A pilot epidemiologic study of possible health effects associated with 2,3,7,8-tetrachlorodibenzo-p-dioxin contaminations in Missouri

Skin diseases associated with Agent Orange and other organochlorine exposures

Organochlorine exposure is an important cause of cutaneous and systemic toxicity. Exposure has been associated with industrial accidents, intentional poisoning, and the use of defoliants, such as Agent Orange in the Vietnam War. Although long-term health effects are systematically reviewed by the Institute of Medicine, skin diseases are not comprehensively assessed. This represents an important practice gap as patients can present with cutaneous findings. This article provides a systematic review of the cutaneous manifestations of known mass organochlorine exposures in military and industrial settings with the goal of providing clinically useful recommendations for dermatologists seeing patients inquiring about organochlorine effects. Patients with a new diagnosis of chloracne, porphyria cutanea tarda, cutaneous lymphomas (non-Hodgkin lymphoma), and soft-tissue sarcomas including dermatofibrosarcoma protuberans and leiomyosarcomas should be screened for a history of Vietnam service or industrial exposure. Inconclusive evidence exists for an increased risk of other skin diseases in Vietnam veterans exposed to Agent Orange including benign fatty tumors, melanomas, nonmelanoma skin cancers, milia, eczema, dyschromias, disturbance of skin sensation, and rashes not otherwise specified. Affected veterans should be informed of the uncertain data in those cases. Referral to Department of Veterans Affairs for disability assessment is indicated for conditions with established associations.

Porphyrin studies in TCDD-exposed workers

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) has been shown to inhibit uroporphyrinogen decarboxylase activity resulting in chronic hepatic porphyria. From a cross-sectional study of 170 workers in chemical industry 68 showed elevated coproporphyrin levels, interpreted as secondary coproporphyrinuria. Three persons suffered from chronic hepatic porphyria in subclinical stages. None of the workers showed an overt porphyria cutanea tarda. A low-grade zinc protoporphyrinemia was observed in three persons. Forty-three of the 170 workers were evaluable for investigating the effect of TCDD on porphyrin levels. No significant correlation was found between TCDD concentration in adipose tissue and the level of uroporphyrin and coproporphyrin. The influence of a chloracne history is described.

Clinical laboratory manifestations of exposure to background levels of dioxins in the perinatal period

The effects of exposure to low levels of dioxins in infants (intrauterine and via breast milk) were studied. In a group of 35 babies, specially selected, laboratory tests were performed in cord blood and in blood sampled at 7 days and 11 weeks of age. The outcome of these laboratory tests was related to dioxin concentrations in milk fat and cumulative dioxin intake. At 11 weeks of age, alanine aminotransferase and aspartate aminotransferase activities in plasma were significantly related to cumulative dioxin intake. A significant negative relation was found between platelet count and cumulative dioxin intake. The results of this study suggest that exposure to background levels of dioxins, both intrauterine and via breast milk, may have effects in newborns.

Polychlorinated biphenyls (PCBs), dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), and related compounds: environmental and mechanistic considerations which support the development of toxic equivalency factors (TEFs)

Halogenated aromatic compounds, typified by the polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), biphenyls (PCBs), and diphenylethers (PCDEs), are industrial compounds or byproducts which have been widely identified in the environment and in chemical-waste dumpsites. Halogenated aromatics are invariably present in diverse analytes as highly complex mixtures of isomers and congeners and this complicates the hazard and risk assessment of these compounds. Several studies have confirmed the common receptor-mediated mechanism of action of toxic halogenated aromatics and this has resulted in the development of structure-activity relationships for this class of chemicals. The most toxic halogenated aromatic is 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and based on in vivo and in vitro studies the relative toxicities of individual halogenated aromatics have been determined relative to TCDD (i.e., toxic equivalents). The derived toxic equivalents can be used for hazard and risk assessment of halogenated aromatic mixtures; moreover, for more complex mixtures containing congeners for which no standards are available (e.g., bromo/chloro mixtures), several in vitro or in vivo assays can be utilized for hazard or risk assessment.

Diminished thymosin alpha-1 levels in persons exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin

There is evidence from animal studies that 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) impairs immune responses, with the thymus being a principal target organ. The purpose of this study was to evaluate thymic function, through measurement of thymic hormone levels, in persons exposed to TCDD. We examined thymosin alpha-1 (Thya-1) levels in sera from a group of 94 persons who were presumed to be exposed to TCDD from living, working, or recreating in a contaminated residential area. We compared these results, along with results from in vitro and in vivo tests of immune function, with those from a group of 105 unexposed persons who were similar with regard to age, sex, and race. The exposed group had a significantly lower mean Thya-1 serum level (977.3 +/- 304.1 pg/ml vs. 1148.7 +/- 482.1 pg/ml, p less than .01 by t-test). We also found a statistically significant trend of decreasing Thya-1 levels with increasing number of years of residence in the TCDD-contaminated area. However, Thya-1 levels were not associated with other measures of immune function in the TCDD-exposed group. Thus, while the principal findings suggest that long-term TCDD exposure may be associated with diminished secretion of Thya-1, the lack of an association with an increased prevalence of clinically diagnosed immune suppression in these TCDD-exposed persons makes the biologic significance of the findings unclear. Further studies are needed to more fully evaluate possible long-term TCDD-induced effects on the thymus and human immune function.

Assessing risks and preventing disease from environmental chemicals

In the last 25 years there has been considerable concern expressed about the extent to which chemical agents in the ambient and work environments are contributing to the causation of disease. This concern is a logical extension of our increased knowledge of the real and potential effects of environmental chemicals and the methodological difficulties in applying new knowledge that could help prevent environmentally induced disease. Chemical risk assessment offers an approach to estimating risks and involves consideration of relevant information including identification of chemical hazards, evaluation of the dose-response relationship, estimation of exposure and finally, risk characterization. Particularly significant uncertainties which are inherent in use of this and other risk models include animal-human and low dose-high dose extrapolation and estimation of exposure. Community public health risks from exposure to environmental chemicals appear to be small relative to other public health risks based on information related to cancer trends, dietary intake of synthetic chemicals, assessment data on substances such as DDT and "dioxin," public health effects of hazardous waste sites and contextual considerations. Because of inherent uncertainty in the chemical risk assessment process, however, we need to apply what methods are available in our efforts to prevent disease induced by environmental chemicals. There are a number of societal strategies which can contribute to overall reduction of risk from environmental chemicals. These include acquisition of information on environmental risk including toxicity, intensity and extensity of exposure, biological monitoring, disease surveillance, improvement in epidemiological methods, control of environmental chemical exposures, and dissemination of hazardous chemical information. Responsible environmental risk communication and information transfer appear to be among the most important of the available strategies for preventing disease induced by chemicals in the environment.

Polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans: the risks to human health. A review

1 PCDDs and PCDFs are ubiquitous and persistent in the environment. They are to be found in body tissues of both humans and animals. 2 The most extensively studied PCDD is 2,3,7,8-TCDD. It has been shown to produce a wide range of effects and is considered to be a (non-genotoxic) carcinogen in animals. 3 Studies into the mechanisms of toxicity so far reveal that there is involvement of a specific receptor (Ah), however further work is required to elucidate the mechanisms of the various effects. 4 Reports on a number of human exposures to PCDDs and PCDFs are described. Results from human epidemiological studies are difficult to interpret: there have been problems in methodology; there has been inadequate information on intake, and exposures have often been to mixtures of PCDDs and/or PCDFs together with other related compounds. 5 Many regulatory authorities faced with the problem of providing an index of risk from exposure to mixtures of PCDDs and PCDFs have employed the concept of 'TCDD equivalents'. 6 Whether or not PCDDs and PCDFs pose a significant human health risk at current levels of exposure they remain of considerable interest to the toxicologist.

An overview of the Missouri dioxin studies

Among the problems inherent in evaluating public health impacts around toxic waste sites are the difficulties in measuring exposure, our incomplete understanding of low-dose effects, the low frequency of disease incidence, the long latency period and silent course of disease development, the nonspecificity of clinical findings, and the probable multifactorial nature of diseases of interest. A multiphase approach for implementing epidemiologic studies in such settings was used in assessing the 2,3,7,8-tetrachlorodibenzodioxin (TCDD, or dioxin) contaminations in Missouri, where waste oil mixtures contaminated with dioxins were sprayed on various sites throughout the state for dust control in 1971. Although the toxic effects of dioxin have been studied extensively in animals and documented in cases of accidental high-level exposure in humans, very little is known of the human health effects, if any, produced by long-term exposure to relatively low levels of dioxin. In addition to medical epidemiologic studies, which were done to evaluate the types of problems present in groups of individuals with high-risk of environmental dioxin exposure, other studies to characterize dioxin levels in adipose tissue and serum are under way in a sample of potentially exposed (as well as in unexposed) Missouri residents. Research in these areas will continue to be pursued to develop a more complete understanding of the risks and appropriate public health interventions in situations of community exposure to environmental dioxins and other environmental contaminants.

Health effects in family pets and 2,3,7,8-TCDD contamination in Missouri: a look at potential animal sentinels

In 1971, waste oils containing 2,3,7,8:tetrachlorodibenzodioxin (TCDD) were sprayed in Missouri for dust control. To determine if pets could serve as sentinels of human health risks associated with this contamination, we asked pet owners in a pilot study of exposed human populations about their pets' illnesses. Of 13 pets with owner-reported illnesses, 8 had potential TCDD exposures and 5 did not (p less than .05 by Mantel-Haenzel chi-square analysis stratified by age). Owner-reported illnesses in 2 of 8 illness categories were associated with TCDD contamination after adjusting for age. Although these findings suggest that pets in TCDD-contaminated areas may have greater health risks, the small sample size, unlikely pathologic groupings, and unconfirmed nature of the data fail to support a relationship between pet illnesses and possible TCDD exposure and thus make extrapolation to human populations inappropriate. The limited validity found for owner-reported pet illnesses should caution against using such data in future environmental health studies.