Skip to main content

Table 3 Initiating events described according to the chemicals and/or chemical groups most pervasive in the event and the number of people who experienced exposure, illness, and the development of TILT-like symptoms

From: Toxicant-induced loss of tolerance for chemicals, foods, and drugs: assessing patterns of exposure behind a global phenomenon

Case study Initiating event # of People
(% of exposed,
% of ill)
Exposure type Key chemical exposures Chemical concentrations
EPA building remodel Carpet installation Exposure: 2000
Illness: 60
TILT: 8 (0.4%, 13%)
Mixed VOCs 4-PCH
1–15 ppb
6–59 ppb
0.9–4.2 ppb
Gulf War Illness Vehicle and burn pit emissions, pesticide use, and nerve and anti-nerve agents Exposure: 700,000
Illness: 210,000
TILT: ~ 200,000 (~ 29%)
Nerve agents Sarin, cyclosarin NA
Nerve agent (anti-) PB NA
Pesticides Organophosphates NA
Combustion products PM10
Mixed metals
104–9576 µg/m3 a
NA-2889 µg/m3a
5–500 µg/m3 a
Mixed VOCs Benzene, acetone, toluene, xylene, etc. 2–55 ppb
Casino workers Pesticides and solvent carriers Exposure: NA
Illness: ~ 250
TILT: 12 (5%)
Pesticides Carbamates 7–8 ppb
Mixed VOCs Xylene, acetone, etc. 240 ppb (max)
Aerotoxic syndrome Pyrolysis products of lubricant oil and additives from airplane engine Exposure: NA
Illness: 142
TILT: 16 (11%)
Mixed SVOCs Triphenyl phosphate and
Tricresyl phosphate
WTC disaster Structure fire and “WTC dust” from building collapse Unknown Mixed SVOCs PCBs, dioxin, phthalates and BFRs NAc
Combustion products PM, PAHs, metals, etc.
Pesticides Organochlorides
Implant syndrome Surgical implants and processing aids Unknown Silicone Poly-dimethylsiloxane
Mixed metals
Peroxides 2,4-Dichlorobenzoyl peroxide
Tunnel workers Outgassing of gasoline vapors Exposure: 30
Illness: NA
TILT: 8 (27%)
Mixed VOCs Benzene 60 ppm
Mold case in Finland Mold spores, mVOCs, cleaning solvents Exposure: 9
Illness: 9
Fungi Mycotoxin NA
nd-0.9 ppbb
Mixed mVOCs 1-octen-3-ol, geosmin, etc.
TILT: 4 (44%, 44%) Mixed VOCs Unknown NA
  1. aSince measurements were not available for this exposure event, concentration values are those from a similar combat zone in a nearby geographic region (Iraq) [21]
  2. bSince measurements were not available for this exposure event, concentration values were drawn from measurements in other homes that were sampled following mold-related complaints (nd=non-detect) [50]
  3. cWhile on-site air sampling was not conducted during the events, the presence of visible smoke/fumes (reported by some pilots in Aerotoxic Syndrome case and well known for WTC case) suggests potentially high exposure