Lung Disease at the Cleaners

Case reports are an important first step in identifying a hazard associated with an occupational exposure. For metalworking fluids, case reports of asthma in the 1980's, and hypersensitivity pneumonitis in the 1990's lead to more robust scientific work which now recognizes these outcomes as routine in environments in compliance with OSHA standards.

BrooklynDodger expects that this first published association of HP with a solvent exposure will lead to further publications and further study.

As manufacturing industry recedes in the US, a few service industries provide health effects data for common industrial chemicals. Dry cleaning is one of those service industries.

Dry cleaning cohorts in Scandinavia provide the strongest evidence for carcinogenicity of trichloroethylene. A dry cleaning cohort in Oklahoma provides the strongest evidence for carcinogencity of aliphatic hydrocarbon solvents [stoddard solvent.]

IARC gives dry cleaning a 2B, possibly carcinogenic to humans, based on epidemiology:

Variation within individual studies of dry cleaners may depend on the nature and level of exposure, which varies from shop to shop and across studies of dry cleaning workers. There is also variation in the types of solvents used over time and across geographic regions. These limitations notwithstanding, the epidemiological studies on dry cleaning indicate that the risks for cancers at two sites, urinary bladder and oesophagus, may be increased by employment in dry cleaning.

4.3 Other relevant data
Inconsistent evidence of slight renal damage among workers exposed to tetrachloroethylene in dry cleaning shops was found in two studies, whereas two other studies in which exposure to tetrachloroethylene was at least as high did not find such an association.

Disturbances of sperm quality and fertility have been observed among dry cleaning workers in a few studies of limited size. Several studies performed in Nordic countries have shown a consistent increase in the risk for spontaneous abortion among dry cleaners, but the studies are not entirely independent of each other. No effect has been observed on other reproductive outcomes, such as stillbirth, congenital malformation or low birth weight, but the power of the studies was limited.

In single studies, lymphocytes from dry cleaning workers showed no increase in the frequency of alkaline-labile sites/DNA single-strand breaks. There was inadequate information to evaluate the genetic effects in humans of exposures in dry cleaning.

4.4 Evaluation
There is limited evidence in humans for the carcinogenicity of occupational exposures in dry cleaning.

Overall evaluation
Dry cleaning entails exposures that are possibly carcinogenic to humans (Group 2B).

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Respiration. 2004 Nov-Dec;71(6):642-5.

Can we still miss tetrachloroethylene-induced lung disease? The emperor returns in new clothes.

Tanios MA, El Gamal H, Rosenberg BJ, Hassoun PM.Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Tufts-New England Medical Center, Boston, MA 02111, USA. mtanios@tufts-nemc.org

Hypersensitivity pneumonitis (HP) is a complex syndrome of varying intensity and clinical presentation, and has been described in association with numerous exposures. Early diagnosis is essential to limit irreversible lung damage. We describe a case of HP in a 42-year-old dry cleaner following occupational exposure to tetrachloroethylene (TCE). The diagnosis was suspected based on clinical presentation and radiographic studies, and confirmed by lung biopsy. A review of the literature reveals that HP has not been reported previously as an occupational lung disease in dry cleaners. We conclude that HP should be suspected in dry cleaners presenting with pulmonary complaints, and TCE should be considered as a potential trigger of disease. The spectrum of TCE-related occupational diseases and the diagnosis of HP are reviewed.