Epidemiology of toluene diisocyanate (TDI)-induced respiratory disease

Chronic Exposure to TDI Induces Cell Migration and Invasion via TGF-β1 Signal Transduction

Toluene diisocyanate (TDI) is commonly used in manufacturing, and it is highly reactive and causes respiratory damage. This study aims to identify the mechanism of tumorigenesis in bronchial epithelial cells induced by chronic TDI exposure. In addition, transcriptome analysis results confirmed that TDI increases transforming growth factor-beta 1 (TGF-β1) expression and regulates genes associated with cancerous characteristics in bronchial cells. Our chronically TDI-exposed model exhibited elongated spindle-like morphology, a mesenchymal characteristic. Epithelial-mesenchymal transition (EMT) was evaluated following chronic TDI exposure, and EMT biomarkers increased concentration-dependently. Furthermore, our results indicated diminished cell adhesion molecules and intensified cell migration and invasion. In order to investigate the cellular regulatory mechanisms resulting from chronic TDI exposure, we focused on TGF-β1, a key factor regulated by TDI exposure. As predicted, TGF-β1 was significantly up-regulated and secreted in chronically TDI-exposed cells. In addition, SMAD2/3 was also activated considerably as it is the direct target of TGF-β1 and TGF-β1 receptors. Inhibiting TGF-β1 signaling through blocking of the TGF-β receptor attenuated EMT and cell migration in chronically TDI-exposed cells. Our results corroborate that chronic TDI exposure upregulates TGF-β1 secretion, activates TGF-β1 signal transduction, and leads to EMT and other cancer properties.

Exposure of Toluene Diisocyanate Induces DUSP6 and p53 through Activation of TRPA1 Receptor

Toluene diisocyanate (TDI), a major intermediate agent used in the manufacturing industry, causes respiratory symptoms when exposed to the human body. In this study, we aimed to determine the molecular mechanism of TDI toxicity. To investigate the impact of TDI exposure on global gene expression, we performed transcriptomic analysis of human bronchial epithelial cells (BEAS-2B) after TDI treatment. Differentially expressed genes (DEGs) were sorted and used for clustering and network analysis. Among DEGs, dual-specificity phosphatase 6 (DUSP6) was one of the genes significantly changed by TDI exposure. To verify the expression level of DUSP6 and its effect on lung cells, the mRNA and protein levels of DUSP6 were analyzed. Our results showed that DUSP6 was dose-dependently upregulated by TDI treatment. Thereby, the phosphorylation of ERK1/2, one of the direct inhibitory targets of DUSP6, was decreased. TDI exposure also increased the mRNA level of p53 along with its protein and activity which trans-activates DUSP6. Since TRPA1 is known as a signal integrator activated by TDI, we analyzed the relevance of TRPA1 receptor in DUSP6 regulation. Our data revealed that up-regulation of DUSP6 mediated by TDI was blocked by a specific antagonist against TRPA1. TDI exposure attenuated the apoptotic response, which suggests that it promotes the survival of cancerous cells. In conclusion, our results suggest that TDI induces DUSP6 and p53, but attenuates ERK1/2 activity through TRPA1 receptor activation, leading to cytotoxicity.

Longitudinal and Cross-sectional Analyses of Lung Function in Toluene Diisocyanate Production Workers

Objective

The aim of this study was to investigate lung function among toluene diisocyanate (TDI) production workers.

Methods

One hundred ninety-seven U.S workers performed spirometry from 2006 through 2012. Results were compared within the study cohort and with U.S. population measures. A mixed-effects model assessed factors affecting repeated forced expiratory volume in 1 second (FEV₁) measurements.

Results

The cohort’s mean FEV₁ and forced vital capacity (FVC) percent reference values, although greater than 90%, were significantly lower and the prevalence of abnormal spirometry (predominantly restrictive pattern) was significantly higher than in the U.S. population. Differences in lung function among workers with higher cumulative TDI exposure were in the direction of an exposure effect, but not significant.

Conclusion

We found little evidence of an adverse effect of TDI exposure on longitudinal spirometry in these workers. The association between TDI exposure and the increasing prevalence of a restrictive pattern needs further exploration.

Incidence of Occupational Asthma and Exposure to Toluene Diisocyanate in the United States Toluene Diisocyanate Production Industry

Objective

This study examines asthma risk in facilities producing toluene diisocyanate (TDI).

Methods

A total of 197 workers were monitored from 2007 to 2012. TDI air concentrations were used to estimate exposures.

Results

The incidence of cases consistent with TDI-induced asthma was 0.009 per person-years (seven cases) or consistent with TDI-induced asthma or asthma indeterminate regarding work-relatedness was 0.012 (nine cases). Increased risk of cases consistent with TDI asthma was observed for cumulative (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.07 to 4.05) per logarithm parts per billion-years and peak TDI exposures (OR = 1.18, 95% CI 1.06 to 1.32) (logarithm parts per billion). There was a weak association with cumulative and peak exposures for decline of short-term forced expiratory volume in one second (FEV₁). Asthma symptoms were associated with workers noticing an odor of TDI (OR 6.02; 95% CI 1.36 to 26.68).

Conclusions

There is evidence that cumulative and peak exposures are associated with TDI-induced asthma.

Toluene diisocyanate: Induction of the autotaxin-lysophosphatidic acid axis and its association with airways symptoms

Diisocyanates are industrial chemicals which have a wide range of applications in developed and developing countries. They are notorious lung toxicants and respiratory sensitizers. However, the mechanisms behind their adverse effects are not adequately characterized. Autotaxin (ATX) is an enzyme producing lysophosphatidic acid (LPA), and the ATX-LPA axis has been implicated in lung related inflammatory conditions and diseases, including allergic asthma, but not to toxicity of environmental low-molecular-weight chemicals. We investigated effects of toluene diisocyanate (TDI) on ATX induction in human lung epithelial cell models, and we correlated LPA-levels in plasma to biomarkers of TDI exposure in urine collected from workers exposed to <5ppb (parts per billion). Information on workers' symptoms was collected through interviews. One nanomolar TDI robustly induced ATX release within 10min in vitro. A P2X7- and P2X4-dependent microvesicle formation was implicated in a rapid ATX release and a subsequent protein synthesis. Co-localization between purinergic receptors and ATX was documented by immunofluorescence and confocal microscopy. The release was modulated by monocyte chemoattractant protein-1 (MCP-1) and by extracellular ATP. In workers, we found a dose-response relationship between TDI exposure biomarkers in urine and LPA levels in plasma. Among symptomatic workers reporting "sneezing", the LPA levels were higher than among non-symptomatic workers. This is the first report indicating induction of the ATX-LPA axis by an environmental low-molecular-weight chemical, and our data suggest a role for the ATX-LPA axis in TDI toxicity.

Assessment of exposure to TDI and MDI during polyurethane foam production in Poland using integrated theoretical and experimental data

The aim of this study was to develop an optimal strategy for the assessment of inhalation exposure to isocyanates such as TDI and MDI in the production of polyurethane foam by integration of theoretical and experimental data. ECETOC TRA and EASE predictive models were used to determine the estimated levels of exposure to isocyanates. The results of our study suggest that both applications EASE and ECETOC TRA can be used as a screening 1st Tier tool in this case study. PROC12 ECETOC TRA category can be linked to exposure on TDI during polyurethane foam manufacturing because it is working properly and exceeds 90th percentile measured concentration with factor 3 and the maximum measured value with factor 1, 5. The value estimated by using category PROC2 is underestimated so this category should not be linked to this scenario. At the same time, the applications of EASE overstate the expected concentrations although the scenario "Use in closed process" seems to underestimate the exposure at the "lower end". For MDI the both models estimate exposure in a conservative manner.

Biomarkers predicting isocyanate-induced asthma

Three diisocyanates can cause occupational asthma (OA): toluene diisocyanate (TDI), 4,4 diphenylmethane diisocyanate (MDI), and 1,6-hexamethylene diisocyanate (HDI). We analyzed potential biomarkers of isocyanate-induced OA, based on investigated immunologic, genetic, neurogenic, and protein markers, because there is no serological testing method. The prevalence of serum IgG to cytokeratin (CK)18 and CK19 in TDI-OA was significantly higher than in controls, although the prevalence of these antibodies was too low for them to be used as biomarkers. Another candidate biomarker was serum IgG to tissue transglutaminase (tTG), because the prevalence of serum specific IgG to tTG was significantly higher in patients with TDI-OA than in controls. The human leukocyte antigen (HLA) DRB1*1501-DQB1*0602-DPB1*0501 haplotype may be used as a genetic marker for TDI-OA in Koreans via enhanced specific IgE sensitization in exposed subjects. The genetic polymorphisms of catenin alpha 3, alpha-T catenin (CTNNA3) were significantly associated with TDI-OA. Additionally, examining the neurokinin 2 receptor (NK2R) 7853G>A and 11424 G>A polymorphisms, the NK2R 7853GG genotype had higher serum vascular endothelial growth factor (VEGF) levels than the GA or AA genotypes among Korean workers exposed to TDI. To identify new serologic markers using a proteomic approach, differentially expressed proteins between subjects with MDI-OA and asymptomatic exposed controls in a Korean population showed that the optimal serum cutoff levels were 69.8 ng/mL for ferritin and 2.5 µg/mL for transferrin. When these two parameters were combined, the sensitivity was 71.4% and the specificity was 85.7%. The serum cytokine matrix metalloproteinase-9 (MMP-9) level is a useful biomarker for identifying cases of TDI-OA among exposed workers. Despite these possible biomarkers, more effort should be focused on developing early diagnostic biomarkers using a comprehensive approach based on the pathogenic mechanisms of isocyanate-induced OA.

Alpha-T-catenin (CTNNA3) gene was identified as a risk variant for toluene diisocyanate-induced asthma by genome-wide association analysis

BACKGROUND

Toluene diisocyanate (TDI) is the most important cause of occupational asthma, but the genetic mechanism of TDI-induced asthma is still unknown.

OBJECTIVE

The objective of the study was to identify susceptibility alleles associated with the TDI-induced asthma phenotype.

METHODS

We conducted a genome-wide association study in 84 patients with TDI-induced asthma and 263 unexposed healthy normal controls using Affymetrix 500K SNPchip. We also investigated the relationships between genetic polymorphisms and transcript levels in Epstein-Barr virus-transformed lymphoblastoid cell lines from patients with TDI-induced asthma enrolled in this study.

RESULTS

Genetic polymorphisms of CTNNA3 (catenin alpha 3, alpha-T catenin) were significantly associated with the TDI-induced asthma phenotype (5.84 x 10(-6) for rs10762058, 1.41 x 10(-5) for rs7088181, 2.03 x 10(-5) for rs4378283). Carriers with the minor haplotype, HT2 [GG], of two genetic polymorphisms (rs10762058 and rs7088181) showed significantly lower PC(20) methacholine level (P=0.041) and lower mRNA expression of CTNNA3 than non-carriers (P=0.040). A genetic polymorphism in the 3' downstream region of CTNNA3 (rs1786929), as identified by DNA direct sequencing, was significantly associated with the TDI-induced asthma phenotype (P=0.015 in recessive analysis model) and the prevalence of serum-specific IgG to cytokeratin 19 (P=0.031).

CONCLUSION

These findings suggested that multiple genetic polymorphisms of CTNNA3 may be determinants of susceptibility to TDI-induced asthma.

Repeated pre-treatment with antihistamines suppresses [corrected] transcriptional up-regulations of histamine H(1) receptor and interleukin-4 genes in toluene-2,4-diisocyanate-sensitized rats

Antihistamines are effective for treatment of seasonal nasal allergy. Recently, prophylactic treatment with antihistamines in patients with pollinosis was reported to be more effective when started before the pollen season. The administration with antihistamines from 2 to 6 weeks before onset of the pollen season is recommended for management of allergic rhinitis in Japan. To determine the reason for the effectiveness of prophylactic treatment with antihistamines, the effects of repeated pre-treatment with antihistamines before provocation with toluene 2,4-diisocyanate (TDI) on their nasal allergy-like behavior and up-regulations of histamine H(1) receptors (H1R) and interleukin (IL)-4 mRNAs in their nasal mucosa were examined. Provocation with TDI induced sneezing and up-regulations of H1R and IL-4 mRNAs in the nasal mucosa of TDI-sensitized rats. Repeated pre-treatments with antihistamines including epinastine, olopatadine, or d-chlorpheniramine for 1 to 5 weeks before provocation with TDI suppressed TDI-induced sneezing and the up-regulations of H1R and IL-4 mRNAs in the nasal mucosa more than their administrations once or for 3 days before TDI provocation. Our data indicate that repeated pre-treatment with antihistamines before provocation with TDI is more effective than their single treatment in reducing nasal allergy-like behavior by causing additional suppression of up-regulations of H1R and IL-4 mRNAs in the nasal mucosa.

Relationship between neurokinin 2 receptor gene polymorphisms and serum vascular endothelial growth factor levels in patients with toluene diisocyanate-induced asthma

BACKGROUND

Among the various pathogenic mechanisms of toluene diisocyanate (TDI)-induced asthma, a contribution from neurogenic inflammation has been suggested.

OBJECTIVE

To evaluate neurokinin 2 receptor (NK2R) gene polymorphisms in association with the clinical phenotype of TDI-induced asthma, 70 TDI-induced occupational asthma (TDI-OA)patients, 59 asymptomatic exposed controls (AEC), and 93 unexposed healthy controls (NC) were enrolled in the study.

METHODS

Two single-nucleotide polymorphisms (SNPs) of NK2R, 7853G>A (Gly231Glu) and 11 424G>A (Arg375His), were genotyped using a single base extension method. The levels of PC20 methacholine, specific IgE and IgG to TDI-human serum albumin conjugate, and serum vascular endothelial growth factor (VEGF), matrix metalloproteinase-9, and TGF-beta1 were compared according to the NK2R genotypes of the subjects with TDI-OA and AEC.

RESULTS

No significant differences in allele, genotype, or haplotype frequencies of these two SNPs were noted among the three groups (P>0.05, respectively). Moreover, subjects with the NK2R 7853GG genotype had higher serum VEGF levels than those with GA or AA among the TDI-exposed workers (P=0.040).

CONCLUSION

The NK2R 7853GG genotype may contribute to increased serum VEGF levels, which result in airway inflammation after TDI exposure.

Occupational asthma, lung function decrement, and toluene diisocyanate (TDI) exposure: a critical review of exposure-response relationships

An extensive amount of clinical/epidemiological literature exists regarding the effects of toluene diisocyanate (TDI) exposure on respiratory health. This review presents an evaluation and synthesis of that literature with an emphasis on assessing exposure-response relationships in the workplace. The key respiratory disorders examined are bronchial asthma and an accelerated decline in lung function. In the early years of the industry, annual incidence rates of TDI-induced occupational asthma (OA) were as high as 5-6 percent. In settings where mean TDI concentrations have been maintained below 5 ppb based on 8-hr personal samples, OA incidence rates have declined to < 1 percent annually. Recent data also suggest that overexposure incidents may play an important role in inducing OA, particularly in work environments engineered to minimize routine ambient air concentrations. Fourteen studies were reviewed that examined lung function decrement. Early studies from the 1960s and 1970s provided evidence of transient or fixed lung function loss (measured as a decline in forced expiratory volume in one second [FEV1]) during periods of ongoing exposure among employees experiencing high rates of work-related symptoms of OA. Such findings would not be unexpected in that modest FEV1 declines have been demonstrated in general population studies of persons with bronchial hyperresponsiveness or persistent non-occupational asthma. More recent workplace studies have provided no consistent evidence of accelerated FEV1 loss among employees exposed up to 5 ppb TDI (8-hr TWA) even with documented routine short-term TDI concentrations exceeding 20 ppb TDI.

Respiratory and other hazards of isocyanates

Isocyanates are increasingly being used for manufacturing polyurethane foam, elastomers, adhesives, paints, coatings, insecticides, and many other products. At present, they are regarded as one of the main causes of occupational asthma. The large number of workers who are exposed to these chemicals have a concentration-dependent risk of developing chronic airway disorders, especially bronchial asthma. Different pathophysiologic mechanisms are involved. Immunoglobulin E (IgE)-mediated sensitization and irritative effects have been clearly demonstrated in both exposed subjects and animals. Presumably, neural inflammation due to neuropeptide release of capsaicin-sensitive afferent nerves is crucial. We collected data on 1780 isocyanate workers who had been examined by our groups. Of them 1095 (including subjects from outpatient departments) had work-related symptoms, predominantly of the respiratory tract. Specific IgE antibodies were found in 14% of the 1095 subjects. The methacholine challenge test was shown to be an inadequate predictor of the results of inhalative isocyanate provocation tests in workers and in asthmatic controls. Isocyanate (toluene diisocyanate TDI) air concentrations of 10 ppb (0.07 mg/m3) and 20 ppb (0.14 mg/m3), respectively, did not cause significant bronchial obstruction in the majority of previously unexposed asthmatics with bronchial hyperreactivity. IgG-mediated allergic alveolitis, a rare disease among isocyanate workers, was found in approximately 1% of the symptomatic subjects. Experimental studies exhibit dose-dependent toxic effects and give evidence for tachykinin-mediated bronchial hyperreactivity after exposure to isocyanates. The clinical role of genotoxic effects of isocyanates and their by-products demonstrated here in vitro and in vivo has yet to be clarified.

The potential impact of epidemiology on the prevention of occupational disease

This presentation reviews occupational epidemiology as a foundation for workplace disease prevention activities. By examining descriptive, etiologic and intervention occupational epidemiology studies, a range of opportunities are illustrated where epidemiology has played, or could play a principal role in guiding preventive efforts. Descriptive studies presented include ones based on vital records, on epidemic investigations, cross-sectional surveys, and surveillance. Etiologic studies review the largely successful development of knowledge for lung cancer and asbestos exposure for pulmonary effects of isocyanate exposures. However, attention is also directed to the need for etiologic studies of work environment risks for both cardiovascular and musculoskeletal disease. Finally importance is placed on the too infrequent epidemiologic studies of intervention. Historical examples of control of large risks from nickel cancers and silicosis are balanced with more recent examples of successes at reducing smaller risks of cardiovascular disease and oil acne. Throughout, emphasis is placed on the importance of reintegrating the academic discipline of epidemiology into the application of study findings to prevention of workplace risks.

Measuring exposure for the epidemiologic study of acute effects

This report explores the importance of characterizing short-term (peak) exposures for successful epidemiologic study of acute reversible effects. By selecting upper respiratory tract irritation, which is time-limited, reversible, and not critically affected by host factor sensitivities, the illustrated approach (directed at an acute respiratory irritant) provides insights on issues important in the general study of acute effects. The fundamental concern in a study of acute irritant effects is that such events occur in response to abrupt increases in exposure. This calls for a closer examination of how to distinguish bursts, or peaks, of exposure from continuous exposures measured simply as time weighted averages. Three parameters of peak exposures are discussed: duration, magnitude, and frequency. The importance of duration is illustrated by contrasting exposure patterns relevant for the study of acute vs. chronic health effects. The minimum magnitude of a peak relevant to the study of a specific physiologic response requires knowledge of the threshold below which no detectable response occurs. For any identified threshold level, only exposures exceeding that level are defined as relevant peaks for an exposure-response analysis. Finally, the issue of frequency, the minimum length of time between successive exposures necessary for the subject to return to baseline risk, is explored. A study of respiratory irritation associated with sodium borates is used to illustrate these issues.

New aspects of isocyanate asthma

Air concentration of isocyanates are associated with the frequency of induced diseases. Asthma, bronchitis and rhinitis, chronic obstructive lung disease, and allergic alveolitis, respectively, were observed in exposed workers. Inhalation challenge tests with isocyanates found some 14% of symptomatic persons immunologically sensitized. At and above current threshold limit values (10 ppb) there is a risk of lung function deterioration also in asymptomatic workers.

Isocyanates and respiratory disease: current status

This paper reviews the known respiratory effects of isocyanates. There is good evidence to indicate that isocyanates: cause chemical bronchitis/pneumonitis; are potent pulmonary sensitizers capable of causing "isocyanate asthma"; cause nonspecific airways disease, including chronic bronchitis; can induce a general asthmatic state; and can cause hypersensitivity pneumonitis. Similar dose-response relationships are seen for both acute and chronic effects. There are plants operating in which exposures are well controlled and in which no respiratory effects can be detected. Suggestions are provided for preplacement assessment and periodic surveillance for workers exposed to these compounds.

Prolonged fever associated with inhalation of multiple pyrolysis products

A case of smoke inhalation with a self-limited but prolonged febrile course, including headaches and chills, is reported. A final diagnosis of polymer fume fever was made, although the duration of fever was longer than generally has been reported with this syndrome. Pyrolysis products involved included those of polyurethane, methylene chloride, and polytetrafluoroethylene ("Teflon"). The results of toxicological testing are reported and discussed.

Respiratory effects of inhaled isocyanates

Numerous industrial chemicals are known to cause allergic reactions in the lung. Prominent among such chemicals are isocyanates, the starting material in the production of polyurethanes. In view of the extensive worldwide production of isocyanates (1.5 million metric tons per year), and the diversity of products manufactured from isocyanates (i.e., cars, airplanes, furniture, bedding, etc.) there is considerable potential for adverse health effects associated with exposure to isocyanates. Syndromes of immediate respiratory reactivity, delayed-onset sensitivity, and hypersensitivity pneumonitis have all been associated with isocyanate exposure. However, little is known concerning how sensitivity develops, which individuals are most likely to become sensitized, or how to best detect early sensitivity. Answers to such questions are beginning to emerge from the recent development of animal models of lung sensitivity. These models will be discussed together with their application to clinical situations.

Amines: possible causative agents in the development of bronchial hyperreactivity in workers manufacturing polyurethanes from isocyanates

Investigations of respiratory symptoms among workers in a factory producing polyurethane foam included measurement of air pollution with amines and isocyanates and a simultaneous health investigation of the exposed workers. An increased bronchial reactivity to inhaled methacholine was found in the study group compared with two unexposed control groups. This finding, together with visual disturbances in the exposed group, were assumed to be caused mainly by the volatile amines. The concentrations of isocyanates in air were well below 0.005 ppm. The amine concentration was 1000 to 10 000 times higher than the isocyanate concentration. The most volatile amine, N-methylmorpholine, occurred in the air in concentrations higher than 10 ppm. The results indicate that not only the isocyanates but also the amines might well be responsible for respiratory symptoms among exposed workers in polyurethane foam production.

Occupational asthma in Finland

In Finland occupational asthma caused by protein allergens and reactive chemicals present in the air of work environments is increasing. This communication describes provocative challenge tests and methods for measuring exposure under simulated work conditions. The importance of lung function measurements during non-exposure and placebo periods is stressed. Especially late reactions are difficult to assess because of the great circadian variation in the lung function parameters of asthmatics. For a positive challenge test, a decrease in peak flow values of at least 15% and a clear deviation from normal circadian variation and placebo periods is required. The allergens of vegetable or animal origin primarily affect patients with an atopic constitution. Chemical allergens seem to attack all exposed workers in the same way. The report lists the occupations with risk for asthma and refers to the population at risk; bakers seem to be the group with the most risk. The importance of early diagnosis, removal of the worker from exposure and improvement of the hygienic aspects of the work environment are stressed.

Chronic pulmonary function loss from exposure to toluene diisocyanate

ABSTRACT In 1972 a total of 112 workers exposed to toluene diisocyanate (TDI) were examined for acute pulmonary function changes during a work shift on the first day of the working week. A dose-response relationship was demonstrated for the acute effects of TDI in this population. The cohort was restudied in 1974 to determine whether there was excessive loss of pulmonary function, and if so, whether there was an exposure level below which this did not occur. The original cohort was reduced to 63 workers available for re-survey of which 57 could be assigned reliable personal exposure levels for the two-year study period. Pulmonary function measurements were made again before and after work on the first day of the working week. A total of 132 environmental samples were collected on this and previous occasions during the study period. The 57 workers were divided into three exposure subgroups (≤ 0·0015; 0·0020 - 0·0030; ≥ 0·0035 ppm). Using the FEV_1·0 as a measure of response, a dose-response relationship was observed. Only those in the lowest exposure subgroup showed normal two-year declines. The FEV_1·0 of those in the highest exposure group fell 206 ml in two years (103 ml/year) which exceeds the expected value by three- to fourfold. The decrement of FEV_1·0 in the middle exposure group was borderline (42 ml/year). These differences in FEV_1·0 by exposure subgroup were not explained by age, months employed, smoking habits, or variables related to lung size. A significant association (r = 0·35, p < 0·005) between acute and chronic decrement in FEV_1·0 was shown again. We conclude that chronic occupational exposure to TDI at 0·003 ppm or higher is unsafe.

Occupational and environmental health hazards in the plastics industry

A brief description of the potential occupational health hazards encountered in the manufacture of plastics (polymers) is given. In general, these hazards are due to the monomers used to make the various plastics, to unreacted monomer contained within the finished products, and to the fillers, stabilizers, pigments, inhibitors, and initiators used in fabricating the finished products. They run the gamut from angiosarcomas of the liver due to vinyl chloride, to dermatitis and asthma-like reactions due to the initiators used with epoxy resins.