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

Masri, Shahir; Miller, Claudia S.; Palmer, Raymond F.; Ashford, Nicholas

doi:10.1186/s12302-021-00504-z

Environmental Sciences Europe

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 Formaldehyde Xylene	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 PM_2.5 PAHs Mixed metals	104–9576 µg/m^{3 a} NA-2889 µg/m^3a 5–500 µg/m^{3 a} NA
			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
Casino workers	Pesticides and solvent carriers	Exposure: NA Illness: ~ 250 TILT: 12 (5%)	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	NA^c
WTC disaster	Structure fire and “WTC dust” from building collapse	Unknown	Mixed SVOCs	PCBs, dioxin, phthalates and BFRs	NA^c
			Combustion products	PM, PAHs, metals, etc.
			Pesticides	Organochlorides
Implant syndrome	Surgical implants and processing aids	Unknown	Silicone	Poly-dimethylsiloxane Mixed metals	NA
Implant syndrome	Surgical implants and processing aids	Unknown	Peroxides	2,4-Dichlorobenzoyl peroxide	NA
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 ppb^b
		Exposure: 9 Illness: 9	Mixed mVOCs	1-octen-3-ol, geosmin, etc.	NA nd-0.9 ppb^b
		TILT: 4 (44%, 44%)	Mixed VOCs	Unknown	NA

^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]
^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]
^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

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