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 symptoms were temporary redness, burning, and itching that occurred after 2 to 3 hr of work; they disappeared overnight or over the weekend. Itching of the eyes or the nose, hoarseness, and burning in the mouth were the other symptoms recorded. Twenty-nine of the 38 received standard skin-patch tests, and 11 were found with one or more reactions. Twenty-five workers were further skin-patch tested with 17 paper substances and with the paper. Eight workers were tested with the paper components plus the paper, but no reactions were observed. Other tests included prick testing, photo-patch testing, open tests on the forehead (dab testing), and short-term patch testing for 20 min. All results were negative. The three skin-prick tests using the paper components were negative. Eight were photo-patch tested, and eight had open-patch tests to assess phototoxicity, but all reactions were negative. Twenty-six were skin-prick tested with two types of CCP; six reacted to one type, and five reacted to the other type with reactions the size of one histamine equivalent. However, authors considered these responses to be nonimmunological. Among the 35 controls, one had a positive reaction to one of the skin-paper prick tests. The controls were also tested with 17 different components of the CCP; all tests were negative. The authors stated that approximately 4,000 separate tests were carried out without reaching any definite conclusions.

Menné et al. [1981] also reported on the case of a worker from a different company who began experiencing redness of the face, headache, and dizzy spells on the day that a new delivery of CCP was made. The worker's symptoms disappeared 2 hr after he returned home. Two months later, the paper was replaced and his symptoms disappeared.

Chrostek and Moshell 1982. Chrostek and Moshell [1982] conducted a walk-through survey and administered nondirected medical interviews with 21 workers at a U.S. telephone company. These service department workers acted on reports of malfunctioning telephone service and requests for new services, which were printed on yellow CCP. Previously, carbon paper had been used with no complaints. The following health complaints were described after the introduction of CCP: eye itching and burning, nose itching and burning, dry throat, headaches, facial itching, and sinus, skin, and respiratory problems. Some of the workers stated that the adverse health problems existed only when handling yellow CCP—not white CCP. Five air samples were collected for total dust; they ranged from 0.06 to 0.2 mg/m³. The two samples collected for formaldehyde were 0.22 mg/m³. Workers handling the CCP were asked to wear white cotton gloves, which were analyzed. The common contaminant in both the gloves and the CCP was dibutyl phthalate, although other contaminants (diethyl phthalate and dioctyl adipate) were also detected in the gloves. Qualitative analysis of the carbonless paper did not detect formaldehyde. On May 13–14, 1981, a NIOSH dermatologist interviewed and examined 33 workers. Of these, 28 were skin-patch tested with unmarked white and yellow CCP—and a marked yellow CCP. On the basis of the negative skin-patch tests and a lack of skin findings consistent with allergic contact dermatitis, the authors ruled out type IV allergic phenomena as a major problem. However, they allowed that certain individuals might have been allergic to a component of the paper.

Levy and Hanoa 1982. Levy and Hanoa [1982] reported on an isolated epidemic that occurred in northern Norway when a new type of invoice form (30,000 sets) had been introduced by a builder's supply company. During the first week of use, workers complained about an unpleasant odor, rashes, headaches, and itching eyes, face, and hands. Thirteen female workers were examined in June 1979; six had serious symptoms and three exhibited mild