Application of the maximum cumulative ratio (MCR) as a screening tool for the evaluation of mixtures in residential indoor air

Self-reported symptoms in Swedish hairdressers and association with exposure to volatile organic compounds (VOCs), including aldehydes

BACKGROUND

Working as a hairdresser involves combined exposure to multiple chemicals in hair treatment products that may induce symptoms in airways and skin.

METHODS

In this cross-sectional study, perceived symptoms among Swedish hairdressers at 10 hair salons were surveyed through a questionnaire. Associations with personal exposure to volatile organic compounds (VOCs), including aldehydes, and their corresponding hazard index (HI), based on the estimated risk for non-cancer health effects, were examined. The prevalence of four out of 11 symptoms was compared to available reference datasets from two other studies of office workers and school staff.

RESULTS

All 11 surveyed symptoms were reported among the hairdressers (n = 38). For the whole study group, the most prevalent symptoms were dripping nose (n = 7) and headache (n = 7), followed by eczema (n = 6), stuffed nose (n = 5), cough (n = 5) and discomfort with strong odors (n = 5). Significant relationships between exposure and symptoms were scarce. The exception was total VOC (TVOC) exposure adjusted to worked years in the profession; a difference was observed for any symptom between hairdressers in the group with 20 + years compared to 0-5 years in the profession (logistic regression, OR 0.03, 95% CI 0.001-0.70). Out of the four symptoms available for comparison, the prevalence of headache and cough was significantly higher in hairdressers than in controls (OR 5.18, 95% CI 1.86-13.43 and OR 4.68, 95% CI 1.17-16.07, respectively).

CONCLUSIONS

Adverse health effects related to occupation was common among the hairdressers, implying a need for exposure control measures in hair salons. Symptoms of headache and cough were more frequently reported by hairdressers than staff in offices and schools. A healthy worker effect among the hairdressers was indicated in the group with 20 + years compared to 0-5 years in the profession. Significant relationships between measured exposure and symptoms were scarce but gave information about advantages and disadvantages of the different exposure measures. The study design could be improved by increasing the size of the study population, using a better match of reference data and increasing the applicability and representability over time of the measured exposure.

Occupational Exposure to Volatile Organic Compounds (VOCs), Including Aldehydes for Swedish Hairdressers

Working as a professional hairdresser involves the daily usage of many different hair treatment products containing chemicals in complex mixtures. Exposure may induce symptoms in the airways and on the skin. In this study, exposure of hairdressers to volatile organic compounds (VOCs), including aldehydes, was measured in the personal breathing zone in the spring of 2017. The study included 30 hairdressers evenly distributed over ten hair salons in the town of Örebro, Sweden. Work tasks and indoor climate were also surveilled. A hazard index (HI) based on chronic reference values for health was calculated to indicate combined exposure risk. In total, 90 VOCs, including nine aldehydes, were identified. Individual exposure expressed as a total concentration of VOCs (TVOCs) were in the range of 50-3600 µg/m3 toluene equivalent (median 460 µg/m3) and the HI was in the range 0.0046-13 (median 0.9). Exposure was more strongly influenced by variability among hairdressers than among salons. The HI indicated an increased risk of non-carcinogenic effects (HI ≥ 1) at four of the 10 hair salons. Individual working procedures, ventilation, volumetric usage of hair treatment products, certain chemicals in products (formaldehyde, isopropanol, and 2,4- and 2,6-toluene diisocyanate), and availability of reference values may have affected estimates of exposure risks. Nevertheless, the HI may be suitable as a screening tool to assess potential exposure risk posed to hairdressers since it considers the complexity of chemical mixtures and the chronic component of VOC exposure occurring in all indoor environments.

TVOC - Revisited

BACKGROUND

TVOC (total volatile organic compounds) has been used as a sum parameter in indoor air sciences for over 40 years. In the beginning, individual VOC concentrations determined by gas chromatography were simply added together. However, several methods for calculating TVOC have become established over time.

METHODS

To understand the manifold definitions of TVOC, one must trace the history of indoor air sciences and analytical chemistry. Therefore, in this work, the original approaches of TVOC are searched and explained. A detailed description of the measurement methods is followed by a critical evaluation of the various TVOC values and their possible applications. The aim is to give the reader a deeper understanding of TVOC in order to use this parameter correctly and to be able to better assess published results. In addition, related sum values such as TSVOC and TVVOC are also addressed.

RESULTS

A milestone was the analytical definition of VOCs and TVOC in 1997. A list of VOCs that should at least be considered when calculating TVOC was also provided. This list represented the status at that time, is no longer up-to-date and is being updated by a European working group as part of a harmonization process. However, there is still confusion about the exact definition and reasonable application of TVOC. The signals of other sum parameters, measured with photoacoustics, flame ionization, photoionization or electrochemical sensors, are also often given under the term TVOC.

CONCLUSIONS

It was recognized early that TVOC is not a toxicologically based parameter and is therefore only suitable for a limited number of screening purposes. Consequently, TVOC cannot be used in connection with health-related and odor-related issues. Nevertheless, such references are repeatedly made, which has led to controversial scientific discussions and even court decisions in Germany about the correct and improper use of TVOC.

Exposure modelling in Europe: how to pave the road for the future as part of the European Exposure Science Strategy 2020-2030

Exposure models are essential in almost all relevant contexts for exposure science. To address the numerous challenges and gaps that exist, exposure modelling is one of the priority areas of the European Exposure Science Strategy developed by the European Chapter of the International Society of Exposure Science (ISES Europe). A strategy was developed for the priority area of exposure modelling in Europe with four strategic objectives. These objectives are (1) improvement of models and tools, (2) development of new methodologies and support for understudied fields, (3) improvement of model use and (4) regulatory needs for modelling. In a bottom-up approach, exposure modellers from different European countries and institutions who are active in the fields of occupational, population and environmental exposure science pooled their expertise under the umbrella of the ISES Europe Working Group on exposure models. This working group assessed the state-of-the-art of exposure modelling in Europe by developing an inventory of exposure models used in Europe and reviewing the existing literature on pitfalls for exposure modelling, in order to identify crucial modelling-related strategy elements. Decisive actions were defined for ISES Europe stakeholders, including collecting available models and accompanying information in a living document curated and published by ISES Europe, as well as a long-term goal of developing a best-practices handbook. Alongside these actions, recommendations were developed and addressed to stakeholders outside of ISES Europe. Four strategic objectives were identified with an associated action plan and roadmap for the implementation of the European Exposure Science Strategy for exposure modelling. This strategic plan will foster a common understanding of modelling-related methodology, terminology and future research in Europe, and have a broader impact on strategic considerations globally.

Chemical Mixtures in the EU Population: Composition and Potential Risks

Regulating chemical mixtures is a complex scientific and policy task. The aim of this study was to investigate typical mixtures and their potential risks based on internal exposure levels in the European population. Based on human biomonitoring (HBM) data made available via the HBM4EU project, we derived generic mixtures representative of a median (P50) and a worst-case scenario (P95) for adults and children. We performed a mixture risk assessment based on HBM concentrations, health-based guidance values (HBGVs) as internal thresholds of concern, and the conservative assumption of concentration addition applied across different toxicological endpoints. Maximum cumulative ratios (MCRs) were calculated to characterize the mixture risk. The mixtures comprise 136 biomarkers for adults and 84 for children, although concentration levels could be quantified only for a fraction of these. Due to limited availability of HBGVs, the mixture risk was assessed for a subset of 20 substance-biomarker pairs for adults and 17 for children. The mixture hazard index ranged from 2.8 (P50, children) to 9.2 (P95, adults). Six to seven substances contributed to over 95% of the total risk. MCR values ranged between 2.6 and 5.5, which is in a similar range as in previous studies based on human external exposures assessments. The limited coverage of substances included in the calculations and the application of a hazard index across toxicological endpoints argue for caution in the interpretation of the results. Nonetheless the analyses of MCR and MAF_ceiling can help inform a possible mixture assessment factor (MAF) applicable to single substance risk assessment to account for exposure to unintentional mixtures.

Application of the maximum cumulative ratio (MCR) as a screening tool for the evaluation of multiple metal mixtures in shellfish in Chinese population

The objective of this study was to investigate the potential effects from exposure to multiple metals, including cadmium (Cd), chromium (Cr), arsenic (As), mercury (Hg), nickel (Ni) and lead (Pb) that exist in shellfish in Chinese populations, and evaluate the impacts of cumulative exposures among individuals. A total 15,469 individual shellfish samples were analyzed following a protocol for elemental analysis. A total of 25,669 respondents were selected through stratified multi-stage cluster sampling from  31 survey sites in China. Individual shellfish consumption data and body weight were collected and analyzed with a 24-hour dietary recall method on three non-consecutive days. The consumers were divided into two groups: aged 2-12 years group and aged ≥13 years. Exposure levels were estimated based using a semi-probabilistic risk assessment method and cumulative exposures among individual persons using the maximum cumulative ratio (MCR) method. The mean, median and 95th percentile of all metals exposure for age 2-12 years group were higher than age ≥13 years group, but none exceeded the respective reference doses of the metals. The mean hazard indices (HI) of each metal in shellfish for both age groups were less than 1. The MCR values calculated among 1283 consumers ranged from 1.28 to 3.25 with the average MCR value was 2.22. There were 51 (3.98%) consumers in group I, 1186 (92.44%) consumers in group II, 26(2.03%) consumers in group III A, and 20 (1.56%) consumers in group III B. And cadmium (Cd) and lead (Pb) produced the HQ_Max that trigged cumulative exposures. It was concluded that heavy metals did not present a potential health risk to people solely through shellfish. The cumulative risks indicated that 7.56% of the surveyed consumers were of concern because of high HI of metals exposure, and Cd, Pb, and Ni made significant contributions to the potential risk.

Guidance Document on Scientific criteria for grouping chemicals into assessment groups for human risk assessment of combined exposure to multiple chemicals

This guidance document provides harmonised and flexible methodologies to apply scientific criteria and prioritisation methods for grouping chemicals into assessment groups for human risk assessment of combined exposure to multiple chemicals. In the context of EFSA's risk assessments, the problem formulation step defines the chemicals to be assessed in the terms of reference usually through regulatory criteria often set by risk managers based on legislative requirements. Scientific criteria such as hazard-driven criteria can be used to group these chemicals into assessment groups. In this guidance document, a framework is proposed to apply hazard-driven criteria for grouping of chemicals into assessment groups using mechanistic information on toxicity as the gold standard where available (i.e. common mode of action or adverse outcome pathway) through a structured weight of evidence approach. However, when such mechanistic data are not available, grouping may be performed using a common adverse outcome. Toxicokinetic data can also be useful for grouping, particularly when metabolism information is available for a class of compounds and common toxicologically relevant metabolites are shared. In addition, prioritisation methods provide means to identify low-priority chemicals and reduce the number of chemicals in an assessment group. Prioritisation methods include combined risk-based approaches, risk-based approaches for single chemicals and exposure-driven approaches. Case studies have been provided to illustrate the practical application of hazard-driven criteria and the use of prioritisation methods for grouping of chemicals in assessment groups. Recommendations for future work are discussed.

Indoor air quality and the associated health risk in primary school buildings in Central Europe - The InAirQ study

The indoor air quality (IAQ) was investigated in sixty-four primary school buildings in five Central European countries (Czech Republic, Hungary, Italy, Poland, and Slovenia). The concentration of volatile organic compounds, aldehydes, PM_2.5 mass, carbon dioxide, radon, as well as physical parameters were investigated during the heating period of 2017/2018. Significant differences were identified for the majority of the investigated IAQ parameters across the countries. The median indoor/outdoor ratios varied considerably. A comprehensive evaluation of IAQ in terms of potential health effects and comfort perception was performed. Hazard quotient values were below the threshold value of 1 with one exception. In contrast, 31% of the school buildings were characterized by hazard index values higher than 1. The maximum cumulative ratio approach highlighted that the concern for non-carcinogenic health effects was either low or the health risk was driven by more substances. The median excess lifetime cancer risk values exceeded the acceptable value of 1 × 10^-6 in the case of radon and formaldehyde. PM_2.5 mass concentration values exceeded the 24 h and annual guideline values set by the World Health Organization in 56 and 85% of the cases, respectively. About 80% of the schools could not manage to comply with the recommended concentration value for carbon dioxide (1000 ppm).

Indoor air quality indicators and toxicity potential at the hospitals' environment in Dhaka, Bangladesh

Indoor air quality (IAQ) is a leading apprehension currently especially in the perilous atmosphere, like hospitals. Clean and fresh air is very crucial for the patients and healthcare professionals in the hospitals. Therefore, we examined IAQ indicators (PM_1.0, PM_2.5, PM₁₀, NO₂, CO₂, and TVOC) at sixteen locations of three hospitals with an emphasis on seasonal variations, indoor/outdoor correlation, and concomitant toxicity potential (TP) of human exposure between October 2019 and January 2020. For the measurement of trace gases (NO₂, CO₂, and TVOC), Aeroqual 500 series (New Zealand) sampler was used; particulate matter (PM_1.0, PM_2.5, and PM₁₀) concentrations and relative humidity (RH) were measured using the IGERESS air quality monitoring device (WP6930S, China). The total average concentration of IAQ indicators were 104.1 ± 67.6 (PM_1.0), 137.4 ± 89.2 (PM_2.5), and 159.0 ± 103.3 (PM₁₀) μgm^-3; 0.11 ± 0.02 (NO₂), 1047.1 ± 234.2 (CO₂), and 176.5 ± 117.7 (TVOC) ppm. Significant variations of IAQ indicators were observed between different locations of the hospitals. Winter IAQ indicators were much higher than post-monsoon season. Indoor particulate matter (PM) levels were lower than outdoor, but gaseous pollutants were higher in indoor than outdoor except NO₂. Indoor TVOC was about two times higher than outdoor and also higher in post-monsoon than winter. A good positive correlation was observed between indoor and outdoor particulate matter during winter. A strong positive correlation was obtained between NO₂ and RH with PM in winter. Very high (> 10) indoor toxicity potential (TP) values of PM_2.5 and PM₁₀ were determined during winter. Extremely high TP values indicated potential severe health consequences of the healthcare professionals and patients in indoor hospitals' environment.

Interindividual Variation in Source-Specific Doses is a Determinant of Health Impacts of Combined Chemical Exposures

All individuals are exposed to multiple chemicals from multiple sources. These combined exposures are a concern because they may cause adverse effects that would not occur from an exposure recieved from any single source. Studies of combined chemical exposures, however, have found that the risks posed by such combined exposures are almost always driven by exposures from a few chemicals and sources and frequently by a single chemical from a single source. Here, a series of computer simulations of combined exposures are used to investigate when multiple sources of chemicals drive the largest risks in a population and when a single chemical from a single source is responsible for the largest risks. The analysis found that combined exposures drive the largest risks when the interindividual variation of source-specific doses is small, moderate-to-high correlations occur between the source-specific doses, and the number of sources affecting an individual varies across individuals. These findings can be used to identify sources with the greatest potential to cause combined exposures of concern.

Impact of Hurricane Maria on Drinking Water Quality in Puerto Rico

This study performed a comprehensive assessment of the impact of Hurricane Maria (HM) on drinking water quality in Puerto Rico (PR) by integrating targeted chemical analysis of both inorganic (18 trace elements) and organic trace pollutants (200 micropollutants) with high-throughput quantitative toxicogenomics and in vitro biomarkers-based toxicity assays. Average concentrations of 14 detected trace elements and 20 organic micropollutants showed elevation after HM. Arsenic, sucralose, perfluorooctanoic acid (PFOA), atrazine-2-hydroxy, benzotriazole, acesulfame, and prometon were at significantly (p < 0.05) higher levels in the post-HM than in the pre-HM samples. Thirteen micropollutants, including four pesticides, were only detected in posthurricane samples. Spatial comparison showed higher pollutant and toxicity levels in the samples from northern PR (where eight Superfund sites are located) than in those from southern PR. Distinctive pathway-specific molecular toxicity fingerprints for water extracts before and after HM and at different locations revealed changes in toxicity nature that likely resulted from the impact of HM on drinking water composition. Correlation analysis and Maximum Cumulative Ratio assessment suggested that metals (i.e., arsenic) and PFOA were the top ranked pollutants that have the potential to cause increased risk after HM, providing a possible direction for future water resource management and epidemiological studies.

A systematic risk characterization related to the dietary exposure of the population to potentially toxic elements through the ingestion of fruit and vegetables from a potentially contaminated area. A case study: The issue of the "Land of Fires" area in Campania region, Italy

Potentially toxic elements are widespread soil contaminants, whose occurrence could entail a concern for human health upon ingestion of fruit and vegetables harvested in a polluted area. This work set out to evaluate the concentrations of lead and cadmium as well as the levels of thirteen heavy metals for which a limit value is yet to be established by the food safety authorities, in order to perform a risk characterization related to the dietary intake of these metals and to provide a scientific opinion with wider relevance in the light of current worldwide regulatory issues. The sampling consisted of fruit and vegetables grown in a potentially contaminated area of southern Italy due to the illegal dump of hazardous wastes. An evaluation of the dietary exposure through the calculation of the Hazard Index (HI), the Maximum Cumulative Ratio (MCR) and the Target Cancer Risk (TCR) was adopted to this end. The results revealed that about the 30% of samples showed quantifiable levels of chemicals and no significant difference emerged between the potentially polluted area and the nearby cities that were selected as a control landfill site. The overall risk characterization for non-carcinogenic endpoints showed that the HI did not reach unsafe values, except for a small number of samples mainly because of aberrant occurrences and, in any case, the cumulative toxicity was mainly driven by thallium and vanadium. As far as the carcinogenic effects of arsenic are concerned, the distribution of TCR values broadly lay below the safety threshold; a certain percentage of data, however, exceeded this limit and should be taken into account for the enforcement of future regulatory thresholds.

Temporal Trends in Exposures to Six Phthalates from Biomonitoring Data: Implications for Cumulative Risk

Phthalates are used in a wide range of consumer goods, resulting in exposures to specific phthalates that vary over time in accordance with changes in product use and how phthalates are utilized. We investigated trends in estimates of daily intake dose and several cumulative risk metrics, including the Hazard Quotient (HQ), Hazard Index (HI), and Maximum Cumulative Ratio (MCR) for six phthalates from 2005 to 2014 using metabolite biomonitoring data collected from spot urine samples under the National Health and Nutrition Examination Survey (NHANES). Over this period, there was a 2.2-fold decrease in the mean HI (0.34 to 0.15) and a 7.2-fold decrease in the percentage of participants with an HI > 1 (5.7% to 0.8%), indicating an overall decrease in combined exposure to these phthalates. Children (aged 6-11 years) had higher mean HI values than either adolescents (aged 12-19 years) or adults (aged 20+ years) during this period. MCR values were generally low and inversely correlated with HI. This indicated that a single phthalate usually drove the hazards for highly exposed individuals. However, the average value of MCR increased 1.2-fold (1.7-2.1) over this period indicating an increasing need to consider exposures to multiple phthalates in this group.

Biomonitoring and Subsequent Risk Assessment of Combined Exposure to Phthalates in Iranian Children and Adolescents

This study aimed to estimate the exposure and related health risks of phthalates, and to assess the health risks from combined exposure to three of the phthalates sharing the same mode of action (anti-androgenicity) in children. We determined the internal exposure of 56 Iranian children and adolescents aged 6 to 18 years by analyzing seven urinary metabolites of five phthalates. The estimated daily intake values derived from the biomonitoring data ranged from 0.01 µg/kg bw/day for butyl benzyl phthalate (BBP), to 17.85 µg/kg bw/day for di(2-ethylhexyl) phthalate (DEHP). The risk assessment revealed that not only the exposure to the individual phthalates, but also the combined exposure to the three anti-androgenic phthalates (DEHP, DBP, BBP) did not raise a safety concern (hazard index values averaged 0.2). The range of maximum cumulative ratio values varied from around 1 for most individuals to around 2 in some individuals, indicating that the combined exposures were dominated by one and in some cases by two of the three anti-androgenic phthalates, especially dibutyl phthalate (DBP) and/or DEHP. Based on biomonitoring data, the overall combined exposure of Iranian children to phthalates does not raise a concern, while reduction of exposure is best focused on DEHP and DBP that showed the highest hazard quotient.

An analysis of cumulative risks based on biomonitoring data for six phthalates using the Maximum Cumulative Ratio

The Maximum Cumulative Ratio (MCR) quantifies the degree to which a single chemical drives the cumulative risk of an individual exposed to multiple chemicals. Phthalates are a class of chemicals with ubiquitous exposures in the general population that have the potential to cause adverse health effects in humans. This work used the MCR to evaluate coexposures to six phthalates as measured in biomonitoring data from the most recent cycle (2013-2014) of the National Health and Nutrition Examination Survey (NHANES). The values of MCR, Hazard Index (HI), and phthalate-specific Hazard Quotients (HQs) were determined for 2663 NHANES participants aged six years and older by using reverse dosimetry techniques to calculate steady-state doses consistent with concentrations of metabolites of six phthalates in urine and using Tolerable Daily Intake values. There were 21 participants (0.8% of the NHANES sample) with HI>1. Of those, 43% (9/21) would have been missed by chemical-by-chemical assessments (i.e. all HQs were less than one). The mean MCR value in the 21 participants was 2.1. HI and MCR values were negatively correlated (p<0.001) indicating that most participants, especially those with elevated HI values, had their cumulative risks driven by relatively large doses of a single phthalate rather than doses of multiple phthalates. The dominate phthalate varied across participants. Children (aged 6-17years) had a higher HI values (p<0.01) than adults (18+ years). However, the probability of having HI>1 was not driven by age, gender, or ethnicity. The cumulative exposures of concern largely originated from a subset of three of the fifteen possible pairs of the six phthalates. These findings suggest that cumulative exposures were a potential concern for a small portion of the surveyed participants involving a subset of the phthalates explored. The largest risks tended to occur in individuals whose exposures were dominated by a single phthalate.

Assessment of inhalation exposure to indoor air pollutants: Screening for health risks of multiple pollutants in Japanese dwellings

Over the past few decades, multiple low level indoor pollutants have been found in domestic dwellings. The types and concentrations of these indoor pollutants have not been consistent over time and have changed with alterations in lifestyle, the development of novel products used in housing, and the development of new measurement technologies. To clarify the highest risk pollutants for which health risks should be reduced, we conducted a health risk assessment of 49 indoor air pollutants measured in 602 houses during winter and summer from 2012 to 2014. Inhalation reference concentrations were determined, and the margins of exposure were estimated for each indoor pollutant from measured indoor air concentrations. Health risks due to ammonia and acidic gases, including formic acid, acetic acid, and hydrogen chloride, were also assessed. Overall, during both winter and summer, the highest risk pollutants were acrolein, nitrogen dioxide, benzene, formic acid, and hydrogen chloride. The health risks of propanal, acetaldehyde, and 1,4-dichlorobenzene were also high. Principal component analysis (PCA) suggested an independent principal component for 1,4-dichlorobenzene. The primary source of exposure to 1,4-dichlorobenzene in Japan is an indoor household insect repellent. The improvement of individual lifestyle and housing may be appropriate targets for reducing the risk associated with this compound. The provision of further information on the risk to consumers and promotion of changes in consumer consciousness are needed. PCA suggested that the health risks of indoor air pollutants are amalgamated into similar chemical families, such as aldehydes, aliphatic hydrocarbons, aromatic hydrocarbons, or acetic esters. Our results suggest that health-based guidelines or source control measures, based on these chemical families and similar health endpoints, are appropriate for reducing total health risk due to multiple low level indoor pollutants.

Evaluating the risk of mixtures in the indoor air of primary school classrooms

In school environments, children are constantly exposed to mixtures of airborne substances, derived from a variety of sources, both in the classroom and in the school surroundings. It is important to evaluate the hazardous properties of these mixtures, in order to conduct risk assessments of their impact on children's health. Within this context, through the application of a maximum cumulative ratio approach, this study aimed to explore whether health risks due to indoor air mixtures are driven by a single substance or are due to cumulative exposure to various substances. This methodology requires knowledge of the concentration of substances in the air mixture, together with a health-related weighting factor (i.e. reference concentration or lowest concentration of interest), which is necessary to calculate the hazard index. Maximum cumulative ratio and hazard index values were then used to categorise the mixtures into four groups, based on their hazard potential and therefore appropriate risk management strategies. Air samples were collected from classrooms in 25 primary schools in Brisbane, Australia. Analysis was conducted based on the measured concentration of these substances in about 300 air samples. The results showed that in 92 % of the schools, indoor air mixtures belonged to the 'low concern' group, and therefore, they did not require any further assessment. In the remaining schools, toxicity was mainly governed by a single substance, with a very small number of schools having a multiple substance mix which required a combined risk assessment. The proposed approach enables the identification of such schools and thus aids in the efficient health risk management of pollution emissions and air quality in the school environment.