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 many months, this patient showed significant clinical improvement. They also mentioned that another investigator had seen chemical sensitivity in about 100 patients with substantial occupational exposure to CCP, but this information was unpublished.

Smith et al. 1999. In the United Kingdom, a 49-year-old male forklift driver at a paper mill producing CCP described a 2-year history of hand dermatitis and was diagnosed as having fissured hyperkeratotic eczema of the thumbs. He responded positively to patch testing with para-phenylenediamine in a standard series; and when tested with a dye series, he reacted to the azo dye Disperse Orange 3. Several azo dyes were used at the mill to produce colored paper; the patient’s job entailed transportation of dye containers. Skin contamination was thought to have occurred during the collection of the used dye containers. Work restrictions from handling the dyes led to resolution of the hand dermatitis. The azo dyes were not likely to have been part of the CCP system, but they were used as a background color for the paper; the authors did not explain the use of the dyes.

This subsection describes case reports or case series that were submitted to the NIOSH docket from sources other than CCP manufacturers in response to the 1987 and 1997 Federal Register notices regarding CCP [52 Fed. Reg. 22534 (1987); 62 Fed. Reg. 8023 (1997)]. Twenty-six cases involving health effects attributed to CCP were submitted. The sex of the respondent is mentioned in 14 cases, all of which were female. Age was mentioned in 11 cases. Mean age was 43, with a range from 32 to 55. Symptoms were reported in 23 cases. Multiple symptoms were attributed to CCP in many cases, with 5 or more symptoms reported in 14 of the 23 cases. The most common symptoms attributed by patients or their doctors to CCP included skin symptoms (irritation, rash), respiratory symptoms (breathing difficulty/shortness of breath, nasal/respiratory irritation, lip sores, frequent colds, hoarseness or loss of voice), eye symptoms (eye irritation, blurred vision, eyes feeling swollen and hurt), and general symptoms (fatigue, dizziness, vertigo, lack of energy, fever, malaise, trouble thinking/focusing, and weakness/pain of muscles in general or specifically of the legs, back, or arms). Some information about laboratory workup was provided in eight cases. Immunologic testing, performed in six cases, was extensive but used tests of unknown utility. Small deviations from laboratory normal ranges were attributed to or said to be compatible with immunotoxicity. Extensive neuropsychiatric testing was reported in seven cases, and abnormal results were attributed to or said to be compatible with neurotoxicity. Sophisticated neuroimaging studies such as magnetic resonance imaging (MRI) scans of the brain and single positron emission computed tomography (SPECT) scans of the brain were reported in three cases. Abnormalities in SPECT scans of unknown importance were often attributed to or said to be compatible with neurotoxicity. Eleven of the subjects were characterized as suffering from MCS or "chemical sensitivity." In four cases, symptoms were attributed to formaldehyde sensitivity. Diagnoses of chronic Epstein-Barr virus infection and chronic fatigue syndrome were each made in one case. One subject reported having been treated with "drops under tongue of formaldehyde and petrochemicals." Another reported having been treated with "antigen."