Page:NIOSH Hazard review of Carbonless Copy Paper.pdf/60

 symptoms. These workers were again examined in November 1979 when some CCP sets were still in circulation but most had been returned to the supplier. The complaints gradually declined until none of the workers exhibited serious symptoms and eight had only mild symptoms. In September 1980, when none of the original CCP remained in use, only one of the workers (who had a previous history of allergy) complained of itching and irritation of the eyes. The solvent MIPB and associated impurities (which had a characteristic odor) were suspected. Formaldehyde was not thought to be of any importance in the incident.

Roure et al. 1982. Roure et al. [1982] described subjective symptoms and objective signs occurring in 22 of 35 workers exposed in a French company during the introduction of CCP. The following frequencies of subjective symptoms were observed: pruritis localized on the hands (13 cases), face (9 cases), forearms (5 cases), or thorax and legs (1 case); burning sensation, nasopharyngeal tingling, slight dysphagia, photophobia, eye irritation, and conjunctival pruritis (11 cases); dryness of the mouth, burning, and taste perturbations (3 cases); and headache (3 cases). All symptoms appeared as early as the start of the workweek, lessened in the evening, and disappeared on the weekends. Objective signs in 18 workers consisted of erythematous patches on the hands and face (9 cases), urticaria (1 case), migratory edema (1 case), conjunctivitis with edema of the eyelid (1 case), conjunctival hyperemia with lacrimation (2 cases), rhinorrhea (4 cases), glottal stricture (1 case), nasal obstruction (1 case), and spasmodic cough and asthmatic breathing (4 cases). An etiologic survey showed evidence of previous allergies in three subjects and enabled a distinction to be made between the risks due to "transfer-contact" and "chemical-contact" copy papers.

Certin and Zissu 1983. Results of analyses requested of the French National Research and Safety Institute were reported by Certin and Zissu [1983] and compared with other published studies. They reported 51 requests for analysis of CCP during the 10 years preceding publication of the results. Reasons stated in 46 of the requests included cutaneous problems (allergies, irritation, pruritis, and chapping) (41), respiratory problems (12), ocular disorders (lacrimation, conjunctivitis) (10), irritation of the nasal mucosa (2), and others including asthenia, anemia, headache, and arthralgias. According to the authors, dermatological and respiratory problems seemed to be linked to the use of these papers and were more likely to be due to irritation than to allergy.

Norbäck et al. 1983a,b,c; 1988. Norbäck et al. [1983a] summarized conclusions from five studies in Sweden. Studies in 80 office workers observed only eye and respiratory tract irritation caused by CCP. Norbäck et al. [1983b] found no correlations between airborne solvent concentrations from CCP and the occurrence of irritative symptoms. Formaldehyde, glutaraldehyde, and the organic solvents in which the color formers are dissolved were studied under standardized conditions. According to the authors, the emission of aldehydes from CCP was too low to cause the irritative symptoms. The highest airborne concentration was that of kerosene, which could not be related to symptoms.

Norbäck et al. [1983c, 1988] searched for the discomfort-inducing factors in 276 paper samples (233 of which were CCP) submitted by workers claiming to have experienced irritative symptoms while handling the papers. Interviews regarding symptoms and handling volume were conducted with subjects who had submitted 190 of the CCP samples. To distinguish between CCP of different makes, GC of paper extracts was performed, sometimes combined with thin-layer chromatography (TLC) of the color formers. Coded paper samples were used to permit blind analyses of the