Veterans and Agent Orange Update 2014 (2016) / Chapter Skim
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Appendix B: Short-Term Adverse Health Responses
Appendix B: Short-Term Adverse Health Responses
Pages 1057-1066
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From page 1057... ...
This appendix has been retained in subsequent volumes in the VAO series to provide easy access to the distilled body of biomedical evidence upon which these decisions were made. CHLORACNE Chloracne is a skin disease that is characteristic of exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)
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From page 1058... ...
Conclusions from VAO and Previous Updates The committee responsible for Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (referred to as VAO; IOM, 1994) determined that there was sufficient evidence of an association between exposure to at least one chemical of interest (TCDD)
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From page 1059... ...
. In comparison with a non-exposed group, Air Force Ranch Hand personnel potentially exposed to Agent Orange reported a significant excess of acne (OR = 1.6)
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From page 1060... ...
Conclusion On the basis of numerous epidemiologic studies of occupationally and environmentally exposed populations and supportive toxicologic information, the committee for Update 2014 concurs with all previous VAO committees that there is sufficient evidence of an association between exposure to at least one chemical of interest and chloracne. Because TCDD-associated chloracne becomes evident shortly after exposure, there is no risk of new cases long after service in Vietnam.
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From page 1061... ...
Conclusions from VAO and Previous Updates On the basis of strong animal studies and case reports demonstrating TCDDinduced PCT and resolution after cessation of exposure, the committee responsible for VAO determined that there was sufficient evidence of an association between exposure to TCDD and PCT in genetically susceptible people. Epidemiologic studies of occupational populations have indicated inconsistent associations between the chemicals of interest and increased urinary uroporphyrin.
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From page 1062... ...
treated human liver–derived cell lines with TCDD, showing that this activated ABCB6 expression, an important requirement to support the increased heme demand that occurs when animals are exposed to xenobiotics. Synthesis No epidemiologic data have emerged in the past decade that refute the conclusion of previous VAO committees that there is limited or suggestive evidence of an association between the chemicals of interest and PCT.
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From page 1063... ...
peripheral neuropathy and chronic peripheral neuropathy. Primarily on the basis of reports of short-term health effects after industrial accidents, the committee responsible for Update 1996 concluded that there was limited or suggestive evidence of an association between exposure to the chemicals of interest and "acute and subacute" neuropathy, which was redesignated early-onset transient peripheral neuropathy by the committee responsible for Update 2004.
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From page 1064... ...
Subjects had increased serum TCDD concentrations more than 30 years after exposure, and evidence of continued neuropathy was noted in 9 of 15 subjects who were available for study. Acute neuropathic symptoms were reported after the Seveso accident, and persistent signs were noted.
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From page 1065... ...
Case reports do not provide conclusive evidence of causal relationships, but the cases discussed above showed a close temporal relationship between a high exposure to 2,4-D and neuropathy. The most likely non-toxicant-related acute neuropathy is Guillain-Barré syndrome; however, this syndrome is associated with characteristic findings on clinical neurophysiologic examination and highly increased protein in CSF.
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From page 1066... ...
Those results constitute evidence of the biologic plausibility of an association between exposure to the chemicals of interest and peripheral neuropathy. Conclusions On the basis of studies of health effects after industrial accidents and the well-documented cases reported above, the current committee reaffirms the conclusion of VAO committees since Update 1996 that there is limited or suggestive evidence of an association between exposure to the chemicals of interest and early-onset peripheral neuropathy.
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