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Experimental Exposure to Propylene Glycol Mist in Aviation Emergency Training: Acute Ocular and Respiratory Evects

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Experimental Exposure to Propylene Glycol Mist in Aviation Emergency Training: Acute Ocular and Respiratory Evects Occup Environ Med 2001;58:649–655 649 Experimental exposure to propylene glycol mist in aviation emergency training: acute ocular and respiratory eVects G Wieslander, D Norbäck, T Lindgren Abstract Keywords: acoustic rhinometry; aviation medicine; pro- Objectives—Propylene glycol (PG) (1–2 pylene glycol; respiratory symptoms; tear film stability propanediol; CAS No 57–55–6) is a low break up time toxicity compound widely used as a food additive, in pharmaceutical preparations, in cosmetics, and in the workplace—for Main messages example, water based paints, de-icing flu- x Propylene glycol is is a low toxicity com- ids, and cooling liquids. Exposure to PG pound widely used in many products. mist may occur from smoke generators in x The concentration of propylene glycol discotheques, theatres, and aviation mist in aviation emergency training can emergency training. Propylene glycol may be high compared with other occupa- cause contact allergy, but there is sparse tional exposure to this compound. Mist from artificial smoke generators may information on health eVects from occu- x cause ocular and upper airway irritation pational exposure to PG. in non-asthmatic subjects. Methods—Non-asthmatic volunteers x A few may also react with cough and (n=27) were exposed in an aircraft simula- slight airway obstruction. tor to PG mist over 1 minute, during real- istic training conditions. Geometric mean concentration of PG was 309 mg/m3 (range 176–851 mg/m3), with the highest concen- Policy implications trations in the afternoon. The medical x Awareness should be spread that expo- investigation was performed both before sure to high concentrations of propylene and after the exposure (within 15 min- glycol in workplaces and public places utes). It included an estimate of tear film may cause ocular and respiratory irrita- stability break up time, nasal patency by tion, and that sensitive subjects should be acoustic rhinometry, dynamic spiro- protected or avoid extreme or prolonged metry, and a doctor’s administered ques- exposure. tionnaire on symptoms. Results—After exposure to PG mist for 1 minute tear film stability decreased, ocu- Propylene glycol (PG) (1–2 propanediol; CAS lar and throat symptoms increased, forced nr 57–55–6) is a widely used compound 1 expiratory volume in 1 second/forced vital because of its low toxicity and lack of carcino- genic or mutagenic eVects.23It is used as a food capacity (FEV1/FVC) was slightly reduced, 4 5 and self rated severity of dyspnoea was additive, in pharmaceutical preparations, and in cosmetics.3 Rarely, allergic contact sensitisa- slightly increased. No eVect was found for 6–8 nasal patency, vital capacity (VC), FVC, tion to PG in consumer products may occur, and one case of systemic skin reactions in a PG nasal symptoms, dermal symptoms, smell Department of sensitised subject after ingestion of food of solvent, or any systemic symptoms. Medical containing PG has been reported.9 Also skin Those exposed to the higher concentra- Sciences/Occupational irritation from PG in tooth paste10 as well as and Environmental tions in the afternoon had a more pro- Medicine, Uppsala nasal and throat irritation related to PG in nounced increase of throat symptoms, and 11 12 University, University nasal spray has been reported. Transdermal a more pronounced decrease of tear film 13 Hospital, S-751 85, adsorption of PG may occur. There are a few Uppsala, Sweden stability. In four subjects who reported case reports on severe systemic reactions from G Wieslander development of irritative cough during PG in humans, including one case of coma in a D Norbäck 14 exposure to PG, FEV1 was decreased by premature infant and two cases of acute renal T Lindgren 5%, but FEV1 was unchanged among those tubular cell injury from pharmaceuticals dis- 15 16 Scandinavian Airline who did not develop a cough. Those who olved in PG. The premature infant went System (SAS), developed a cough also had an increased into coma after treatment for burns with STOIM-O, S-195 87 perception of mild dyspnoea. antiseptic dressings containing unusually high Stockholm, Sweden Conclusion—Short exposure to PG mist concentrations of PG. Ending the topical treat- T Lindgren from artificial smoke generators may ment resulted in complete recovery.14 Correspondence to: cause acute ocular and upper airway irri- Propylene glycol is metabolised to lactic acid Dr G Wieslander tation in non-asthmatic subjects. A few and pyromaleic acid, normal intermediates in gunilla.wieslander@medsci may also react with cough and slight human metabolism, either by oxidisation or .uu.se airway obstruction. phosphatisation.4 Metabolic formation of PG Accepted 1 June 2001 (Occup Environ Med 2001;58:649–655) and 2,3-butanediol has been reported in www.occenvmed.com 650 Wieslander, Norbäck, Lindgren alcoholic subjects, both in the presence and history of atopy, whereas three women and 16 absence of alcohol,17 in premature infants,17 in men did not have atopy, a non-significant but diabetic patients,17 and with specific enzyme numerically higher occurrence of atopy among deficiencies (congenital propionic and methyl- the women. None had ever had any respiratory malonic acidaemia). Also, alcohol related diols disorders, including asthma or chronic bron- (PG and 2,3-butanediol) have been shown to chitis diagnosed by a doctor, and none had any cause insulin resistance in rats.18 febrile respiratory infection the week before the Occupational exposure to PG may occur in investigation. The subjects were naive, in that many occupational settings. The phasing out of none had previous occupational exposure to organic solvents at work has increased the use PG. The investigations were done at normal of PG in Sweden, as it is commonly used in aviation emergency training, during 1 week in many water based products—such as water March 1998, before the pollen season had based paints.19–22 The annual Swedish con- started in mid-Sweden. The flight simulator sumption (8 million inhabitants) of PG is belonged to a training centre of the flight acad- between 13 200 and 13 300 tonnes, and it is emy of the Scandinavian Airline System (SAS). used in 1183 products. It is the 17th most The artificial smoke generator was placed in common chemical counted as number of the flight simulator, with a commercial PG products in which it is used.19 Other sources of solution for smoke generation. The exposure occupational exposures include aircraft de- was performed as a part of the regular training icing work, where both ethylene glycol23 and schedules for pilots, aiming to train pilots for PG are used,23 and exposure to glycol based evacuation at fire emergency situations. cooling liquids in car engines.24 Also, PG is commonly used in artificial ASSESSMENT OF PERSONAL FACTORS smoke generators in discotheques, theatres, One general medical questionnaire was used to and emergency training. In connection with gather information on personal factors, includ- use of smoke generators in aviation emergency ing medical disorders, medication, occupa- training, being a part of the basic education of tional data, the home environment, and smok- pilots and flight attendants at Scandinavian ing habits.28–30 Atopy was defined as having a Airline Systems (SAS), concern was raised history of childhood eczema or current history about possible respiratory eVects from this of allergy related to exposure to common IgE exposure mediated allergens in Sweden (tree pollen, There is sparse published information on grass pollen, or furry animals). Current smoker irritative or respiratory eVects of PG in was defined as reporting actual smoking in the humans.25 Recently, clinical methods that can interview (>1 cigarette/day), or stopping smok- be applied in exposure studies have become ing less than 1 year ago. available, including measurement of tear film 26 27 stability break up time, and nasal patency INFORMATION ON CURRENT SYMPTOMS by acoustic rhinometry.28–30 These methods Information on current symptoms was ob- have been applied to study transient physi- tained from two questionnaires used in previ- ological eVects at controlled exposures to vola- ous investigations. The first questionnaire con- tile organic compounds. Decreased nasal tained 10 rating scales on current ocular, nasal, patency has been reported at exposure to a throat symptoms, dyspnoea, malodour, and mixture (4 h; 10 mg/m3)of22diVerent volatile systemic symptoms.33 Answers were given on a organic compounds, not including PG.31 In 100 mm visual analogue rating scale (VAS- another experimental study, exposure to a mix- scale) adapted from Kjellberg et al,34 graded ture of PG and three glycol ethers induced from “not at all” to “almost unbearable” . The ocular symptoms, but did not aVect tear film second questionnaire contained 23 yes or no stability, nasal patency, or lung function.32 questions on diVerent types of ocular, respira- The aim of the investigation was to study tory, and dermal symptoms, as well as systemic eVects of an experimental exposure to PG mist, symptoms—for example, headache, nausea, at exposure levels occurring during normal and fatigue.30 Both questionnaires were admin- aviation emergency training. The physiological istered before and after the exposure to PG. eVects studied included tear film stability, nasal patency, and lung function, as well as subjective ASSESSMENT OF TEAR FILM STABILITY symptoms. The study was approved by the eth- Tear film stability was estimated by a standard- ics committee of the Medical Faculty of ised method, self reported tear film stability Uppsala University. break up time measuring the time the subject could keep the eyes open without pain, when Material and methods watching a fixed point at the wall. The method STUDY POPULATION is mentioned in our introduction as tear film Healthy non-asthmatic volunteers (n=27), 22 stability and has been used previously. It has men and five women, were examined medically been shown to correlate well with the fluores- before and after exposure to PG mist.
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