Polymer fume fever
Abstract: ‘Polymer fume fever’
(PFF), a temporary, intense, but only very rarely serious
influenza-like syndrome previously related only to the pyrolysis
of polytetrafluoroethylene (PTFE), may also be induced by fluorocarbon
systems with molecular weights in the telomeric and possibly monomeric
range.
Ref: ‘Polymer fume fever’ without
polymer. P. W. Townsend, G. G. Vernice and R. L. Williams. Journal
of Fluorine Chemistry Volume 42, Issue 3 , March 1989, Pages 441-443.
Abstract: When Teflon is heated the developing fumes produce
in exposed humans an influenza-like syndrome
(polymer fume fever) or also
severe toxic effects like pulmonary edema, pneumonitis and death.
The decomposition products and the resulting health effects are
temperature-dependent. The toxic effects seem to be related to
the ultrafine particulate fraction of the fume. To test the hypothesis
that exposure to ultrafine particles results in an increased interstitialization
of the particles which is accompanied by an acute pathological
inflammation, rats were exposed to titanium dioxide (TiO2) particles
by intratracheal instillation and by inhalation. Both acute intratracheal
instillation and subchronic inhalation studies on rats show that
ultrafine TiO2 particles (~20 nm diameter) access the pulmonary
interstitium to a larger extent than fine particles (~250 nm diameter)
and that they elicit an inflammatory response as indicated by
PMN increase in lavaged cells. The release of ultrafine particles
into the air of an enclosed environment from a thermodegradation
event or from other sources is a potential hazard for astronauts.
Knowing the mechanisms of action is a prerequisite for technical
or medical countermeasures.
Ref: Part 2—Biomedical support. Polymer
degradation and ultrafine particles: Potential inhalation hazards
for astronauts. by J. Ferin and G. Oberdörster (Environmental
Health Sciences Center School of Medicine & Dentistry University
of Rochester, Rochester, NY 14642, USA). Acta Astronautica Volume
27 , July 1992, Pages 257-259.
Abstract:
Urinary fluoride levels were investigated as an index of polytetrafluoroethylene
(PTFE) exposure, since carbonyl fluoride, a pyrolysis product
of PTFE, is metabolized and excreted as inorganic fluoride ion.
Spot urine samples and occupational histories relating to polyment
fume fever were obtained from 77 workers at a small PTFE fabricating
plant. Environmental air samples for PTFE were taken. Air levels
of PTFE ranging from 0-5.48 mg/m-3 were found. All urine values
fell below the level at which systemic effects are reported to
occur. Analysis of variance demonstrated
that the mean urinary fluoride level among workers who had 1 or
more years of exposure to PFTE who also had experienced 1 or more
reported episodes of polymer fume fever was significantly higher
(P< 0.01) than that among employees with less than 1 yr or
more of exposure and no history of polymer fume fever.
Additional exposure beyond 1 yr and additional polymer fume fever
episodes did not result in the further elevation of urine fluoride
levels.
Ref: Urinary fluoride levels in polytetrafluoroethylene
fabricators; POLAKOFF PL, BUSCH KA , OKAWA MT. AM IND HYG ASSOC
J; 35 (2). 1974 99-106.
Abstract: Teflon (9002-84-0),
a physically inert tetrafluoroethylene (116-14-3) resin, is discussed
in a paper presented at the American Industrial Hygiene Association
Annual Meeting in Cincinnati, Ohio on April 26, 1955, and it is
noted that its pyrolytic products are toxic, and exposure to various
mixtures of them will induce polymer fume
fever in humans. The latter influenza like syndrome has
not been reproduced in animals. Sufficiently intense exposure
of animals to Teflon's thermal products, however, is generally
lethal. The associated evidence of pulmonary edema, together with
other early test results, originally suggested that hydrogen fluoride
(7664-39-3) (HF) was the responsible toxic agent. The pyrolysis
of Teflon starts at 200 degrees-C and proceeds slowly up to 420
degrees-C; at 500 to 550 degrees-C, the degradational weight loss
reaches 10% to 5% per hour, respectively, depending on conditions.
In the temperature range 300 to 360 degrees-C,
hexafluoroethane (C2F6) and octafluorocyclobutane (C4F8) were
identified as decomposition products. In
the range 380 to 400 degrees-C, octafluoroisobutylene (also C4F8)
could be detected and, at 500 to 550 degrees-C, the chief pyrolysis
products other than tetrafluoroethylene (116143) (C2F4) were hexafluoropropylene
(116154), (C3F6) octafluorocyclobutane, and octafluoroisobutylene
plus a complex residue of perfluoroolefins. Inhalation toxicity
tests indicated that the octafluoroisobutylene gas, the most potent
product, was approximately ten times as toxic as phosgene (75-44-5).
The rat mortality factor seemed to be proportional to the product
of exposure time and Teflon surface area as a function of pyrolysis
temperature. Teflon 6, a lower molecular weight polymer than Teflon
1, produced more toxic pyrolysis products. Other kinds of industrial
polymers were observed to produce lethal atmospheres under less
drastic conditions than either form of Teflon.
Ref:
Toxicity of Pyrolysis Products of "Teflon" Tetrafluoroethylene
Resin by Zapp JA Jr, Limperos G, Brinker KC. Proceedings of the
American Industrial Hygiene Association Annual Meeting, Cincinnati,
Ohio, April 26, 1955.
Abstract: An incident
where five cockatiels (Nymphicus
hollandicus) died within 30 minutes following exposure from a
frying pan coated with the plastic polytetrafluoroethylene (900-284-0)
(PTFE) that had accidentally overheated is reported. Within
an hour the owner developed symptoms of polymer fume fever
but recovered within 24 hours. A PTFE coated milk pan boiled dry
for 15 minutes with the cockatiels in a cage in the next room.
The birds were examined by a veterinary surgeon and were found
to be normal except for the lungs, which were severely congested
and edematous and were considered to be the cause of death. It
is concluded that parakeets are unusually susceptable to the pyrolyses
products of frying pans coated with plastic polytetrafluoroethylene.
Ref.
Case of Polytetrafluoroethylene Poisoning in Cockatiels Accompanied
by Polymer Fume Fever in the Owner by Blandford TB, Hughes R,
Seamon PJ, Pattison M, Wilderspin
MP. Veterinary
Record, Vol. 96, pages 175-176, 6 references, 1975.
Abstract: Background: Certain fluorocarbon polymers can produce
a clinical syndrome called polymer fume
fever when the products of pyrolysis are inhaled. Summary:
A previously healthy 21-year-old white man presented with severe
chest tightness, difficulty in breathing, pyrexia, nausea, vomiting,
and a dry irritating cough. These symptoms occurred suddenly
while smoking a cigarette 2 hours after leaving his place of work,
where he is a plastics machinist. A chest roentgenogram revealed
a bilateral patchy alveolar air space filling pattern involving
the mid and lower lung fields. The
diagnosis of polymer fume fever was established on the
basis of the symptom complex, the association with cigarette smoking,
and the occupational exposure to
micronized polytetrafluoroethylene. Conclusions: A thorough
occupational and smoking history is necessary to recognize polymer
fume disease, which may resemble influenza.
Ref: Acute noncardiogenic pulmonary edema
due to polymer fume fever. by SILVER MJ, YOUNG DK. CLEVELAND CLINIC
JOURNAL OF MEDICINE; 60 (6). 1993. 479-482.
Abstract: A case of marked progression
of chronic obstructive pulmonary disease after several episodes
of occupational inhalation fever in a carding machine operator
was reported. The patient was a 45 year old male with a history
of exertional dyspnea who experienced recurrent episodes of flu
like symptoms beginning 2 weeks after starting work at a synthetic
textile plant. After approximately 9 months on the job the patient
was hospitalized with fever, chills, chest pain, productive cough,
and malaise that had not responded to antibiotic treatment. A
decreased white cell count was seen along
with evidence of moderately severe obstructive disease. The patient
returned to work after the acute symptoms resolved; however, he
experienced dyspnea with mild exertion at this time. The
flu like illnesses continued to recur
over the next 18 months at which time the patient stopped working
on the advice of his physician. He was hospitalized 1 month later
with chest pain and diaphoresis. Severe
obstruction with a significant bronchodilator response was seen
and he was placed on disability leave. Polymer
fume fever due to exposure to polytetrafluoroethylene (9002-84-0)
was suspected as the cause of his illness. A subsequent
examination of the patient's workplace demonstrated that major
renovations had been done since his departure to improve chemical
contamination and air quality; however, potential for significant
exposures to formaldehyde (50000) were still evident. The authors
conclude that polymer fume fever may not always be a benign, self
limiting disease and may result in permanent airways damage. Long
term follow up is recommended.
Ref: Progression of Chronic Obstructive
Pulmonary Disease after Multiple Episodes of an Occupational Inhalation
Fever by Kales SN, Christiani DC. Journal of Occupational Medicine,
Vol. 36, No. 1, Grant No. T15-OH-07096, pages 75-78, 10 references,
1994.
Abstract: Polymer fume fever and other syndromes related to
the inhalation of fluoropolymer pyrolysis products were discussed
in this review. Polymer fume fever has primarily
been seen following the inhalation of thermal decomposition products
of materials such as polytetrafluoroethylene (9002-84-0) (PTFE),
fluorinated ethylene-propylene (61789002), and perfluoroalkoxyethylene
resins. The disease has been identified in plastics, chemical,
electronics, textile manufacturing, rubber stamp shop, print shop,
and aircraft repair shop workers as well as in several isolated
occupational and residential incidents. The pyrolysis and combustion
chemistry of PTFE and other fluoropolymers was discussed.
Animal studies on fluoropolymer inhalation
toxicology and pathology have demonstrated pulmonary hemorrhage,
edema, focal emphysema, and interstitial fibrosis
and the toxicity varied with the temperature of pyrolysis, the
test animal, length of study, and the presence or absence of particles.
Early clinical features in humans have included flu like symptoms,
chest discomfort, leukocytosis with a left shift, an elevated
erythrocyte sedimentation rate, and inconsistent pulmonary function
alterations. The disease has generally tended to be acute and
self limiting however late sequelae such as pulmonary infiltrates
and persistent ventilatory impairment have been documented. A
crude dose response relationship for cases with severe pulmonary
damage has been suggested. The use of urinary fluoride levels
for biological monitoring of fluoride exposure was discussed.
Exposure standards established by the OSHA were presented.
Ref: Polymer Fume Fever and Other Fluorocarbon
Pyrolysis-Related Syndromes. by Shusterman DJ. Occupational Medicine:
State of the Art Reviews, Vol. 8, No. 3, pages 519-531, 66 references,
1993.
Abstract: Employee interviews were conducted, work practices
were observed, and ventilation systems were inspected at the Plastic
Department of the Xomox Corporation (SIC-3079) in Cincinnati,
Ohio on May 30 and July 24, 1979. The evaluations were requested
by the company's Safety Coordinator to determine
if employee reports of polymer fume fever were due to exposure
to decomposition products of Teflon fluorocarbon polymer (9002-84-0).
Because of the variety of products generated by fluorocarbon polymer
decomposition, no sampling or analysis techniques were considered
adequate, and no evaluation criteria for exposure levels exist.
Results from employee interviews show that six of 15 workers experienced
symptoms which they attributed to the work environment and three
others reported some symptoms, including fever, chills, respiratory
difficulties, and headaches. It is concluded that only the stripping
operations area can be identified as a definite exposure area.
It is recommended that a no smoking rule be enforced in all areas
where polymers are handled and processed. Recommendations also
are made for routine medical examinations, engineering controls
to improve ventilation, use of respirators, and workplace hygiene.
Ref: Hazard Evaluation and Technical Assistance Report No. TA-79-32,
Xomox Corporation, Cincinnati, Ohio. by Tharr DG. Hazard Evaluation
and Technical Assistance Branch, NIOSH, Cincinnati, Ohio, Report
No. TA-79-32, 10 pages, 4 references, 1979.
Abstract: An epidemiologic investigation of an outbreak
of polymer fume fever in a large
industrial facility was conducted. A history form was used
to collect data from all employees working in selected areas of
a fabricated metals facility where epoxy resins were used for
bonding. All workers with polymer fume fever symptoms were
subjected to ventilatory function studies. Symptoms were observed
in 59 percent of the workers interviewed. The
most frequent complaint was a tightness of the chest. Workers
usually noticed symptoms after being at work 4 to 5 hours. Attacks
occurred at least once per week for most workers. Among those
with symptoms, only 9 of 36 did not smoke. Ventilatory function
studies failed to demonstrate any pulmonary findings attributed
to occupational exposure. The authors conclude
that the outbreak was due to the recent introduction of polytetrafluoroethylene
(9002-84-0) into the industrial process. Fine dusts were
deposited on the workers hands and ingested via their cigarettes.
For nonsmokers, exposure was probably caused by the use of a small
hot air gun in the factory which generated hot air currents that
were inhaled.
Ref: An Epidemic of Polymer-Fume Fever.
by Lewis CE, Kerby GR. Journal of the American Medical Association,
Vol. 191, No. 5, pages 375-378, 18 references, 1965.
Abstract: Thirty payroll and eight staff employees of a polytetrafluoroethylene
(9002-84-0) (PTFE) manufacturing plant were interviewed
and the plant investigated to determine the cause of polymer
fume fever in plant employees. Fourteen of the 30 payroll
employees had experienced symptoms of the fever in the two months
previous to the interview. Thirty-two incidents of polymer fume
fever were reported by these 14 workers. Only employees working
in the finishing room, where PTFE was dried, sifted, and packed,
had been affected. Of the 18 men who worked in the finishing room,
12 who were smokers accounted for 30 incidents. Six of the workers
who rolled their own cigarettes had incurred 21 of these 30 attacks.
Of the eight staff employees, only one, a pipe smoker, had experienced
an attack of polymer fume fever. Air samples were taken in the
finishing room at points close to the drying ovens and the ovens
where the polymer was further heated when required. When PTFE
was heated to normal drying temperatures, hydrochloric-acid (7647010)
was occasionally detected in concentrations up to 35ppm. Hydrogen
fluoride (7664393), in concentrations no greater than 6ppm, was
detected when the temperature was increased beyond 300 degrees-C.
The results indicate that the majority of incidents of
polymer fume fever resulted from the smoking of PTFE contaminated
tobacco. Precautionary measures, designed to prevent further incidents
of polymer fume fever, were recommended.
Ref: Polymer Fume Fever Due to Inhalation
of Fumes from Polytetrafluoroethylene. by Adams WGF. Transactions
of the Association of Industrial Medical Officers, Vol. 13, pages
20-21, 4 references, 1963.
Abstract: Polymer fume fever and other syndromes related to the
inhalation of fluoropolymer pyrolysis products were discussed
in this review. Polymer fume fever has primarily
been seen following the inhalation of thermal decomposition products
of materials such as polytetrafluoroethylene (9002-84-0) (PTFE),
fluorinated ethylene-propylene (61789002), and perfluoroalkoxyethylene
resins. The disease has been identified in plastics, chemical,
electronics, textile manufacturing, rubber stamp shop, print shop,
and aircraft repair shop workers as well as in several isolated
occupational and residential incidents. The pyrolysis and combustion
chemistry of PTFE and other fluoropolymers was discussed. Animal
studies on fluoropolymer inhalation toxicology and pathology have
demonstrated pulmonary hemorrhage, edema, focal emphysema, and
interstitial fibrosis and the toxicity varied with the temperature
of pyrolysis, the test animal, length of study, and the presence
or absence of particles. Early clinical features in humans have
included flu like symptoms, chest discomfort, leukocytosis with
a left shift, an elevated erythrocyte sedimentation rate, and
inconsistent pulmonary function alterations. The disease has generally
tended to be acute and self limiting however late sequelae such
as pulmonary infiltrates and persistent ventilatory impairment
have been documented. A crude dose response relationship for cases
with severe pulmonary damage has been suggested. The
use of urinary fluoride levels for biological monitoring of fluoride
exposure was discussed. Exposure standards established
by the OSHA were presented.
Ref: Polymer Fume Fever and Other Fluorocarbon
Pyrolysis-Related Syndromes. by Shusterman DJ. Occupational Medicine:
State of the Art Reviews, Vol. 8, No. 3, pages 519-531, 66 references,
1993.
• POLYMER-FUME FEVER.
Discussion.
The Lancet, Volume 300, Issue 7766, 1 July 1972,
Pages 27-28.
• POLYMER-FUME FEVER.
Correspondence. The Lancet, Volume
258, Issue 6694, 15 December 1951,
Pages 1141-1142.
R. N. Compton Smith.
• POLYMER-FUME FEVER. Article.
The Lancet, Volume 258, Issue 6692, 1 December 1951,
Pages 1008-1011. D. Kenwin Harris.