Airway response to formaldehyde inhalation in asthmatic subjects with suspected respiratory formaldehyde sensitization

A review of plants formaldehyde metabolism: Implications for hazardous emissions and phytoremediation

The wide use of hazardous formaldehyde (CH₂O) in disinfections, adhesives and wood-based furniture leads to undesirable emissions to indoor environments. This is highly problematic as formaldehyde is a highly hazardous and toxic compound present in both liquid and gaseous form. The majority of gaseous and atmospheric formaldehyde derive from microbial and plant decomposition. However, plants also reversibly absorb formaldehyde released from for example indoor structural materials in such as furniture, thus offering beneficial phytoremediation properties. Here we provide the first comprehensive review of plant formaldehyde metabolism, physiology and remediation focusing on release and absorption including species-specific differences for maintaining indoor environmental air quality standards. Phytoremediation depends on rhizosphere, temperature, humidity and season and future indoor formaldehyde remediation therefore need to take these biological factors into account including the balance between emission and phytoremediation. This would pave the road for remediation of formaldehyde air pollution and improve planetary health through several of the UN Sustainable Development Goals.

A methodological approach for quantifying aerial formaldehyde released by some hair treatments-modeling a hair-salon environment

Formaldehyde is a well-known toxic agent, therefore having a highly regulated status. Despite, some cosmetic firms recently introduced high and illegal concentrations of formaldehyde in hair treatments for increasing straightening and long-lasting performances. The objective of this study was to assess how and to which extent, these products may disperse formaldehyde in the environment of a hair salon, possibly exposing the consumer and the hair professional technician to hazardous airborne amounts of formaldehyde. A laboratory room was equipped with three air pumps located at three locations: close to the heads of a mannequin, nearby the hair technician and the whole volume of the room. Pumps were connected to cartridges apt at trapping airborne formaldehyde. The latter was further quantified through an HPLC procedure.As compared to hair treatments free from formaldehyde that do not modify the airborne formaldehyde levels, products with a high concentration of formaldehyde (1.7% and 9.3%) disperse this compound in the environment to a high and hazardous concentration, detrimental to both consumer and hair professional. The brushing procedure on the hair led to a much higher dispersion of airborne formaldehyde than the hair straightening/ironing technique. To conclude, the use of hair treatments that contain high and illegal amounts of formaldehyde creates a hazardous environment to all people present within a hair salon.Implications: This methodology adopted here might be used to evaluate during conception phase the level of Formaldehyde release and be used as part of safety data for the registration. However, the present work also strongly promotes the adoption of electronic detectors (commercially available) that continuously record the aerial concentration of Formaldehyde, when dealing with hair styling products that contain legal or illegal (> 0.2%w/w) content of Formaldehyde These detectors not only cover an adequate and realistic range of aerial Formaldehyde but can be used and transported at different locations of a given space. Such a cautious measure comes from common sense as it relates to the health status of consumers and operators present in a hair salon environment.

Beneficial effects of polyherbal formulation (Bronco-T) on formaldehyde-induced lung toxicity in male Wistar rats

Polyherbal compound (Bronco-T) has been extensively used as a traditional medicine for various therapies. However, very few report studies on anti-inflammatory and lung regeneration properties are evidenced. In the present study, we evaluated the beneficial actions and anti-inflammatory properties of polyherbal medicine, Bronco-T, exhibited by treating the lungs of rats exposed to formaldehyde to evaluate the beneficial properties. For this study, we divided into five groups': i.e. Group-I served as a control and the other four groups such as II, III, IV, and V are experimental. All animals maintained by regular feed and water ad libitum during the study. Formaldehyde vapors exposure at a single period of time (1 hour) daily (40%formaldehyde at room temperature) for 21 days period exposed all groups. The Bronco-T extracts about 50 mg/kg BW administered to experimental groups and group IV rats treated with 500μ grams/Kg BW salbutamol. To understand the impact of formaldehyde exposure on the beneficial effects of Bronco-T, we evaluated hematological parameters, bronchoalveolar lavage (BAL), histamine levels, and histological alterations of lung architecture. Formaldehyde-induced adverse effects in lung and increased histamine levels in BAL compared to Bronco-T-treated rats act as a preventive immunological role in blood toxicity and recovery of lung architecture in Bronco-T-treated rats. This study showed the evaluation of antihistamine levels through HPLC analysis. Bronco-T has antioxidant and anti-histamine properties as the widest therapeutic window, and we continue to evaluate the pharmacological evaluations needed in our further studies.

Evaluation of environmental impact on the formaldehyde emission and flame-retardant performance of thermal insulation materials

Thermal insulation material, an essential building material, is used to preserve heat or block heat gains in buildings. Insulation material is currently attracting significant attention, and thermal conductivity, i.e., thermal insulation performance, is expressed at a very low value. Therefore, since the era of industrialization, several chemicals have been used to secure thermal insulation performance in each sector; therefore, the resulting hazards have increased. To date, researches have been mainly conducted to secure the low thermal conductivity of insulating material; however, the hazards remain unaddressed. Therefore, this study quantitatively evaluates 18 building construction products and the emission of pollutants and harmful gas during combustion events. Pollutant emission was conducted using the 20-L small chamber method according to the ISO 16000, and formaldehyde, total volatile organic compounds, and five volatile organic compounds were analyzed. Gas hazard evaluation during combustion was evaluated by KS F 2271: Fire Retardant Testing Method of Interior Finishes and Structures as the average behavioral stop time of rats under thermal insulation combustion conditions.

Protective role of (Bronco-T) against formaldehyde induced antioxidant, oxidative and histopathological changes in lung of male Wistar rats

The present study was sought to evaluate the oxidative, antioxidant status and histopathological changes by the acute chronic exposure of formaldehyde. Bronco-T a poly-herbal formulation treatment, changes the oxidative, antioxidant status and histopathology of rat lungs with antioxidant and regenerative property. In this experiment thirty adult male albino Wister rats were used for the study and subdivided in to five groups consist of 6 rats for each group. Group-I served as control and the other 4 groups such as II, III, IV and V are considered as experimental. The control and treatment rats are maintained for 21 days of experimental period. Experimental rats are exposed to 40 percent formaldehyde for 1 h treated with Bronco-T and salbutamol. In the present investigation, the formaldehyde exposed rats a series of free radical chain reactions were grimly provoked, the evaluation of antioxidant enzymes (SOD, CAT), other enzymes oxidative enzymes (G-6-PDH, SDH) and (ALT, ALAT and LDH) were measured. A clear assertive imbalance between oxidation and anti-oxidation status was critically observed, and oxidative stress was clearly exacerbated in lung tissue leading to altrations in architecture of lung histopathology. Oral gavage Bronco-T exhibits a beneficial action by bringing normal architecture in lung tissue of formaldehyde inhaled rats with antioxidant properties. Bronco-T treatment may be a suitable remedy for formalin occupational diseases.

Exposure to low doses of formaldehyde during pregnancy suppresses the development of allergic lung inflammation in offspring

Formaldehyde (FA) is an environmental and occupational pollutant, and its toxic effects on the immune system have been shown. Nevertheless, no data are available regarding the programming mechanisms after FA exposure and its repercussions for the immune systems of offspring. In this study, our objective was to investigate the effects of low-dose exposure of FA on pregnant rats and its repercussion for the development of allergic lung inflammation in offspring. Pregnant Wistar rats were assigned in 3 groups: P (rats exposed to FA (0.75 ppm, 1 h/day, 5 days/week, for 21 days)), C (rats exposed to vehicle of FA (distillated water)) and B (rats non-manipulated). After 30 days of age, the offspring was sensitised with ovalbumin (OVA)-alum and challenged with aerosolized OVA (1%, 15 min, 3 days). After 24 h the OVA challenge the parameters were evaluated. Our data showed that low-dose exposure to FA during pregnancy induced low birth weight and suppressed the development of allergic lung inflammation and tracheal hyperresponsiveness in offspring by mechanisms mediated by reduced anaphylactic antibodies synthesis, IL-6 and TNF-alpha secretion. Elevated levels of IL-10 were found. Any systemic alteration was detected in the exposed pregnant rats, although oxidative stress in the uterine environment was evident at the moment of the delivery based on elevated COX-1 expression and reduced cNOS and SOD-2 in the uterus. Therefore, we show the putative programming mechanisms induced by FA on the immune system for the first time and the mechanisms involved may be related to oxidative stress in the foetal microenvironment.

Formaldehyde inhalation reduces respiratory mechanics in a rat model with allergic lung inflammation by altering the nitric oxide/cyclooxygenase-derived products relationship

Bronchial hyperresponsiveness is a hallmark of asthma and many factors modulate bronchoconstriction episodes. A potential correlation of formaldehyde (FA) inhalation and asthma has been observed; however, the exact role of FA remains controversial. We investigated the effects of FA inhalation on Ovalbumin (OVA) sensitisation using a parameter of respiratory mechanics. The involvement of nitric oxide (NO) and cyclooxygenase-derived products were also evaluated. The rats were submitted, or not, to FA inhalation (1%, 90 min/day, 3 days) and were OVA-sensitised and challenged 14 days later. Our data showed that previous FA exposure in allergic rats reduced bronchial responsiveness, respiratory resistance (Rrs) and elastance (Ers) to methacholine. FA exposure in allergic rats also increased the iNOS gene expression and reduced COX-1. L-NAME treatment exacerbated the bronchial hyporesponsiveness and did not modify the Ers and Rrs, while Indomethacin partially reversed all of the parameters studied. The L-NAME and Indomethacin treatments reduced leukotriene B₄ levels while they increased thromboxane B₂ and prostaglandin E₂. In conclusion, FA exposure prior to OVA sensitisation reduces the respiratory mechanics and the interaction of NO and PGE₂ may be representing a compensatory mechanism in order to protect the lung from bronchoconstriction effects.

Recent trend in risk assessment of formaldehyde exposures from indoor air

Studies about formaldehyde (FA) published since the guideline of 0.1 mg/m(3) by the World Health Organization (WHO) in 2010 have been evaluated; critical effects were eye and nasal (portal-of-entry) irritation. Also, it was considered to prevent long-term effects, including all types of cancer. The majority of the recent toxicokinetic studies showed no exposure-dependent FA-DNA adducts outside the portal-of-entry area and FA-DNA adducts at distant sites were due to endogenously generated FA. The no-observed-adverse-effect level for sensory irritation was 0.5 ppm and recently reconfirmed in hypo- and hypersensitive individuals. Investigation of the relationship between FA exposure and asthma or other airway effects in children showed no convincing association. In rats, repeated exposures showed no point mutation in the p53 and K-Ras genes at ≤15 ppm neither increased cell proliferation, histopathological changes and changes in gene expression at 0.7 ppm. Repeated controlled exposures (0.5 ppm with peaks at 1 ppm) did not increase micronucleus formation in human buccal cells or nasal tissue (0.7 ppm) or in vivo genotoxicity in peripheral blood lymphocytes (0.7 ppm), but higher occupational exposures were associated with genotoxicity in buccal cells and cultivated peripheral blood lymphocytes. It is still valid that exposures not inducing nasal squamous cell carcinoma in rats will not induce nasopharyngeal cancer or lymphohematopoietic malignancies in humans. Reproductive and developmental toxicity are not considered relevant in the absence of sensory irritation. In conclusion, the WHO guideline has been strengthened.

A dynamic system for single and repeated exposure of airway epithelial cells to gaseous pollutants

In vitro models are promising approaches to investigate the adverse effects and the mode of action of air pollutants on the respiratory tract. We designed a dynamic system that allows the single or repeated exposure of cultured cells to two major indoor air gaseous pollutants, formaldehyde (HCHO) and nitrogen dioxide (NO2), alone or as a mixture. In this system, the Calu-3 human bronchial epithelial cell line was exposed at the air-liquid interface (ALI) or submerged by culture medium to synthetic air or to target concentrations of HCHO and/or NO2 once or on 4 consecutive days before assessment of cell viability and necrosis, IL-6 and IL-8 release and trans-epithelial electrical resistance. Our data showed that whereas the ALI method can be used for single short-term exposures only, the submerged method provides the possibility to expose Calu-3 cells in a repeated manner. As well, we found that repeated exposures of the cells to HCHO and NO2 at concentrations that can be found indoors triggered a significant decrease in cell metabolism and an increase in IL-8 release that were not evoked by a single exposure. Thus, our work highlights the fact that the development of systems and methods that allow repeated exposures of cultured cells to gaseous compounds in mixtures is of major interest to evaluate the impact of air pollution on the respiratory tract.

Exposure to formaldehyde and its potential human health hazards

A widely used chemical, formaldehyde is normally present in both indoor and outdoor air. The rapid growth of formaldehyde-related industries in the past two decades reflects the result of its increased use in building materials and other commercial sectors. Consequently, formaldehyde is encountered almost every day from large segments of society due to its various sources. Many governments and agencies around the world have thus issued a series of standards to regulate its exposure in homes, office buildings, workshops, public places, and food. In light of the deleterious properties of formaldehyde, this article provides an overview of its market, regulation standards, and human health effects.

Identifying an indoor air exposure limit for formaldehyde considering both irritation and cancer hazards

Formaldehyde is a well-studied chemical and effects from inhalation exposures have been extensively characterized in numerous controlled studies with human volunteers, including asthmatics and other sensitive individuals, which provide a rich database on exposure concentrations that can reliably produce the symptoms of sensory irritation. Although individuals can differ in their sensitivity to odor and eye irritation, the majority of authoritative reviews of the formaldehyde literature have concluded that an air concentration of 0.3 ppm will provide protection from eye irritation for virtually everyone. A weight of evidence-based formaldehyde exposure limit of 0.1 ppm (100 ppb) is recommended as an indoor air level for all individuals for odor detection and sensory irritation. It has recently been suggested by the International Agency for Research on Cancer (IARC), the National Toxicology Program (NTP), and the US Environmental Protection Agency (US EPA) that formaldehyde is causally associated with nasopharyngeal cancer (NPC) and leukemia. This has led US EPA to conclude that irritation is not the most sensitive toxic endpoint and that carcinogenicity should dictate how to establish exposure limits for formaldehyde. In this review, a number of lines of reasoning and substantial scientific evidence are described and discussed, which leads to a conclusion that neither point of contact nor systemic effects of any type, including NPC or leukemia, are causally associated with exposure to formaldehyde. This conclusion supports the view that the equivocal epidemiology studies that suggest otherwise are almost certainly flawed by identified or yet to be unidentified confounding variables. Thus, this assessment concludes that a formaldehyde indoor air limit of 0.1 ppm should protect even particularly susceptible individuals from both irritation effects and any potential cancer hazard.

Adjuvant effects of gaseous formaldehyde on the hyper-responsiveness and inflammation in a mouse asthma model immunized by ovalbumin

Asthma is a complex pulmonary inflammatory disease, which is characterized by airway hyper-responsiveness, airflow obstruction, and airway inflammation. Exposure to a number of chemicals including formaldehyde (FA) can lead to asthma. This study aimed to explore the underlying role of FA exposure in occupational asthma, especially when it is combined with allergen exposure. Balb/c mice were randomly divided into six groups (n = 6/group): (1) saline control; (2) ovalbumin (OVA)-immunized (OVA(imm)) only; (3) 0.5 mg FA/m(3) exposure; (4) OVA(imm) + 0.5 mg FA/m(3); (5) 3.0 mg FA/m(3) FA exposure; and, (6) OVA(imm) + 3.0 mg FA/m(3). These low and high exposure FA levels were adopted from current (0.5 mg/m(3)) and original (3.0 mg/m(3)) Chinese Occupational Threshold Limit Values. Experiments were conducted after 3 week of combined exposure and a 1-week challenge with aerosolized OVA. Airway hyper-responsiveness, pulmonary tissue damage, eosinophil infiltration, and increased interleukin (IL)-4 and IL-6 levels in lung tissues were found in the OVA + 3.0 mg FA/m(3) hosts as compared to values seen in the OVA-immunized only mice. The results here suggest to us that FA exposure can induce and aggravate asthma in Balb/c mice when it is combined with OVA immunization.

Formaldehyde interferes with airway epithelium integrity and functions in a dose- and time-dependent manner

Formaldehyde (HCHO) is a common indoor air pollutant. To assess its potential role and mechanism of action in asthma, we exposed the bronchial epithelial cell lines Calu-3 and 16HBE to HCHO (70-7000 μM) according to two exposure schedules (30 min and 24 h), before measuring cell viability, necrosis and apoptosis, reactive oxygen species production, cytokine release, as well as trans-epithelial electrical resistance (TEER) of cell monolayers. Whereas exposure to HCHO for 30 min had a limited effect on cell viability, exposure for 24h to 1400-7000 μM HCHO induced a pronounced dose-dependent cell death. The important decrease in cell viability observed after 24h exposure to the highest concentrations of HCHO (1400-7000 μM) was accompanied by important LDH release and ROS production, whereas a 4h exposure to lower HCHO concentrations (350 μM) induced cell apoptosis. Also, exposure to HCHO for 30 min dose-dependently inhibited basal and lipopolysaccharide-induced interleukin-6 (IL-6) and IL-8 production by bronchial epithelial cells. As well, HCHO triggered a dose- and time-dependent decrease in TEER of Calu-3 cell monolayers. The present work demonstrates that HCHO interferes with airway epithelium integrity and functions, and may thus modulate the onset and the severity of asthma. However, importantly, conditions of exposure to HCHO, e.g. level and duration, are determinant in the nature of the effects triggered by the pollutant.

Non-cancer effects of formaldehyde and relevance for setting an indoor air guideline

There is considerable recent focus and concern about formaldehyde (FA). We have reviewed the literature on FA with focus on chemosensory perception in the airways and lung effects in indoor environments. Concentrations of FA, both personal and stationary, are on average in the order of 0.05 mg/m(3) or less in Europe and North America with the exception of new housing or buildings with extensive wooden surfaces, where the concentration may exceed 0.1 mg/m(3). With the eye the most sensitive organ, subjective irritation is reported at 0.3-0.5 mg/m(3), which is somewhat higher than reported odour thresholds. Objective effects in the eyes and airways occur around 0.6-1 mg/m(3). Dose-response relationships between FA and lung function effects have not been found in controlled human exposure studies below 1 mg/m(3), and epidemiological associations between FA concentrations and exacerbation of asthma in children and adults are encumbered by complex exposures. Neither experimental nor epidemiological studies point to major differences in susceptibility to FA among children, elderly, and asthmatics. People with personal trait of negative affectivity may report more symptoms. An air quality guideline of 0.1 mg/m(3) (0.08 ppm) is considered protective against both acute and chronic sensory irritation in the airways in the general population assuming a log normal distribution of nasal sensory irritation.

Influence of indoor factors in dwellings on the development of childhood asthma

Asthma has become the most common, childhood chronic disease in the industrialized world, and it is also increasing in developing regions. There are huge differences in the prevalence of childhood asthma across countries and continents, and there is no doubt that the prevalence of asthma was strongly increasing during the past decades worldwide. Asthma, as a complex disease, has a broad spectrum of potential determinants ranging from genetics to life style and environmental factors. Environmental factors are likely to be important in explaining the regional differences and the overall increasing trend towards asthma's prevalence. Among the environmental conditions, indoor factors are of particular interest because people spend more than 80% of their time indoors globally. Increasing prices for oil, gas and other sources of primary energy will further lead to better insulation of homes, and ultimately to reduced energy costs. This will decrease air exchange rates and will lower the dilution of indoor air mass with ambient air. Indoor air quality and potential health effects will therefore be an area for future research and for gaining a better understanding of asthma epidemics. This strategic review will summarize the current knowledge of the effects of a broad spectrum of indoor factors on the development of asthma in childhood in Western countries based on epidemiological studies. In conclusion, several epidemiological studies point out, that indoor factors might cause asthma in childhood. Stronger and more consistent findings are seen when exposure to these indoor factors is assessed by surrogates for the source of the actual toxicants. Measurement-based exposure assessments for several indoor factors are less common than using surrogates of the exposure. These studies, however, mainly showed heterogeneous results. The most consistent finding for an induction of asthma in childhood is related to exposure to environmental tobacco smoke, to living in homes close to busy roads, and in damp homes where are visible moulds at home. The causing agents of the increased risk of living in damp homes remained uncertain and needs clarification. Exposure to pet-derived allergens and house dust mites are very commonly investigated and thought to be related to asthma onset. The epidemiological evidence is not sufficient to recommend avoidance measures against pet and dust mites as preventive activities against allergies. More research is also needed to clarify the potential risk for exposure to volatile and semi-volatile organic compounds due to renovation activities, phthalates and chlorine chemicals due to cleaning.

Formaldehyde induces apoptosis through decreased Prx 2 via p38 MAPK in lung epithelial cells

Formaldehyde (FA) is an important substance that induces sick house syndrome and diseases, such as asthma and allergies. Oxidative stress is involved in the development of respiratory disease, and diverse antioxidants may protect respiratory tract cells from apoptosis. Peroxiredoxin is a pivotal endogenous antioxidant. In the present study, FA induced death in A549 cells, a lung epithelial cell line, in a dose-dependent manner. FA also increased lipid peroxide formation (LPO) in A549 cells, suggesting a role for oxidative stress. Additionally, FA decreased peroxiredoxin 2 (Prx 2) protein levels after a 24 or 48h exposure to FA. We also examined whether the FA-induced decrease in Prx 2 was associated with apoptosis. Prx 2 overexpression protected against FA-induced cell apoptosis but not necrosis. Prx 2 overexpression blocked FA-induced increase in Bax, a pro-apoptotic molecule, and a decrease in Bcl-2, an anti-apoptotic molecule. Prx 2 overexpression also protected against FA-induced activation of some special apoptosis-associated proteins [caspase-3, caspase-9, and polypeptide poly (ADP-ribose) polymerase (PARP)]. Furthermore, we examined the signaling molecules involved in the FA-induced decrease in Prx 2 expression. The FA-induced decrease in Prx 2 and increase in cell apoptosis was restored by treatment with SB203580 [a p38 mitogen activated protein kinase (MAPK) inhibitor], but not by SP600125 [a c-jun-N-terminal kinase (JNK) inhibitor]. Also, FA-induced events were blocked by treatment with p38 siRNA, but not by scrambled siRNA. Indeed, FA increased p38 MAPK activation, suggesting a role for p38 MAPK in FA action. In conclusion, FA mediated apoptosis in lung epithelial cells by decreasing Prx 2 via p38 MAPK.

Irritant and adjuvant effects of gaseous formaldehyde on the ovalbumin-induced hyperresponsiveness and inflammation in a rat model

BACKGROUND

Formaldehyde (FA) is a common indoor air pollutant that can cause asthma in people experiencing long-term exposure. While FA and other man-made chemicals contribute to the stimulation of asthma in the general population, the underlying molecular pathogenesis of this relationship is not yet well understood.

OBJECTIVE

To explore FA as an irritant for the onset of asthma and as an adjuvant for the induction of allergy.

METHODS

In the present study, 40 Wistar rats in five experimental groups were exposed to: (i) saline; (ii) ovalbumin (OVA); (iii) OVA + FA at 417 ppb; (iv) OVA + FA at 2500 ppb; and (v) FA at 2500 ppb. Current and prior occupational exposure limits in China were established at 417 ppb and 2500 ppb, respectively. Gaseous FA was administrated to the animals for 6 h/day before and during OVA immunization or saline treatment. Measured outcomes included in situ lung function analysis, cytokine measurement, and histological changes in the rat lungs.

RESULTS

The airway reactivity, lung histological changes, pulmonary interleukin-4 secretion, and eosinophil infiltration in the OVA and FA exposed rats were significantly higher after gaseous FA exposures of 417 and 2500 ppb. While FA exposure alone did not induce significant structural changes to the airway, and the rate of inflammatory cell infiltration was the same as for the control group, pulmonary levels of interferon-gamma were significantly elevated in the exposed rats.

CONCLUSIONS

FA may be an irritant as well as serve as an adjuvant for the onset of asthma or asthma-like symptoms.

The ontogeny, distribution, and regulation of alcohol dehydrogenase 3: implications for pulmonary physiology

Class III alcohol dehydrogenase (ADH3), also termed formaldehyde dehydrogenase or S-nitrosoglutathione reductase, plays a critical role in the enzymatic oxidation of formaldehyde and reduction of nitrosothiols that regulate bronchial tone. Considering reported associations between formaldehyde vapor exposure and childhood asthma risk, and thus potential involvement of ADH3, we reviewed the ontogeny, distribution, and regulation of mammalian ADH3. Recent studies indicate that multiple biological and chemical stimuli influence expression and activity of ADH3, including the feedback regulation of nitrosothiol metabolism. The levels of ADH3 correlate with, and potentially influence, bronchial tone; however, data gaps remain with respect to the expression of ADH3 during postnatal and early childhood development. Consideration of ADH3 function relative to the respiratory effects of formaldehyde, as well as to other chemical and biological exposures that might act in an additive or synergistic manner with formaldehyde, might be critical to gain better insight into the association between formaldehyde exposure and childhood asthma.

Reduced allergic lung inflammation in rats following formaldehyde exposure: long-term effects on multiple effector systems

Clinical and experimental evidences show that formaldehyde (FA) exposure has an irritant effect on the upper airways. As being an indoor and outdoor pollutant, FA is known to be a causal factor of occupational asthma. This study aimed to investigate the repercussion of FA exposure on the course of a lung allergic process triggered by an antigen unrelated to FA. For this purpose, male Wistar rats were subjected to FA inhalation for 3 consecutive days (1%, 90-min daily), subsequently sensitized with ovalbumin (OVA)-alum via the intraperitoneal route, and 2 weeks later challenged with aerosolized OVA. The OVA challenge in rats after FA inhalation (FA/OVA group) evoked a low-intensity lung inflammation as indicated by the reduced enumerated number of inflammatory cells in bronchoalveolar lavage as compared to FA-untreated allergic rats (OVA/OVA group). Treatment with FA also reduced the number of bone marrow cells and blood leukocytes in sensitized animals challenged with OVA, which suggests that the effects of FA had not been only localized to the airways. As indicated by passive cutaneous anaphylactic reaction, FA treatment did not impair the anti-OVA IgE synthesis, but reduced the magnitude of OVA challenge-induced mast cell degranulation. Moreover, FA treatment was associated to a diminished lung expression of PECAM-1 (platelet-endothelial cell adhesion molecule 1) in lung endothelial cells after OVA challenge and an exacerbated release of nitrites by BAL-cultured cells. Keeping in mind that rats subjected solely to either FA or OVA challenge were able to significantly increase the cell influx into lung, our study shows that FA inhalation triggers long-lasting effects that affect multiple mediator systems associated to OVA-induced allergic lung such as the reduction of mast cells activation, PECAM-1 expression and exacerbation of NO generation, thereby contributing to the decrease of cell recruitment after the OVA challenge. In conclusion, repeated expositions to air-borne FA may impair the lung cell recruitment after an allergic stimulus, thereby leading to a non-responsive condition against inflammatory stimuli likely those where mast cells are involved.

Mechanistic and dose considerations for supporting adverse pulmonary physiology in response to formaldehyde

Induction of airway hyperresponsiveness and asthma from formaldehyde inhalation exposure remains a debated and controversial issue. Yet, recent evidences on pulmonary biology and the pharmacokinetics and toxicity of formaldehyde lend support for such adverse effects. Specifically, altered thiol biology from accelerated enzymatic reduction of the endogenous bronchodilator S-nitrosoglutathione and pulmonary inflammation from involvement of Th2-mediated immune responses might serve as key events and cooperate in airway pathophysiology. Understanding what role these mechanisms play in various species and lifestages (e.g., child vs. adult) could be crucial for making more meaningful inter- and intra-species dosimetric extrapolations in human health risk assessment.

Inhalation challenge test in the diagnosis of occupational rhinitis

BACKGROUND

Evaluations of rhinitis reactions in inhalation challenges (ICs) are sparse compared with research on nasal challenges. This study evaluates the outcome of IC tests in assessing occupational rhinitis (OR). It presents the largest rhinologic IC data in the literature, analyzing the exposure method of various agents causing OR and their relation to asthma.

METHODS

Challenge tests performed on 829 individuals with suspected cases of OR were reviewed. Results from both exposures with occupational agents (n = 1229) and placebo (n = 838) were evaluated.

RESULTS

A total of 10% of the occupational ICs (n = 123) were positive, suggesting OR, and 13% (n = 161) showed asthmatic reaction in the same challenge. In control challenges 2% showed rhinitis and 6% showed asthma symptoms. The most common agents tested were molds (160 tests), flours, and animal fodders (115 tests) and formaldehyde (122 tests). Obeche wood dust and latex produced positive nasal reactions the most frequently, followed by acid anhydrides.

CONCLUSION

Although IC is a resource-intensive methodology, the evaluation of nasal symptoms and signs together with bronchial reactions saves time and expense compared with the organization of multiple individual challenges. We encourage the simultaneous evaluation of both nasal and bronchial reactions in IC tests.

Mechanistic considerations for formaldehyde-induced bronchoconstriction involving S-nitrosoglutathione reductase

Inhalation of formaldehyde vapor has long been suspected of producing airway pathophysiology such as asthma and hyperresponsivity, presumably via irritant mechanisms. Recent studies on asthma and airway biology implicate changes in nitric oxide (NO) disposition in the adverse effects of formaldehyde, principally because enzymatic reduction of the endogenous bronchodilator S-nitrosoglutathione (GSNO) is dependent upon GSNO reductase (formally designated as alcohol dehydrogenase-3, ADH3), which also serves as the primary enzyme for cellular detoxification of formaldehyde. Considering recent evidence that regulation of bronchodilators like GSNO might play a more important role in asthma than inflammation per se, formaldehyde also needs to be considered as influencing ADH3-mediated GSNO catabolism. This is due to changes in ADH3 cofactors and thiol redox state among several potential mechanisms. Data suggest that deregulation of GSNO turnover provides a plausible, enzymatically based mechanism by which formaldehyde might exacerbate asthma and induce bronchoconstriction.

Indoor air quality and respiratory health of children

Indoor air pollution (IAP) is an important environmental health issue in developing countries and is a major contributor to mortality and morbidity from acute lower respiratory illness in children. In developed countries, IAP in homes is not nearly as severe as it can be in developing countries; however, evidence suggests that it does contribute significantly to the risk of adverse respiratory health in children. Children spend the majority of their time indoors, mostly at home. Homes are built so that air exchange between the indoor and outdoor environments is minimised and there is a large range of pollution emission sources inside. For many pollutants, indoor concentrations regularly exceed those outdoors. Although there has been considerable interest in the health effects of IAP, questions still remain regarding the role of IAP in the exacerbation and/or development of respiratory disease. Prospective, longitudinal studies are required to better clarify the contribution of IAP to the respiratory health of children.

Evaluation and application of the RD50 for determining acceptable exposure levels of airborne sensory irritants for the general public

BACKGROUND

The RD(50) (exposure concentration producing a 50% respiratory rate decrease) test evaluates airborne chemicals for sensory irritation and has become an American Society for Testing and Materials (ASTM) standard method. Past studies reported good correlations (R(2)) between RD(50)s and the occupational exposure limits, particularly threshold limit values (TLVs).

OBJECTIVE

The main purpose of this study was to examine the relationship between RD(50)s and human sensory irritation responses in a quantitative manner, particularly for chemicals that produce burning sensation of the eyes, nose, or throat, based on lowest observed adverse effect levels (LOAELs) reported for human subjects.

METHODS

We compared RD(50)s with LOAELs and acute reference exposure levels (RELs). RELs, developed by the California Environmental Protection Agency's Office of Environmental Health Hazard Assessment, represent a level at which no adverse effects are anticipated after exposure. We collected RD(50)s from the published literature and evaluated them for consistency with ASTM procedures. We identified LOAELs for human irritation and found 25 chemicals with a corresponding RD(50) in mice.

DISCUSSION

We found the relationship between RD(50)s and LOAELs as log RD(50) = 1.16 (log LOAEL) + 0.77 with an R(2) value of 0.80. This strong correlation supports the use of the RD(50) in establishing exposure limits for the public. We further identified 16 chemical irritants with both RD(50)s and corresponding acute RELs, and calculated the relationship as log RD(50) = 0.71 (log REL) + 2.55 with an R(2) value of 0.71. This relationship could be used to identify health protective values for the public to prevent respiratory or sensory irritation.

CONCLUSION

Consequently, we believe that the RD(50) has benefits for use in setting protective levels for the health of both workers and the general population.

Evaluation of the health impact of lowering the formaldehyde occupational exposure limit for Quebec workers

This study aimed at assessing the impact on irritating effects of lowering the current occupational exposure limit (OEL) for formaldehyde in occupational settings in the Province of Quebec, Canada, from a 2 ppm ceiling value to 1, 0.75 or 0.3 ppm. This was achieved through (i) a re-assessment of the exposure-response relationship based on a pooled analysis of published controlled human studies on the incidence of the most sensitive effects related to acute formaldehyde exposure (irritation of the eyes, nose and throat) and (ii) application of this relationship to the data on current exposure to formaldehyde in industrial sectors of Quebec. Results show that the exposure-irritating effect relationship compiled by concentration ranges and by degree of severity was best described by quadratic regression. Considering the current distribution of formaldehyde exposure among the 143,491 Quebec workers concerned, eye irritation, the most sensitive effect, could affect 526 workers (0.367%) at a moderate degree and 50 workers (0.035%) at a severe degree. By reducing the OEL to 1, 0.75 and 0.3 ppm, the proportion of these effects estimated to be avoided would be 442/526 (84%), 526/526 (100%) and 526/526 (100%), respectively. Results for nose and throat irritation follow the same trend. The greatest gain would thus be obtained by respecting the current OEL; the additional gain was estimated to be negligible below 0.75 ppm. The level of 0.75 ppm can be considered as a safe level that allows protecting virtually all workers.

Does Haber's law apply to human sensory irritation?

Irritation of the eyes, nose, and throat by airborne chemicals--also referred to as "sensory irritation"--is an important endpoint in both occupational and environmental toxicology. Modeling of human sensory irritation relies on knowledge of the physical chemistry of the compound(s) involved, as well as the exposure parameters (concentration and duration). A reciprocal relationship between these two exposure variables is postulated under Haber's law, implying that protracted, low-level exposures may be toxicologically equivalent to brief, high-level exposures. Although time is recognized as having an influence on sensory irritation, the quantitative predictions of Haber's Law have been addressed for only a handful of compounds in human experimental studies. We have conducted a systematic literature review that includes a semiquantitative comparison of psychophysical data extracted from controlled human exposure studies versus. the predictions of Haber's law. Studies containing relevant data involved exposures to ammonia (2), chlorine (2), formaldehyde (1), inorganic dusts such as calcium oxide (1), and the volatile organic compound 1-octene (1). With the exception of dust exposure, varying exposure concentration has a proportionally greater effect on sensory irritation than does changing exposure duration. For selected time windows, a more generalized power law model (c(n) x t = k) rather than Haber's law per se (c x t = k) yields reasonably robust predictions. Complicating this picture, however, is the frequent observation of intensity-time "plateauing," with time effects disappearing, or even reversing, after a relatively short period, depending on the test compound. The implications of these complex temporal dynamics for risk assessment and standard setting have been incompletely explored to date.

Pulmonary neutrophil recruitment and bronchial reactivity in formaldehyde-exposed rats are modulated by mast cells and differentially by neuropeptides and nitric oxide

We have used a pharmacological approach to study the mechanisms underlying the rat lung injury and the airway reactivity changes induced by inhalation of formaldehyde (FA) (1% formalin solution, 90 min once a day, 4 days). The reactivity of isolated tracheae and intrapulmonary bronchi were assessed in dose-response curves to methacholine (MCh). Local and systemic inflammatory phenomena were evaluated in terms of leukocyte countings in bronchoalveolar lavage (BAL) fluid, blood, bone marrow lavage and spleen. Whereas the tracheal reactivity to MCh did not change, a significant bronchial hyporesponsiveness (BHR) was found after FA inhalation as compared with naive rats. Also, FA exposure significantly increased the total cell numbers in BAL, in peripheral blood and in the spleen, but did not modify the counts in bone marrow. Capsaicin hindered the increase of leukocyte number recovered in BAL fluid after FA exposure. Both compound 48/80 and indomethacin were able to prevent the lung neutrophil influx after FA, but indomethacin had no effect on that of mononuclear cells. Following FA inhalation, the treatment with sodium cromoglycate (SCG), but not with the nitric oxide (NO) synthase inhibitor L-NAME, significantly reduced the total cell number in BAL. Compound 48/80, L-NAME and SCG significantly prevented BHR to MCh after FA inhalation, whereas capsaicin was inactive in this regard. On the other hand, indomethacin exacerbated BHR. These data suggest that after FA inhalation, the resulting lung leukocyte influx and BHR may involve nitric oxide, airway sensory fibers and mast cell-derived mediators. The effect of NO seemed to be largely restricted to the bronchial tonus, whereas neuropeptides appeared to be linked to the inflammatory response, therefore indicating that the mechanisms responsible for the changes of airway responsiveness caused by FA may be separate from those underlying its inflammatory lung effects.

The spectrum of building-related airway disorders: difficulty in retrospectively diagnosing building-related asthma

INTRODUCTION

The specific causes and mechanism(s) for asthma occurring among occupants of non-residential buildings with poor indoor air quality are not known, but allergic and nonallergic processes are possible explanations

METHODS

Repeated indoor air quality measurements were made while employees were working in a building where cigarette smoking was allowed. Seven of 19 employees who sought medical care from their private physicians because of respiratory complaints received a diagnosis of asthma. Subsequently, 19 symptomatic employees were examined at the University of South Florida (USF) 2 +/- 0.8 months (mean +/- SD) after removal from the building.

RESULTS

The first floor of the building, where employee complaints were prevalent, was characterized by markedly reduced outdoor fresh air supply, diminished air circulation to the occupant spaces, and elevated airborne concentrations of formaldehyde. Nineteen workers examined at the USF 2 +/- 0.8 months after leaving the building reported ear, nose, and throat irritation and asthma-like symptoms while working in the building. There was resolution of symptoms in most of the seven employees (37%) with asthma previously diagnosed by their private physician. In fact, 16 of 19 subjects (84%) reported resolution or significant improvement of symptoms. Among 11 persons with symptoms suggesting asthma while working in the building, 4 persons (21%) showed a negative provocative concentration of methacholine producing a 20% fall in FEV1, including two subjects with doctor-diagnosed asthma.

CONCLUSIONS

Confirmation of building-related asthma is influenced by time factors and the clinical criteria used for diagnosis. A nonallergic mechanism seems operative in our cases. While considered an example of occupational asthma, building-related asthma is a challenge for the practicing physician to confirm retrospectively.

Flow cytometric determination of neutrophil respiratory burst activity in workers exposed to formaldehyde

AIM

The aim of the study was to investigate neutrophil respiratory burst activity (NRBA) in workers who were occupationally exposed to formaldehyde.

METHODS

NRBA, spontaneous and stimulated with E. coli, N-formyl-methionyl-leucyl-phenylalanine (fMLP) and phorbol 12-myristate 13-acetate (PMA), was studied by means of quantitative flow cytometric determination in 29 workers who were occupationally exposed to formaldehyde; 21 healthy subjects, not exposed to formaldehyde, served as controls. All subjects underwent clinical assessment, including a review of a summary of their medical history and a physical examination. Routine haematological tests were performed.

RESULTS

A statistically significant predominance of subjective symptoms and objective clinical findings of chronic upper respiratory tract inflammation, as well as decreased resistance to infections, was observed in the 29 workers exposed to formaldehyde, compared with the controls (chi2 = 9.28, P = 0.02). No statistically significant difference in the spontaneous and stimulated NRBA between the exposed workers and the control group was observed. The spontaneous NRBA (percentage oxidizing cells) was significantly lower in the group of exposed workers with upper respiratory tract findings and frequent and long-lasting infectious inflammatory relapses (median and range 0.45 (0.02-2.03), mean values 0.65 +/- 0.74) than in the healthy controls (median and range 1.35 (0.07-8.69), mean values 2.42 +/- 2.47; P < 0.05), and in the group of exposed workers with rare and short, acute, inflammation of the upper respiratory tract or without any inflammations (median and range 1.00 (0.02-8.67), mean values 1.67 +/- 2.08; P < 0.05). A significant negative correlation between the duration of occupational exposure to formaldehyde and erythrocyte count and haematocrit was found.

CONCLUSIONS

The observed decrease of spontaneous NRBA in workers with a history and clinical findings of frequent and long-lasting relapses of chronic inflammation of the upper respiratory tract could be due to formaldehyde exposure and individual susceptibility. The results obtained suggest that functional changes in polymorphonuclear neutrophil granulocytes could serve as an early indicator of an impact of formaldehyde on NRBA. The applied method might be used for identifying groups at increased toxicological risk.

Expression of cytokine mRNAs in mice cutaneously exposed to formaldehyde

In this study, we have investigated the expression of cytokine mRNAs in mice cutaneously exposed to formaldehyde using semiquantitative RT-PCR. We show that formaldehyde induced the long-lasting expression of IL-4 and IFN-gamma mRNAs and the transient expression of IL-13 mRNA in mouse spleen and draining lymph nodes. The transient increases in IL-2, IL-15, IL-12p40, IL-15 and IL-18 mRNAs, but long-lasting IL-15 mRNA were only seen in the formaldehyde-exposed mouse spleen. Moreover, a weak contact hypersensitivity (CH) and the significant increases in IL-4 and IFN-gamma mRNAs were detected in the ear skin of formaldehyde-cutaneously exposed mice when rechallenged mouse ears. Furthermore, CH as measured by mouse ear swelling response was positively correlated with IL-4 and IFN-gamma mRNA levels in the challenged ears. This study thus suggests that the induction of Th1 and Th2 cytokine mRNAs, particularly IL-4 and IFN-gamma, are a common immunological feature caused by contact allergens irrespective of strong or weak contact allergens. The analysis of IL-4 and IFN-gamma mRNAs may be useful markers in establishing the novel test for predicting chemical sensitizing potentials.

The use of noncancer endpoints as a basis for establishing a reference concentration for formaldehyde

Published studies involving formaldehyde were selected for quality and relevance for determining whether noncancer endpoints could be used to derive a reference concentration for formaldehyde. Chamber studies provided the highest quality data for determining the presence of eye, nose, or throat irritation at a known level of formaldehyde. Some individuals begin to sense irritation at about 0.5 ppm, 5-20% report eye irritation at 0.5 to 1 ppm, and greater certainty for sensory irritation appears at 1 ppm or greater. These levels of formaldehyde do not appear to impact asthmatics even though these individuals are thought to be more sensitive to irritants. Mild, reversible changes in pulmonary function (forced expiratory volume at 1 s and midexpiratory flow) can occur in sensitized individuals at levels approaching 2 ppm. Studies in the manufacturing setting, while confounded by multiple exposures, provide useful information for setting boundaries for sensory irritation or changes in pulmonary function. Community surveys do not provide the specificity nor sensitivity needed to establish a reference concentration. Histological studies of the nasal mucosa suffer significant methodological and technological shortcomings in addition to issues commonly associated with the design of residential and workplace studies. Based on the review of chamber, community, and workplace studies of human exposures to formaldehyde, it is not possible to identify a specific no observed adverse effect level or lowest observed adverse effect level for formaldehyde. Ranges of exposures associated with acute sensory irritation can be derived and do include sensitive subpopulations. However, given the quality and variability of the data, human studies alone, especially those involving sensory irritation, are not adequate to serve as a reference concentration for estimating risk, or lack thereof, for a lifetime of exposure to formaldehyde. Alternative approaches, such as modeling cellular changes observed in animal studies, may be more useful for quantitative risk assessment of noncancer endpoints and should be used as an adjunct to interpreting human sensory studies.

Short-term effects of formaldehyde on peak expiratory flow and irritant symptoms

The authors studied the respiratory effects of formaldehyde exposure among students who dissected cadavers in a gross anatomy laboratory. Peak expiratory flow and respiratory symptoms were measured before and after each weekly laboratory session. Each of 38 students was exposed to formaldehyde for 2.5 hr/wk for 14 wk. Individual, daily formaldehyde measurements averaged 1.1 ppm (standard deviation = 0.56 ppm). Multivariate models demonstrated two different time scales of effect of formaldehyde on peak expiratory flow: (1) exposure during the previous 2.5 hr reduced peak expiratory flow by -1.0% per ppm, and (2) average exposure during all preceding weeks reduced peak expiratory flow by an additional -0.5% per ppm of formaldehyde. However, the short-term exposure effect was diminished during the first 4 wk, suggesting at least partial acclimatization. Symptom reporting was also associated with exposure during the previous 2.5 hr, and similar evidence of acclimatization was observed. These results suggest that there are two different time scales of response to formaldehyde, and they emphasize the need for longitudinal studies, characterized by quantitative exposure characterization, and frequent measurements of outcome.

Chemicals and gases

This article covers the major chemicals and gases that are considered to be of the most clinical relevance to the primary care provider. The reader is referred to other comprehensive textbooks of toxicology and occupational medicine for a complete discussion of the numerous additional products found in the workplace that may result in occupational exposure.