposure (RR = 4.6, 95°/O CT = 2.5-~.71.
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From page 490... ...
TABLE 9.2 Selected Epidemiologic Studies: Aplastic Anemia and Exposure to Organic Solvents r Reference Population Exposed Estimated Relative Cases Risk (95% CI) Benzene Cohort Studies Paci et al., 1989 Shoe-manufacturing workers in Florence, Italy Females l 4.1 6a Males 6 15.66 (5.47-32.64)
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From page 491... ...
bStudy reported no nonexposed workers with aplastic anemia. CARDIOVASCULAR EFFECTS Cardiovascular disease is among the most common causes of death, chronic illness, and disability among adults in the United States.
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From page 492... ...
Epidemiologic Studies of Cardiovascular Effects and Exposure to Organic Solvents The literature on cardiovascular effects of solvent exposure is primarily on the shortterm consequences of acute exposure. For some solvents, short-term cardiovascular effects are known to occur following acute exposure (reviewed in Kristensen, 1989, Wilcosky and Simonsen, 1991~.
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From page 493... ...
reported on the Copenhagen Male Study, which began in 1970 as a prospective cardiovascular cohort study of 2974 men who were free of THD at the study's outset. At the time of the analysis, IS4 men had had at least one AD event; 258 members of the cohort reported occupational exposure to organic solvents.
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From page 494... ...
Other occupational cohort and case-control studies are fraught with the difficulties of assigning subjects in a retrospective exposure assessment and of controlling for lifestyle and other risk factors. The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insuff~cient evidence to determine whether an association exists between exposure to the specific organic solvents under review or solvent mixtures and irreversible cardiovascular outcomes.
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From page 495... ...
(adjusted OR = I.8, 95% C} = 1.~-3.~. The study was limited by its partial reliance on subjective questionnaire data, by possible selection bias, and by confounding by noninsecticidal occupational exposures.
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From page 496... ...
Epidemiologic Studies of Respiratory Effects and Exposure to Organic Solvents Acute solvent exposure is generally recognized as causing acute mucosal irritation of the eyes, nose, and upper airways and symptoms of eye irritation, cough, and dyspnea that improve after exposure ends (reviewed in De Raeve and Nemery, ~ 999; Schenker and Jacobs, 19961. Rare case reports have described acute pulmonary edema or chemical pneumonitis after (frequently accidental)
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From page 497... ...
Those studies have involved mixed solvent exposures in conjunction with exposures to substances that are known to cause respiratory effects, including reactive and irritant chemicals, metal fumes, agncultural products, and mineral dusts. More than half have shown a higher prevalence of respiratory symptoms such as cough, wheezing, or dyspnea in exposed workers than in control subjects (e.g., Kilburn, 1999; Lebowitz, 1977; McCurdy et al., 1995; Sabroe and Olsen, 1979; Talini et al., 1998; Zuskin et al., 1997a)
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From page 498... ...
There is inadequate/insuff~cient evidence to determine whether an association exists between exposure to the specific organic solvents under review or solvent mixtures and persistent respiratory symptoms or impairment after cessation of exposure.
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From page 499... ...
Common causes of cirrhosis are alcohol-related liver disease and viral infection. Epidemiologic Studies of Hepatic Effects and Exposure to Organic Solvents As discussed in this section, studies on exposure to solvents and hepatic outcomes were limited for the purposes of this review.
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From page 500... ...
can result in hepatic steatosis, which can persist after exposure ends (Dossing et al., 1983; Redlich et al., 1990~. Larger clinical studies also suggest that chronic solvent exposure is associated with hepatic steatosis.
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From page 501... ...
The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insuff~cient evidence to determine whether an association exists between chronic exposure to specific organic solvents under 40ther solvents, particularly carbon tetrachloride, have also been associated with cirrhosis.
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From page 502... ...
There is limited/suggestive evidence of an association between chronic exposure to solvents and hepatic steatosis that could persist after cessation of exposure. TABLE 9.3 Selected Epidemiologic Studies: Hepatic Steatosis and Exposure to Organic Solvents Reference Brodkin et al., 1995 Population Dry-cleaning workers in Seattle Hepatic parenchymal changes arid tetrachloroe~ylene exposure Crude exposure Exposed Estimated Relative Cases Risk (95% CI)
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From page 503... ...
The few studies that have examined pancreatic outcomes had inconsistent results and a lack of specific exposure measures. The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insufficient evidence to determine whether an association exists between exposure to the specific organic solvents under review or solvent mixtures and chronic pancreatitis or other persistent gastrointestinal outcomes.
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From page 504... ...
Epidemiologic Studies of Renal Effects an(1 Exposure to Organic Solvents A number of studies have examined both the short- and Tong-tenn effects on the kidney of exposure to solvents. Acute tubular necrosis has been associated with exposure to a number of solvents.
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From page 505... ...
In a discordant-triplet analysis, the point-estimate rate ratio for gIomerulonephritis and solvent exposure was 3.9 (95°/O CT = I.9-~.~. When the exposure scores were used, there was a trend of increased risk with increased exposure: exposure score less than I, RR = ~ .0; I-]
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From page 506... ...
Logistic regression analyses revealed a trend in occupational-solvent exposure (no exposure, OR = 1.0; lower exposure, OR = 2.12, 95°/0 CT = 0.~-5.57; higher exposure, OR = 5.42, 95°/0 CT: 2.01-14.59; p for linear trend = 0.0002~; no similar response to dose was observed for nonoccupational exposures. Other case-control studies have examined the relationship between gIomerular disease and exposure to solvents.
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From page 507... ...
The RR for rapidly progressive giomerulonephritis with regular exposure to organic solvents was 5.0 (95% CI = .22.00. A large, well-designed case-control study that examined the outcome of end-stage renal disease included cases of giomerulonephritis, hypertensive kidney disease, and interstitial kidney disease (SteenIand et al., 1990~.
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From page 508... ...
Harrington et al., Patients in the United Kingdom 50 total cases 1.0 (0.16-6.3) 1989 Sesso et al., 1990 Patients in Brazil 17 total cases Organic solvents 52.9%a 5.0 (1.14-22.00)
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From page 509... ...
Patch testing has become highly standardized; the concentrations of the potential allergens are below the irritant threshold, so they do not cause false-positive reactions when applied to the skin of nonsensitized subjects who serve as controls (Adams, 1997; Mathias, 1994~. Epidemiologic Studies of Dermatitis and Exposure to Insecticides This section reviews the literature on exposure to insecticides and allergic or imtant contact dermatitis.
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From page 510... ...
Irritant Contact Dermatitis and Other Skin Disorders Several studies have looked at dermatitis and occupational exposures; however, the extent to which the studies specifically differentiate between irritant and allergic contact dermatitis varies. A cross-sectional study in the Netherlands studied male agricultural and horticultural workers and pesticide formulators to determine the effects of exposure to various pesticides, including organophosphates, pyrethrins, chlorinated hydrocarbons, carbamates, and fungicides (Ensberg et al., 19741.
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From page 511... ...
Although case studies and review articles discuss an increased incidence of short-term dermatitis after handling pesticides, there is a limited amount of information about the long-term dermatologic effects of insecticide exposure. Several of the insecticides reviewed in this report have been found to be potential sensitizers, and reexposure to those agents could result in allergic contact dermatitis in sensitized persons.
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From page 512... ...
There is inadequate/insufficient evidence to determine whether an association exists between exposure to the insecticides under review and chronic irritant contact dermatitis after cessation of exposure. Epidemiologic Studies of Dermatitis anti Exposure to Organic Solvents Many solvents are irritants to the skin and cause acute dermatitis.
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From page 513... ...
Eleven had positive patch-test reactions after a 48-hour application. However, because none of the study's subjects gave a history consistent with possible allergic contact dermatitis related to propylene glycol, the authors concluded that all the reactions were irritant effects.
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From page 514... ...
The committee concludes, from its assessment of the epidemiologic literature, that there is sufficient evidence of an association between exposure to propylene glyco] and allergic contact dermatitis that results from sensitization to the compound and subsequent reexposure.
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From page 515... ...
For the purposes of this report, the committee sought to evaluate studies related to MCS that examined populations with known exposure to the relevant Insecticides or organic solvents. Furthermore, studies were sought that evaluated participants (compared with a control or comparison group)
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From page 516... ...
Although not statistically precise, the risk estimates for associations with pesticide exposure were larger than those for other exposures. When ill Gulf War veterans whose self-perception of chemical sensitivity had increased since deployment were compared with healthy veterans, the associations with exposure to both pesticides (OR = 12, 95°/O C} = I.3-]
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From page 517... ...
. That study reported increased risk of systemic sclerosis for males with high cumulative intensity of "any solvent exposure" (OR = 2.9, 95% CI = I.~7.6; 60 exposed cases)
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From page 518... ...
In the analysis, which was based on a job-exposure matrix of occupational use of solvents, the study reported an increase for males with substantial use of organic solvents (RR = 1.2, 95°/O C]
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From page 519... ...
Although there is an indication of elevated risks in several studies of sclerode~ma and exposure to solvents, additional studies using control groups could clarify the nature of this association. The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insufficient evidence to determine whether an association exists between chronic exposure to specific organic solvents under review or solvent mixtures and the systemic rheumatic diseases: scleroderma, rheumatoid arthritis, undifferentiated connective tissue disorders, and systemic lupus erythematosus.
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From page 520... ...
1984. Aplastic anemia due to chemicals and drugs: A study of 108 patients.
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From page 521... ...
1994. A review of recent research on health effects of human occupational exposure to organic solvents.
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From page 522... ...
1983. Bone marrow injury in lithographers exposed to glycol ethers and organic solvents used in multicolor offset and ultraviolet curing printug processes.
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From page 523... ...
1993. Occupational exposure to organic solvents as a cause of sleep apnoea.
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From page 524... ...
1998. Study of the cardiovascular effects of occupational exposure to organic solvents.
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From page 525... ...
1992. The clinical significance of sleep apnoea in workers exposed to organic solvents: Implications for the diagnosis of organic solvent encephalopathy.
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From page 526... ...
1989. Aplastic anemia, leukemia and other cancer mortality in a cohort of shoe workers exposed to benzene.
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From page 527... ...
American Journal of Industrial Medicine 29(3)
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From page 528... ...
1994. Study of some biochemical changes among workers occupationally exposed to phenol, alone or in combination with other organic solvents.
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From page 529... ...
1981. Aplastic anemia and occupational pesticide exposure: A case-control study.
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From page 530... ...
American Journal of Industrial Medicine 31~2~:250~255.
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