This public health statement tells you about formaldehyde and the effects of exposure.
The Environmental Protection Agency (EPA) identifies the most serious hazardous waste sites in the nation. These sites make up the National Priorities List (NPL) and are the sites targeted for long-term federal cleanup activities. Formaldehyde has been found in at least 26 of the 1,428 current or former NPL sites. However, it's unknown how many NPL sites have been evaluated for this substance. As more sites are evaluated, the sites with formaldehyde may increase. This is important because exposure to this substance may harm you and because these sites may be sources of exposure.
When a substance is released from a large area, such as an industrial plant, or from a container, such as a drum or bottle, it enters the environment. This release does not always lead to exposure. You are exposed to a substance only when you come in contact with it. You may be exposed by breathing, eating, or drinking the substance or by skin contact.
If you are exposed to formaldehyde, many factors determine whether you'll be harmed. These factors include the dose (how much), the duration (how long), and how you come in contact with it. You must also consider the other chemicals you're exposed to and your age, sex, diet, family traits, lifestyle, and state of health.
Formaldehyde can react with many other chemicals, and it will break down into methanol (wood alcohol) and carbon monoxide at very high temperatures.
Formaldehyde is naturally produced in very small amounts in our bodies as a part of our normal, everyday metabolism and causes us no harm. It can also be found in the air that we breathe at home and at work, in the food we eat, and in some products that we put on our skin. A major source of formaldehyde that we breathe every day is found in smog in the lower atmosphere. Automobile exhaust from cars without catalytic converters or those using oxygenated gasoline also contain formaldehyde. At home, formaldehyde is produced by cigarettes and other tobacco products, gas cookers, and open fireplaces. It is also used as a preservative in some foods, such as some types of Italian cheeses, dried foods, and fish. Formaldehyde is found in many products used every day around the house, such as antiseptics, medicines, cosmetics, dish-washing liquids, fabric softeners, shoe-care agents, carpet cleaners, glues and adhesives, lacquers, paper, plastics, and some types of wood products. Some people are exposed to higher levels of formaldehyde if they live in a new mobile home, as formaldehyde is given off as a gas from the manufactured wood products used in these homes.
Following Hurricane Katrina, many families filed complaints with FEMA due to respiratory illness and symptoms of Sick Building Syndrome in the FEMA trailer temporary housing. Their symptoms have been linked to Formaldehyde off-gasing from building materials used in the manufacture of the FEMA trailers the Katrina evacuees were being temporarily housed in.
Elevated levels of Formaldhyde in FEMA trailers is proof that materials such as particle board and carpeting can be hazardous to your health due to chemical off-gasing. It is unknown how many lawsuits and toxic tort cases related to Formaldehyde exposure are pending - but Formaldehyde IS known to be a common source of Sick Building Syndrome.
Formaldehyde is used in many industries. It is used in the production of fertilizer, paper, plywood, and urea-formaldehyde resins. It is present in the air in iron foundries. It is also used in the production of cosmetics and sugar, in well-drilling fluids, in agriculture as a preservative for grains and seed dressings, in the rubber industry in the production of latex, in leather tanning, in wood preservation, and in photographic film production. Formaldehyde is combined with methanol and buffers to make embalming fluid. Formaldehyde is also used in many hospitals and laboratories to preserve tissue specimens.
There is usually more formaldehyde present indoors than outdoors. Formaldehyde is released to the air from many home products and you may breath in formaldehyde while using these products. Latex paint, fingernail hardener, and fingernail polish release a large amount of formaldehyde to the air. Plywood and particle board, as well as furniture and cabinets made from them, fiberglass products, new carpets, decorative laminates, and some permanent press fabrics give off a moderate amount of formaldehyde. Some paper products, such as grocery bags and paper towels, give off small amounts of formaldehyde. Because these products contain formaldehyde, you may also be exposed on the skin by touching or coming in direct contact with them. You may also be exposed to small amounts of formaldehyde in the food you eat. You are not likely to be exposed to formaldehyde in the water you drink because it does not last a long time in water.
Many other home products contain and give off formaldehyde although the amount has not been carefully measured. These products include household cleaners, carpet cleaners, disinfectants, cosmetics, medicines, fabric softeners, glues, lacquers, and antiseptics. You may also breathe formaldehyde if you use unvented gas or kerosene heaters indoors or if you or someone else smokes a cigar, cigarette, or pipe indoors. The amount of formaldehyde in mobile homes is usually higher than it is in conventional homes because of their lower air turnover.
People who work at or near chemical plants that make or use formaldehyde can be exposed to higher than normal amounts of formaldehyde. Doctors, nurses, dentists, veterinarians, pathologists, embalmers, workers in the clothing industry or in furniture factories, and teachers and students who handle preserved specimens in laboratories also might be exposed to higher amounts of formaldehyde. The National Institute for Occupational Safety and Health (NIOSH) estimates that 1,329,332 individuals in the United States have had the potential for occupational exposure to formaldehyde.
To protect the public from the harmful effects of toxic chemicals and to find ways to treat people who have been harmed, scientists use many tests.
One way to see if a chemical will hurt people is to learn how the chemical is absorbed, used, and released by the body; for some chemicals, animal testing may be necessary. Animal testing may also be used to identify health effects such as cancer or birth defects. Without laboratory animals, scientists would lose a basic method to get information needed to make wise decisions to protect public health. Scientists have the responsibility to treat research animals with care and compassion. Laws today protect the welfare of research animals, and scientists must comply with strict animal care guidelines.
Several studies of laboratory rats exposed for life to high amounts of formaldehyde in air found that the rats developed nose cancer. Some studies of humans exposed to lower amounts of formaldehyde in workplace air found more cases of cancer of the nose and throat (nasopharyngeal cancer) than expected, but other studies have not found nasopharyngeal cancer in other groups of workers exposed to formaldehyde in air. The Department of Health and Human Services (DHHS) has determined that formaldehyde may reasonably be anticipated to be a human carcinogen (NTP). The International Agency for Research on Cancer (IARC) has determined that formaldehyde is probably carcinogenic to humans. This determination was based on specific judgments that there is limited evidence in humans and sufficient evidence in laboratory animals that formaldehyde can cause cancer. The Environmental Protection Agency (EPA) has determined that formaldehyde is a probable human carcinogen based on limited evidence in humans and sufficient evidence in laboratory animals.
Formaldehyde is likely to contribute to Occupational Asthma and Allergic Contact Dermititis
Children and adults are likely to be exposed to formaldehyde in the same way. The most common way for children to be exposed to formaldehyde is by breathing it. Children may also be exposed by wearing some types of new clothes or cosmetics. A small number of studies have looked at the health effects of formaldehyde in children. It is very likely that breathing formaldehyde will result in nose and eye irritation (burning feeling, itchy, tearing, and sore throat). We do not know if the irritation would occur at lower concentrations in children than in adults. Studies in animals suggest that formaldehyde will not cause birth defects in humans. Inhaled formaldehyde or formaldehyde applied to the skin is not likely to be transferred from mother to child in breast milk or to reach the developing fetus.
Formaldehyde is usually found in the air. Formaldehyde levels are also higher indoors than outdoors. Opening windows or using a fan to bring in fresh air is the easiest way to lower formaldehyde levels in the home and reduce the risk of exposure to your family.
Removing formaldehyde sources from the house will also reduce the risk of exposure. Since formaldehyde is found in tobacco smoke, not smoking or smoking outside will reduce exposure to formaldehyde. Unvented heaters, such as portable kerosene heaters, also produce formaldehyde. If you do not use these heaters in your home or shop, you help to prevent the build up of formaldehyde indoors.
Formaldehyde is found in small amounts in many consumer products including antiseptics, medicines, dish-washing liquids, fabric softeners, shoe-care agents, carpet cleaners, glues, adhesives, and lacquers. If you or a member of your family uses these products, providing fresh outdoor air when you use them. This will reduce your exposure to formaldehyde. Some cosmetics, such as nail hardeners, have very high levels of formaldehyde. If you do not use these products in a small room, or if you have plenty of ventilation when you use them, you will reduce your exposure to formaldehyde. If your children are not in the room when you use these products, you will also reduce their exposure to formaldehyde.
Formaldehyde is emitted from some wood products such as plywood and particle board, especially when they are new. The amount of formaldehyde released from them decreases slowly over a few months. If you put these materials in your house, or buy furniture or cabinets made from them, opening a window will lower formaldehyde in the house. The amount of formaldehyde emitted to the house will be less if the wood product is covered with plastic laminate or coated on all sides. If it is not, sealing the unfinished sides will help to lower the amount of formaldehyde that is given off.
Some permanent press fabrics emit formaldehyde. Washing these new clothes before use will usually lower the amount of formaldehyde and reduce your family's risk of exposure.
Regulations and recommendations can be expressed in not-to-exceed levels in air, water, soil, or food that are usually based on levels that affect animals, then they are adjusted to help protect people. Sometimes these not-to-exceed levels differ among federal organizations because of different exposure times (an 8-hour workday or a 24-hour day), the use of different animal studies, or other factors.
Recommendations and regulations are also periodically updated as more information becomes available. For the most current information, check with the federal agency or organization that provides it. Some regulations and recommendations for formaldehyde include the following:
Several international, national, and state authorities have established regulations or guidelines for the use and production of formaldehyde. OSHA has established the permissible exposure limit (PEL) 8-hour time-weighted average (TWA) at 0.75 ppm and the 15-minute Short-Term Exposure Limit (STEL) at 2 ppm. The EPA sets regulations for reporting quantities used and how much formaldehyde can legally be produced from automobile exhaust; the FDA also has regulations about the use of formaldehyde in the food you eat.
Non-enforceable guidelines have also been established for formaldehyde. The American Conference of Governmental and Industrial Hygienists (ACGIH) has established a ceiling limit for occupational exposure (Threshold Limit Value [TLV]) of 0.4 ppm. NIOSH has a recommended exposure limit for occupational exposure (8-hour TWA) of 0.016 ppm, and a 15-minute ceiling limit of 0.1 ppm.
If you have any more questions or concerns, please contact your community or state health or environmental quality department or:
Agency for Toxic Substances and Disease Registry
Division of Toxicology
1600 Clifton Road NE, Mailstop F-32
Atlanta, GA 30333
Phone: 888-422-8737
FAX: (770)-488-4178
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.
Synonyms and Identifiers
Human Health Effects:
Evidence for Carcinogenicity:
CLASSIFICATION: B1; probable human carcinogen. BASIS FOR CLASSIFICATION: Based on limited evidence in humans, and sufficient evidence in animals. Human data include nine studies that show statistically significant associations between site-specific respiratory neoplasms and exposure to formaldehyde or formaldehyde-containing products. An increased incidence of nasal squamous cell carcinomas was observed in long-term inhalation studies in rats and in mice. The classification is supported by in vitro genotoxicity data and formaldehyde's structural relationships to other carcinogenic aldehydes such as acetaldehyde. HUMAN CARCINOGENICITY DATA: Limited. ANIMAL CARCINOGENICITY DATA: Sufficient.
[U.S. Environmental Protection Agency's Integrated Risk Information System (IRIS) on Formaldehyde (50-00-0) Available from: http://www.epa.gov/ngispgm3/iris on the Substance File List as of March 15, 2000]**PEER REVIEWED**
A2. A2= Suspected human carcinogen.
[American Conference of Governmental Industrial Hygienists. Threshold Limit Values (TLVs) for Chemical Substances and Physical Agents and Biological Exposure Indices (BEIs) for 1995-1996. Cincinnati, OH: ACGIH, 1995., p. 22]**PEER REVIEWED**
Evaluation: There is limited evidence in humans for the carcinogenicity of formaldehyde. There is sufficient evidence in experimental animals for the carcinogenicity of formaldehyde. Overall evaluation: Formaldehyde is probably carcinogenic to humans (Group 2A).
[IARC. Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva: World Health Organization, International Agency for Research on Cancer, 1972-PRESENT. (Multivolume work)., p. V62 336 (1995)]**PEER REVIEWED**
Human Toxicity Excerpts:
IF SOLN IS INGESTED, MUCOUS MEMBRANES OF MOUTH, THROAT, & INTESTINAL TRACT ARE IRRITATED, & SEVERE PAIN, VOMITING, & DIARRHEA RESULT. AFTER ABSORPTION, FORMALDEHYDE DEPRESSES CNS & SYMPTOMS NOT UNLIKE THOSE OF ALC INTOXICATION ARE NOTED. THEY CONSIST OF VERTIGO, DEPRESSION, & COMA. RARELY CONVULSIONS ARE OBSERVED.
[Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975., p. 993]**PEER REVIEWED**
ALTERATION OF TISSUE PROTEINS BY FORMALDEHYDE CAUSES LOCAL TOXICITY & PROMOTES ALLERGIC REACTIONS. REPEATED CONTACT WITH SOLN ... MAY CAUSE ECZEMATOID DERMATITIS. DERMATITIS FROM CLOTHING TREATED WITH FORMALDEHYDE ... HAS OCCURRED.
[Gilman, A. G., L. S. Goodman, and A. Gilman. (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 6th ed. New York: Macmillan Publishing Co., Inc. 1980., p. 971]**PEER REVIEWED**
AQ SOLN ... SPLASHED OR DROPPED ON HUMAN EYES HAVE CAUSED INJURIES RANGING FROM SEVERE PERMANENT CORNEAL OPACIFICATION & LOSS OF VISION TO MINOR TRANSIENT INJURY OR DISCOMFORT, DEPENDING UPON WHETHER SOLN WERE OF HIGH OR LOW CONCN.
[Grant, W.M. Toxicology of the Eye. 3rd ed. Springfield, IL: Charles C. Thomas Publisher, 1986., p. 443]**PEER REVIEWED**
INHALATION OF HIGH CONCN ... CAUSED SEVERE IRRITATION OF RESP TRACT, LEADING IN 2 INSTANCES TO DEATH. ... PULMONARY EDEMA, WITH RESIDUAL CARDIAC IMPAIRMENT IN 1 CASE, WAS REPORTEDLY CAUSED BY SINGLE ACUTE INHALATIONS ... .
[American Conference of Governmental Industrial Hygienists. Documentation of the Threshold Limit Values and Biological Exposure Indices. 5th ed. Cincinnati, OH: American Conference of Governmental Industrial Hygienists, 1986., p. 276]**PEER REVIEWED**
IN SENSITIZED SUBJECTS SPECIFIC LATE ASTHMATIC REACTIONS MAY BE PROVOKED BY BRIEF EXPOSURES AT APPROX 3 PPM.
[HENDRICK DJ ET AL; J OCCUP MED 24 (11): 893 (1982)]**PEER REVIEWED**
Ingestion of formaldehyde can cause a reduction in body temperature.
[Environment Canada; Tech Info for Problem Spills: Formaldehyde p.83 (1985)]**PEER REVIEWED**
Symptoms related to ingestion of formaldehyde include: jaundice, acidosis, & hematuria. Symptoms related to inhalation include: rhinitis, anosmia, laryngospasm, tracheitis, & gastroenteritis.
[ITII. Toxic and Hazardous Industrial Chemicals Safety Manual. Tokyo, Japan: The International Technical Information Institute, 1988., p. 250]**PEER REVIEWED**
In a survey of 57 embalmers who were exposed to atmospheric concn below 2 ppm, there was a high incidence of symptoms of irritant effects on the eyes (81%) nose & throat (75%). Other respiratory effects included cough (33%), chest tightness (23%), wheezing (12%), & shortness of breath (11%). On the basis of the results, 10% were acute bronchitics, & 30% were chronic bronchitics. No control group was used & cigarette smoking was not taken into account.
[Plunkett ER, Barbela T; Am Ind Hyg Assoc J 38: 61 (1977)]**PEER REVIEWED**
Eyes: concn 1-10 ppm may produce appreciable eye irritation on initial exposure; lacrimation occurs at about 4 ppm.
[Health and Safety Executive Monograph: Formaldehyde p.8 (1981)]**PEER REVIEWED**
CULTURED BRONCHIAL & FIBROBLASTIC CELLS FROM HUMANS WERE USED TO STUDY DNA DAMAGE & TOXICITY. FORMATION OF CROSSLINKS BETWEEN DNA & PROTEINS, CAUSED SINGLE-STRAND BREAKS IN DNA, & INHIBITED RESEALING OF SINGLE-STRAND BREAKS PRODUCED BY IONIZING RADIATION.
[GRAFSTROM RC ET AL; SCIENCE 220 (4593): 216-8 (1983)]**PEER REVIEWED**
Formaldehyde induced a 1.5-3 fold increase in sister chromatid exchanges in ... human lymphocytes in culture.
[Obe G, Beek B; Drug and Alcohol Dependence 4: 91-4 (1979)]**PEER REVIEWED**
Formaldehyde was mutagenic for diploid human lymphoblasts in culture ... /inducing an incr number of mutations at/ 130 uM or 4 ppm by weight.
[Goldmacher VS et al; Toxicol Epidemiol Mech (Pap Meet) 173-91 (1983)]**PEER REVIEWED**
OUTBREAK OF HEMOLYTIC ANEMIA, ATTRIBUTED TO ACCIDENTAL EXPOSURE ... OCCURRED AMONG PATIENTS ON HEMODIALYSIS. 41 YR OLD WOMAN DIED 28 HR AFTER INGESTING 120 ML OF ... SOLN (37% WT/VOL FORMALDEHYDE, 12.5% VOL/VOL METHANOL, CONTAINING NO FORMIC ACID).
[IARC. Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva: World Health Organization, International Agency for Research on Cancer, 1972-PRESENT. (Multivolume work)., p. V29 369 (1982)]**PEER REVIEWED**
EFFECTS IN WOMEN ATTRIBUTED TO EXPOSURE ... INCL MENSTRUAL DISORDERS & SECONDARY STERILITY.
[IARC. Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva: World Health Organization, International Agency for Research on Cancer, 1972-PRESENT. (Multivolume work)., p. V29 370 (1982)]**PEER REVIEWED**
SYMPTOMATOLOGY: A. Inhalation: 1. Irritation of mucous membranes, especially of eyes, nose & upper respiratory tract. 2. With higher concn, cough, dysphagia, bronchitis, pneumonia, edema or spasm of the larynx. Pulmonary edema is uncommon. B. Ingestion. 1. Immediate intense pain in mouth, pharynx & stomach. 2. Nausea, vomiting, hematemesis, abdominal pain & occasionally diarrhea (which may be bloody). 3. Pale, clammy skin & other signs of shock. 4. Difficult micturition, hematuria, anuria. 5. Vertigo, convulsions, stupor, & coma. 6. Death due to respiratory failure. C. Skin contact: 1. Irritation & hardening of skin. Strong solutions produce coagulation necrosis. 2. Dermatitis & hypersensitivity from prolonged or repeated exposure.
[Gosselin, R.E., R.P. Smith, H.C. Hodge. Clinical Toxicology of Commercial Products. 5th ed. Baltimore: Williams and Wilkins, 1984., p. III-197]**PEER REVIEWED**
INVESTIGATIONS OF CILIOSTATIC EFFECT OF ALDEHYDES ARE OF SPECIAL INTEREST SINCE MANY HAVE IRRITATING EFFECT ON TRACHEAL MUCOSA. COMPARISON OF CILIOSTATIC EFFECT SHOWED FORMALDEHYDE TO BE MOST TOXIC FOLLOWED BY ACETALDEHYDE & ACROLEIN. CROTONALDEHYDE & METHACROLEIN SHOWED WEAKEST EFFECT. TECHNIQUE USED FOR OBSERVING TRACHEAL CILIARY ACTIVITY WAS THE IN VITRO TECHNIQUE.
[DALHAMN T, ROSENGREN A; ARCH OTOLARYNGOL 93 (5): 496-500 (1971)]**PEER REVIEWED**
One hundred nine workers & 254 control subjects were studied to evaluate the effects of formaldehyde on the mucous membranes & lungs. A modified, respiratory symptom questionnaire & spirometry were admin to all study participants before & after their work shift, & formaldehyde levels were determined for each test subject. Over the course of the monitored work shift, test subjects demonstrated a dose-dependent excess of irritant symptoms & a statistically significant decline in certain lung function parameters. Baseline spirometry values were not significantly different between test & control groups, & formaldehyde-exposed workers did not report an excess of respiratory symptoms. Formaldehyde is a dose-dependent irritant of the eyes & mucous membranes at low-level exposures. It can exert a small, across-shift effect on airways but after a mean exposure of 10 yr does not appear to cause permanent respiratory impairment.
[Horvath EP et al; J Am Med Assoc 259 (5): 701-7 (1988)]**PEER REVIEWED**
The effect of formaldehyde exposure on medical students conducting dissections in the gross anatomy laboratory course /was evaluated using/ self-administered questionnaires designed to assess the frequency of occurrence of various symptoms indicating the acute effects of formaldehyde exposure. The questionnaires were given to a cohort of 1st-yr medical students on completion of the gross anatomy lab course. Air sampling of formaldehyde levels in the anatomy labs was carried out on one day during the time in which these students were conducting dissections. ... Although the results of the air sampling showed formaldehyde levels to be well below current occupational standards, significant numbers of students reported experiencing symptoms associated with formaldehyde exposure. Estimates of the relative risk of experiencing formaldehyde-related symptoms in the anatomy laboratories compared to the control laboratories ranged from 2.0-19.0, depending on the particular symptom. In addn, it was found that female students were 3 times more likely to report formaldehyde-related symptoms than male students.
[Fleischer JM; NY J Med 87 (7): 385-8 (1987)]**PEER REVIEWED**
A population based case control study was undertaken in 13 counties of western Washington to determine if occupational formaldehyde exposure was related to cancer of the oropharynx & hypopharynx (OHPC, N=205), nasopharynx (NPC, N=27) or sinus & nasal cavity (SNC, N=53). Controls were selected by random digit dialing (N= 552). A telephone interview inquired about lifetime occupational history as well as a number of potential confounding factors, including smoking & drinking. Approximately half (N=143) of the case interviews were with next of kin. ... Logistic regression was used to estimate exposure odds ratios STET while taking into account multiple risk factors for each site. No significant associations were found between occupational formaldehyde exposure & any of the cancer sites under study. However, relative risk estimates associated with the highest exposure score categories were evaluated for oropharynx & hypopharynx (OR=1.3, 95% Confidence Interval= 0.6-3.1) & nasopharynx (OR=2.1, 95% Cl=0.4-10.0). When an induction period was accounted for only oropharynx & hypopharynx & nasopharynx increased to 1.7 & 3.1, respectively. Several limitations in the study tend to conservatively bias the results. ...
[Vaughn TL et al; Int J Cancer 38 (5): 677-84 (1986)]**PEER REVIEWED**
Because of the paucity of scientific data concerning the inhalation toxicity of formaldehyde in humans, determinations of the symptoms & alterations in pulmonary function resulting from inhalation for 1 hr of 3 ppm formaldehyde were studied. The protocol consisted of randomized exposure of each subject to clean air or 3.0 ppm formaldehyde on 2 separate days. Twenty-two healthy normal subjects engaged in intermittent heavy exercise (VE= 65/min) & 16 asthmatic subjects performed intermittent moderate exercise (VE= 37/min). Symptoms & pulmonary functions were assessed during the time course of exposure; nonspecific airway reactivity was assessed after exposure. Both groups exhibited similar, significant (p<0.01) increases in perceived odor, nose/throat irritation, & eye irritation throughout the exposure. The non-asthmatic group had the following slight but statistically significant (p<0.02) lower pulmonary functions after 55 min of exposure to formaldehyde as compared to clean air: 3.8% in FEV1, 2.6% in FVC, & 2.8% in FEV3. The asthmatic group showed no statistically significant decrements in pulmonary function.
[Green DJ et al; Am Rev Respir Dis 135 (6): 1261-6 (1987)]**PEER REVIEWED**
A retrospective mortality analysis was conducted in a cohort of 9,365 individuals employed as of 1940 in two chrome leather tanneries in the United States and followed to the end of 1982. Vital status as of the closing date was determined for over 95% of the cohort. Potential hazardous workplace exposures varied with department and included ... formaldehyde. ... Mortality from all causes combined was lower than expected for each tannery. ... Deaths from cancer of each site, including the lung, were also lower than expected compared to those of either the population of the United States or of local state rates. A significant excess of deaths was observed, however, due to accidental causes in one tannery and cirrhosis of the liver, suicide, and alcoholism in the other. These excesses did not appear to be casually associated with occupational exposures.
[Stern FB et al; Scand J Work Environ Health 13 (2): 108-17 (1987)]**PEER REVIEWED**
Infectivity of human T-cell lymphotropic virus, Type III (HTLV-III) was ... efficiently inactivated by formalin ... .
[Quinnan GV et al; Transfusion 26 (5): 481-3 (1986)]**PEER REVIEWED**
Eight symptomatic individuals chronically exposed to indoor formaldehyde at low concentrations (0.07-0.55 ppm) were compared to 8 nonexposed subjects with respect to: (1) presence of IgG and IgE antibodies to formaldehyde conjugated to human serum albumin (F-HSA); (2) the percentage of venous blood T- and B-cells by E- and EAC-rosetting; and (3) the ability of T- and B-cells to undergo mitogen (phytohemagglutin and pokeweed) stimulated blastogenesis as measured by the incorporation of tritiated thymidine. Anti-F-HSA IgG, but not IgE, antibodies were detected in the sera of the 8 exposed subjects; none were found in 7 of the controls. T-lymphocytes were decreased in the exposed (48%) compared to the control (65.9%) subjects (p< 0.01). B-cells were 12.6% (exposed group) and 14.75% (controls) (p< 0.05). The incorporation of labeled thymidine by T-cells (phytohemagglutin) was decreased: 17,882 cpm (exposed group) and 28,576 cpm (p< 0.01). T- and B-cell blastogenesis (pokeweed) was 9,698 cpm (exposed group) and 11,279 (controls) (p< 0.1).
[Thrasher JD et al; Arch Environ Health 42 (6): 347-50 (1987)]**PEER REVIEWED**
Both death and survival from 4-oz formalin ingestions have been reported in adults. The probable mean lethal adult dose is 1 to 2 oz. Death may occur within 3 hours; survival past 48 hours usually means recovery.
[Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1214]**PEER REVIEWED**
An environmental survey of 2 wood products (plywood, particle-board) companies revealed mean concns in the plywood forming areas of 0.8 ppm &, in 2 particle-board forming areas, of 1.1 to 1.4 ppm /formaldehyde/. Ophthalmologic evaluations were conducted & eye irritation self-reports were collected from 84 subject workers, including unexposed controls, from various areas in the plants. Results from both were unremarkable, as were tests mapping their visual fields. However, there were subjective reports of at least occasional eye irritation in 67% of the exposed subjects, with more such reports coming from workers in areas of the plant with the higher concns. An explosion at the factory closed a major product line & resulted in laying off many of the volunteer subjects prior to performance testing; the remaining 49 workers were tested before & after their workshift (& 13 of them were tested on 2 days) in order to assess acute effects of formaldehyde on visual acuity, depth perception, peripheral vision, accommodation, eye movement & fixation, divided attention, & color vision. Subjective reports of eye irritation on the day of testing did not correlate, or correlated negatively, with formaldehyde concns on the test day, which averaged 0.4 ppm. Average visual test scores were better at the end of the day than at the beginning, & there was a trend for those with higher formaldehyde levels to demonstrate greater improvement. Some of the changes reached traditional levels of statistical significance. The results from this investigation, while relevant to the neurotoxicity of formaldehyde, suffer from the small sample size & the possibility that the comparison subjects had also experienced formaldehyde exposure. With these caveats, this study suggests that mean formaldehyde exposures at 0.4 ppm produce no deleterious acute effects on visual performance, but chronic exposures between 0.8 & 1.4 ppm may produce an increased incidence of self reported symptoms of eye irritation in persons who do not have clinical ophthalmologic defects.
[O'Donoghue, J.L. (ed.). Neurotoxicity of Industrial and Commercial Chemicals. Volume I. Boca Raton, FL: CRC Press, Inc., 1985., p. 59]**PEER REVIEWED**
Symptoms: Local: Conjunctivitis, corneal burns; brownish discoloration of skin; dermatitis, urticaria (hives), pustulovesicular eruption. Inhalation: rhinitis & anosmia (loss of sense of smell); pharyngitis, laryngospasm; tracheitis & bronchitis; pulmonary edema, cough, constriction in chest; dypsnea (difficult breathing), headache, weakness, palpitation (rapid heart beat), gastro enteritis (inflammation of the stomach & intestines). Ingestion: Burning in mouth & esophagus; nausea & vomiting; abdominal pain, diarrhea, vertigo (dizziness), unconsciousness, jaundice, albuminuria, hematuria, anuria, acidosis, convulsions.
[ITII. Toxic and Hazardous Industrial Chemicals Safety Manual. Tokyo, Japan: The International Technical Information Institute, 1988., p. 249]**PEER REVIEWED**
Aldehydes increase airflow at concentrations below those that decrease respiratory frequency. /Aldehydes/
[Gilman, A.G., T.W. Rall, A.S. Nies and P. Taylor (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. New York, NY. Pergamon Press, 1990., p. 1618]**PEER REVIEWED**
Data on concentration of formaldehyde and 15 organic solvents in Finnish furniture factories from 1975 to 1984 were presented. Workers often complained of severe eye, nose, and upper respiratory tract irritation. Formaldehyde was collected in a 1% sodium bisulfite solution and analyzed by the chromatropic method. The solvents were adsorbed in a charcoal tube, desorbed with carbon-disulfide or dimethylformamide, and analyzed by gas chromatography. All highly exposed workers were monitored. The widest range of formaldehyde concentration was recorded in the operation of the curtain painting furniture receiving operation, which was between 0.2 and 5.4 ppm. The mean concentrations of most organic solvents studied ranged from 4 to 66 ppm. Formaldehyde levels were high and the 1 ppm exposure limit, defined as the 15 minute time weighted average by the Finnish Board of Labor Protection, was exceeded about 40% of the time.
[Priha E et al; Ann Occup Hyg 30 (3): 289-94 (1986)]**PEER REVIEWED**
A study of 759 histologically verified cancers of the nasal cavity (287 cases), paranasal sinuses (179 cases), and nasopharynx (293 cases) and 2465 cancer controls diagnosed in Denmark between 1970 and 1982 was conducted to investigate the importance of occupational exposure to formaldehyde. Information on job history for cases and controls was derived from a national data linkage system and exposure to formaldehyde and wood dust was assessed by industrial hygienists unaware of the case control status of the patients. The exposure rates for formaldehyde among male and female controls were 4.2% and 0.1% respectively. After proper adjustment for contemporary wood dust exposure, relative risk of 2.3 (95% CI= 0.9-5.8) for squamous cell carcinoma and 2.2 (95% CI= 7-7.2) for adenocarcinoma of the nasal cavity and paranasal sinuses were detected among men who have been exposed to formaldehyde in their job compared with those never exposed.
[Olsen JH, Asnaes S; Br J Ind Med 43 (11): 769-74 (1986)]**PEER REVIEWED**
The National Cancer Institute study on the relationship between exposure to formaldehyde & mortality from nasophryngeal cancer was evaluated. The study had indicated little evidence of a link between formaldehyde at concns normally encountered in the workplace & risk of nasopharyngeal cancer. Although the overall standardized mortality ration was significantly elevated in subjects exposed to formaldehyde, the overall risk did not incr with increasing intensity of exposure. A reanalysis, however, suggested that simultaneous exposure to particulates & formaldehyde could be a risk factor. A further review of the National Cancer Institute findings showed that the significant excess mortality was based on deaths occurring in a single factory (factory-A) & occurred primarily in short term employees. When the data were analyzed in terms of cumulative exposures that were known to include both formaldehyde & particulates, only the highest exposure group had a significantly increased excess nasopharyngeal cancer mortality. This excess was clearly located in factory-A. A follow-up study of factory-A that added 5 more years of follow-up was initiated. It showed no additional deaths from nasopharyngeal cancer even among workers with the highest formaldehyde & particulate exposures. The four deaths from nasopharyngeal cancer in this factory occurred in workers employed in the same department & hired between 1949 & 1955. Although these workers were exposed to formaldehyde & particulates, they were not among the most highly exposed.
[Collins JJ et al; J NCI 80 (5): 376-7 (1988)]**PEER REVIEWED**
This study evaluates the histological changes, especially the presence of possible precancerous lesions, in the nasal mucosa of workers exposed to formaldehyde. Nasal biopsies of 37 workers occupationally exposed to formaldehyde for more than five years and 37 age matched referents showed a higher degree of metaplastic alterations in the former group. In addition, three cases of epithelial dysplasia were observed among the exposed. These results indicate that formaldehyde may be potentially carcinogenic in man. Combination of this finding with the inconclusive epidemiological studies suggests that formaldehyde is a weak carcinogen and that occupational exposure to formaldehyde alone is insufficient to induce nasal cancer.
[Boysen M et al; Br J Ind Med 47 (2): 116-21 (1990)]**PEER REVIEWED**
Clinical & animal studies suggest that formaldehyde adsorbed on respirable particles may elicit a greater pulmonary physiologic & inflammatory effect than gaseous formaldehyde alone. This study was to determine if respirable carbon particles have a synergistic effect on the acute symptomatic & pulmonary physiologic response to formaldehyde inhalation. Normal, nonsmoking, methacholine-nonreactive subjects were exposed to 2 hr each of clean air, 3 ppm formaldehyde, 0.5 mg/cu m respirable activated carbon aerosol, & the combination of 3 ppm formaldehyde plus activated carbon aerosol. The subjects engaged in intermittent heavy exercise (VE= 57 1/min) for 15 min each half hour. Formaldehyde exposure was associated with significant increases in reported eye irritation, nasal irritation, throat irritation, headache, chest discomfort, & odor. Synergistic increases in cough, but not in other irritant respiratory tract symptoms, were observed with inhalation of formaldehyde & carbon. Small (<5%) synergistic decreases in FVC & FEV3 were also seen. No formaldehyde effect was observed on FEV1; however, we did observe small (<10%) significant decreases in FEF25-75%, which may be indicative of increased airway tone. Overall, results demonstrated synergism, but the effect is small & its clinical significance is uncertain.
[Green DJ et al; J Toxicol Environ Health 28 (3): 261-75 (1989)]**PEER REVIEWED**
To study the cytotoxic effect of formaldehyde on the human nasal mucosa 75 men with occupational exposure to formaldehyde or to formaldehyde & wood dust, were examined, looking particularly at early signs of irritative effects & histopathological changes in the nasal mucosa. A nasal biopsy specimen was graded from 0-8 according to the morphological changes. A high frequency of nasal symptoms, mostly a running nose & crusting, was related to exposure to formaldehyde. Only three men had a normal mucosa; the remainder has loss of cilia & goblet cell hyperplasia (11%) & squamous metapolasia (78%); in 6 cases (8%) there was a mild dysplasia. The histological grading showed a significantly higher score when compared with unexposed controls (2.9 v 1.8). There was no dose response relation, no malignancies, & no difference in the histological score between those exposed to formaldehyde or to formaldehyde & wood dust.
[Edling C et al; Br J Ind Med 45 (11): 761-5 (1988)]**PEER REVIEWED**
A study of respiratory symptoms and pathophysiological effects associated with occupational exposure to formaldehyde and wood dust was conducted. The cohort consisted of 70 Swedish workers exposed to formaldehyde during the production of formaldehyde and formaldehyde based products (formaldehyde group) and 100 furniture workers exposed to formaldehyde and wood dust (formaldehyde/wood dust group). The comparisons consisted of 36 local government clerks. The formaldehyde group was exposed to 0.05 to 0.5 mg/cu m formaldehyde and the furniture workers to 0.2 to 0.3 mg/cu m formaldehyde and 1 to 2 mg/cu m wood dust. Annual formaldehyde exposures of the comparisons averaged 0.09 mg/cu m. Sixty four percent of the formaldehyde group, 53% of the formaldehyde/wood dust group, and 25% of the comparisons reported nasal discomfort. Symptoms from the lower airways were reported by 44% of the formaldehyde group, 39% of the formaldehyde/wood dust group, and 14 % of the comparisons. Symptoms of nasal obstruction and watery discharges were more frequent in the exposed subjects than in the comparisons. More pronounced nasal swelling was found in the cohort than in the comparisons. 20% of the formaldehyde and 15% of the formaldehyde/wood dust group had impaired mucociliary clearance versus only 3% of the comparisons. Both exposed groups had a reduced sense of smell. Forced vital capacity was significantly decreased in the exposed groups.
[Holmstorm M, Wilhelmsson B; Scandinavian J Work Environ Health 14 (5): 306-11 (1988)]**PEER REVIEWED**
A study was conducted to determine if pathologists with exposure to formaldehyde demonstrate an excess risk of cancer, particularly cancers of the nasopharyngeal and pharyngeal areas. A population of 6411 physicians with occupational formaldehyde exposure participated in the study. The occurrence of these types of cancers was 4.7 times higher in these persons than in a comparable sized group of psychiatrists, but even so it is difficult to determine the importance of this increased risk as being directly tied to formaldehyde exposure. Pathologists and other members of the study group were exposed to other chemicals and infectious agents as well as formaldehyde. There was an apparent excess of mortality from pancreatic cancer and brain cancers as well as leukemia.
[Matanoski GM; Risks of Pathologists Exposed to Formaldehyde School of Hygiene and Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, Grant No. RO1-OH-01511 (1989)]**PEER REVIEWED**
The relation of chronic respiratory symptoms & pulmonary function to formaldehyde in homes was studied in a sample of 298 children (6-15 yr of age) & 613 adults. Formaldehyde measurements were made with passive samplers during two 1 wk periods. Significantly greater prevalence rates of asthma & chronic bronchitis were found in children from houses with formaldehyde levels 60-120 ppb than in those less exposed, especially in children also exposed to environmental tobacco smoke. In children, levels of peak expiratory flow rates decreased linearly with formaldehyde exposure, with the estimated decr due to 60 ppb of formaldehyde equivalent to 22% of peak expiratory flow rates level in nonexposed children. The effects in asthmatic children exposed to formaldehyde below 50 ppb were greater than in healthy ones. The effects in adults were less evident: decrements in peak expiratory flow rates due to formaldehyde over 40 ppb were seen only in the morning, & mainly in smokers.
[Krzyzanowski M et al; Environ Res 52 (2): 117-25 (1990)]**PEER REVIEWED**
The long term effects of formaldehyde on the respiratory tract have been investigated in a group of 164 workers exposed daily to the chemical during the production of urea formaldehyde resin, together with 129 workers not exposed to free formaldehyde. Exposure was classified as high (corresponding to an 8 hr time weighted exposure of >2.0 ppm), medium (0.6-2.0 ppm), or low (0.1-0.5 ppm). 25% of workers had high exposure at some time & 17% moderate exposure. Both exposed & unexposed groups had an annual assessment that included lung function. The proportion with self reported respiratory symptoms was similar in the two groups, 12% & 16% reporting breathlessness on hurrying & 26% & 20% wheezing. The initial forced expiratory volume in 1 sec was within 0.5 l (approx on standard deviation) of the predicted value (by age & height) in 65% of the exposed & 59% of unexposed workers & >0.5 l below the predicted value in 9% of exposed & 11% unexposed workers. The mean decline in forced expiratory volume in 1 sec was 42 ml/yr (standard deviation 45) in the exposed & 41 ml/yr in the unexposed group (standard deviation 40 ml/yr). The rate of decline showed the expected association with smoking in the unexposed group, but in the exposed group the mean rate of decline in the never smokers was similar to that in current smokers. There were, however, relatively few never smokers & considerable variation in the rates of decline. In the exposed group no association was found between the rate of decline & indices of exposure to formaldehyde. Thus there is no evidence from this study of an excess of respiratory symptoms or decline in lung function in the workers exposed to formaldehyde. The similar rate of decline of forced expiratory volume in 1 sec however in never smokers & smokers of the exposed group is consistent with finding of other studies for workers exposed to formaldehyde.
[Nunn AJ et al; Br J Ind Med 47 (11): 747-52 (1990)]**PEER REVIEWED**
A prospective evaluation of pulmonary function & respiratory symptoms was conducted among 103 medical students exposed to formaldehyde over a 7 month period to determine the incidence of bronchoconstriction & respiratory symptoms in response to exposure. Time-weighted average formaldehyde exposures were generally <1 ppm & peak exposures were <5 ppm. Acute symptoms of eye & upper respiratory irritation were significantly associated with exposure. There was no pattern of bronchoconstriction in response to exposure after either 2 wks or 7 months. Twelve subjects had a history of asthma; they were likely to have symptoms of respiratory irritation or changes in pulmonary function than those without such a history. These findings are consistent with previous case reports that indicate exposure to formaldehyde vapor at levels that are commonly encountered in occupational & residential seetings do not commonly cause significant bronchonconstriction, even among subjects with preexisting asthma.
[Uba G et al; Am J Ind Med 15 (1): 91-101 (1989)]**PEER REVIEWED**
A case of anaphylactoid reaction to a patch test with formaldehyde was described. The 40 year old woman developed bronchospasm and laryngospasm following the inhalation of formaldehyde vapor. A year later she accidentally entered a hospital room relatively soon after it had been disinfected, and was hospitalized with dyspnea, cyanosis, bronchospasm, and laryngospasm. Days later she did react to a patch test with a 1% solution of formaldehyde in water. Pulmonary function tests 20 min after the patch test revealed a 50% reduction in FEV1 and a 63% reduction in MEF 25.
[Orlandini A et al; Contact Dermatitis 19 (5): 383-4 (1988)]**PEER REVIEWED**
Four groups of patients with long-term inhalation exposure to formaldehyde were compared with controls who had short-term periodic exposure to formaldehyde. The following were determined for all groups: total white cell, lymphocyte, and T cell counts; T helper/suppressor ratios; total Ta1+, IL2+, and B cell counts; antibodies to formaldehyde-human serum albumin conjugate and autoantibodies. When compared with the controls, the patients had significantly higer antibody titers to formaldehyde-human serum albumin. In addition, significant increases in Ta1+, IL2+, and B cells and autoantibodies were observed. Immune activation, autoantibodies, and anti formaldehyde-human serum albumin antibodies are associated with long-term formaldehyde inhalation.
[Thrasher JD et al; Arch Environ Health 45 (4): 217-23 (1990)]**PEER REVIEWED**
The incidence of spontaneous abortions among hospital staff who used ethylene oxide, glutaral (glutaraldehyde) & formaldehyde for the chemical sterilization of instruments was studied using data from a questionnaire & a hospital discharge register. ... When the staff were concerned in sterilizing during their pregnancy the frequency was 16.7% compared with 5.6% for the nonexposed pregnancies. The incr frequency ... correlated with exposure to ethylene oxide but not with exposure to glutaral or formaldehyde.
[Hemminki K et al; Brit Med J 285: 1461-63 (1982)]**PEER REVIEWED**
Employees exposed to formaldehyde in the woodworking industry and nonexposed control subjects were examined by spirometry and the nitrogen washout technique. A dose-response relationship was found between exposure to formaldehyde and decrease in lung function. Industrial exposure to formaldehyde causes transient lung function impairment over a work shift, with a cumulative effect over the years. The impairment, however, can be reversed with 4 wk of no exposure.
[Alexandersson R, Hedenstierna G; Arch Environ Health 44 (1): 5-11 (1989)]**PEER REVIEWED**
The mortality of 1,332 male workers employed at least 30 days in 1959-1980 in a resins-manufacturing plant was examined. Ambient measurements taken in the plant between 1974 and 1979 documented a potential for exposure to levels of formaldehyde as high or greater than 3.0 mg/cu m. Vital status was ascertained for 98.6% of the cohort members, and their mortality was compared with expected deaths drawn from the national and local population rates. A statistically significant increase in lung cancer was observed, based on 18 deaths, which was not fully accounted for by possible confounding factors linked to personal habits or sociocultural characteristics. This elevated risk, however, could not be attributed specifically to exposure to formaldehyde. Mortality from digestive cancer (14 deaths observed) and hematologic neoplasms (5 deaths observed) was not substantially higher than expected.
[Bertazzi PA et al; Scand J Work Environ Health 12 (5): 461-8 (1986)]**PEER REVIEWED**
Formaldehyde has been found to cause bronchial asthma-like symptoms in humans. A young male neurology resident who spent 2 hr in autopsy of formaldehyde-preserved human brains experienced both conjunctival & nasal irritation while working; however, over the next 15 hr after cessation of exposure, he developed progressive dyspnea & tightness in the chest. Early edema indicative of pneumonitis was visible on Xray, & after treatment with aminophyline, hydrocortisone, & oxygen (nasal prong at 4 l/min), he gradually improved over the following 2 days. He continued to need prednisone (20 mg every other day for 2 wk), & he had fully recovered 5 wk after the onset of his hypersensitivity reaction to inhaled formaldehyde.
[American Conference of Governmental Industrial Hygienists, Inc. Documentation of the Threshold Limit Values and Biological Exposure Indices. 6th ed. Volumes I, II, III. Cincinnati, OH: ACGIH, 1991., p. 677]**PEER REVIEWED**
In cultured human bronchial fibroblasts exposed to the carcinogen N-methyl-N-nitrosourea (NMU) in combination with formaldehyde, formaldehyde was observed to inhibit repair of alkylation of DNA at the O6 guanine position induced by NMU. Whether formaldehyde enhances the effects of other DNA-damaging agents has not yet been evaluated.
[Rom, W.N. (ed.). Environmental and Occupational Medicine. 2nd ed. Boston, MA: Little, Brown and Company, 1992., p. 868]**PEER REVIEWED**
Hemodialysis patients are exposed chronically to trace levels of formaldehyde (by formalin sterilization of their dialyzers to permit reuse). Erythrocytes can be characterized in terms of MN phenotypes, analogous to the AB-O system. The normal distribution of MM, NN, an MN phenotypes is about 25, 25, and 50%, respectively. Only 25% of the population would be expected to have anti-N antibodies. Formaldehyde exposure may be followed by the development of anti-N-like antibodies probably as a result of reaction with the dissolved form of formaldehyde, methylene glycol. The anti-N-like antibodies are also found following exposure to sodium hypochlorite.
[Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1216]**PEER REVIEWED**
The use of formaldehyde as a nail hardener, on the other hand, is accompanied by a significant number of serious injuries to sensitive nail and adnexal tissues. This type of exposure may contribute substantially to that portion of the 4% sensitization index seen in clinical patients which is cosmetic-related.
[Marzulli, F.N., H.I. Maibach. Dermatotoxicology 4th ed. New York, NY: Hemisphere Publishing Corp., 1991., p. 424]**PEER REVIEWED**
In a study ..., a group of 33 observers judged the perceived irritation & odor of formaldehyde during 29-min chamber esposures to concns ranging from 0.3-2.4 mg/cu m. The sensory irritation increased with time for the lower concns & decreased with time for the highest. This effect was true for irritation of eyes, nose, & throat & the sensitivity proved to be roughly equal for all three sites. The sensory irritant effect of formaldehyde at 1.2 mg/cu m was shown to decr when the chemical pyridine was injected into the chanber; such sensory interactions occur in environmentally realistic situations.
[WHO; Environ Health Criteria 89: Formaldehyde p.138 (1989)]**PEER REVIEWED**
... Healthy volunteers (24 men, 9 women) /were exposed/ to formaldehyde concns ranging between 0.036 & 4.8 mg/cu m air (33 volunteers for 35 min, 48 volunteers for 1.5 min. Eye blinking rates as well as subjective irritation effects were determined. The irritation threshold was found to range between 1.2 & 2.4 mg formaldehyde/cu m. A similar threshold (1 mg/cu m) was found in other studies. ... /It was/ noted that 9 out of 53 medical student volunteers exposed to formaldehyde concns of between 0.39 & 0.60 mg/cu m for 8 hr/wk, complained of headaches, a burning sensation in the eyes, sore throat, & annoyance because of the smell.
[WHO; Environ Health Criteria 89: Formaldehyde p.138 (1989)]**PEER REVIEWED**
A 60-yr old man swallowed 60-90 mg of a 40% formaldehyde soln. Thirty hr after death, the mucosa of the lowere part of the esophagus, stomach, & first portion of duodenum were dark chocolate brown in color & of the consistency of leather. All organs & tissues in contact with the stomach were "hardened" to a depth of about 8 mm.
[WHO; Environ Health Criteria 89: Formaldehyde p.141 (1989)]**PEER REVIEWED**
Workers exposed to 0.35-1.0 ppm (0.43-1.2 mg/cu m) for 6 minutes had a significant irritation response at 1.0 ppm; nonsignificant responses were reported at 0.7 and 0.9 ppm(0.9 and 1.1 mg/cu m).
[IARC. Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva: World Health Organization, International Agency for Research on Cancer, 1972-PRESENT. (Multivolume work)., p. V62 303 (1995)]**PEER REVIEWED**
Formaldehyde vapor is very irritating to the mucous membranes and toxic to animals, including man.
[Tomlin, C.D.S. (ed.). The Pesticide Manual - World Compendium. 10th ed. Surrey, UK: The British Crop Protection Council, 1994., p. 525]**PEER REVIEWED**
... examined smears of nasal respiratory mucosa cells sampled from the inner turbinate of 15 nonsmokers who were exposed to formaldehyde released from a urea-formaldehyde glue used in a plywood factory and 15 age- and sex-matched nonexposed clerks from outside of the factory. Estimates of formaldehyde air conc ranged from : 0.21 to 0.60 (mean 0.39 + or - 0.20 ppm) in the warehouse where seven subject worked, 0.08 to 0.14 ppm (mean 0.1 + or - 0.02 ppm) in the shearing press where six subjects worked, and 0.09 ppm (only one sample taken) in the sawmill area where two subjects worked. Mean wood dust concn for the three areas were 0.23 + or - 0.1 mg/m3, 0.41 + or - 0.21 mg/m3, and 0.73 mg/m3, respectively. Exposed subjects worked at the factory for 2-19 yr (mean 6.8 + or - 5.0 yr). Nasal mucosal slides were scored as follows: normal cellularity, 1; number of mucus-secreting cells greater than ciliated cells, 1.5; hyperplasia, 2; squamous metaplasia, 2.5; mild dysplasia, 3; moderate dysplasia, 4; severe dysplasia, 5; and malignant cells, 6. In the exposed group, all subjects had a greater number of nonciliated than ciliated cells, 40% had hyperplasia, 67% had squamous metaplasia, and 6% slight dysplasia. In controls, 26% had normal cytology, 67% had more ciliated than nonciliated cells, 33% had hyperplasia, and 6% had squamous metaplasia. The mean cytology score for the exposed group (2.3 + or - 0.5) was reported to be statistically significantly greater than the control score (1.6 + or - 0.5). Also found in this study was a statistically significantly higher percentage of micronucleated mucosal cells in the exposed group compared with the control group (0.91% + or - 0.47 versus 0.25% + or - 0.22).
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 51 (1999)]**PEER REVIEWED**
Mean baseline PEFR /(peak expiratory flow rate)/ declined by about 2% over a 10-wk period in a group of 24 physical therapy students who dissected cadavers for 3-hr periods/wk ... . Estimates of breathing zone formaldehyde concn ranged from 0.49-0.93 ppm (geometric mean 0.72 + or - 1.22 ppm). PEFR, the only pulmonary function variable measured in this study, was measured before & after each exposure period. Postexposure PEFR means were 1-3% lower than preexposure PEFR means during the first 4 wk, but this difference was not apparent during the last 6 wk. Fourteen wk after the end of the 10-wk period, the mean PEFR for the group returned to the preexposure baseline value.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 53 (1999)]**PEER REVIEWED**
... evaluated the immunologic response of asthmatic subjects exposed to urea-formaldehyde foam insulation (UFFI) off-gas products. Subjects consisted of 23 individuals with a history of asthmatic symptoms attributed to UFFI & 4 individuals (controls) with asthma unrelated to UFFI by-products. Subjects were exposed to one of the following: room air (placebo) for 30 min; 1 ppm formaldehyde gas for 3 hr; UFFI particles (4 um, 0.5 particles/ml) for 3 hr, commencing 48 hr after formaldehyde gas exposure; & UFFI off-gas products for 3 hr, commencing 48 hr after UFFI particle exposure. There were no significant alterations in any of the white blood cell populations ... . However, there was a significant incr in the % & absolute number of eosinophils & basophils in the subject (who also lived in UFFI-homes) after exposure to UFFI in the exposure chamber when compared to the white blood cell values obtained before chamber exposure to UFFI.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 66 (1999)]**PEER REVIEWED**
Occupational exposures to formaldehyde have been assoc with dermal irritation and the diagnosis of allergic contact dermatitis by patch testing. Reported historical percentages of subjects with skin problems showing positive responses to formaldehyde in patch tests performed by dermatologists using aqueous soln with 1 or 2% formaldehyde incl 7.8% in North America between 1992 and 1994 ... 1.6% in a 1983-1984 Swedish study ... 2.6% in a 1988-1989 European study ... and 3.7% in a 1990-1994 Polish study ... . Lack of case-specific exposure info for these patients precludes the determination of the degree to which sensitization may have been caused by direct dermal contact to formaldehyde in liquids or by contact with formaldehyde gas in air, but the widespread use of formaldehyde or formaldehyde-releasing chemicals in cosmetics and cleaning agents ... suggest that the dermal route of exposure may be the more important sensitizing route.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 69 (1999)]**PEER REVIEWED**
... measured elevated levels of formaldehyde-specific IgE in 24/62 8-yr old children who were students in three particle board-paneled classrooms with est formaldehyde air concn of 0.075, 0.069, and 0.043 ppm. In a health survey, the children reported headaches (29/62), fatigue (21/62), dry nasal mucosa (9/62), rhinitis (23/62) cough (15/62), and nosebleeds (14/62). Sums of numbers of children with each of nine symptoms for each classroom decr with decr formaldehyde conc (49, 47, and 24, respectively for the 0.075-, 0.069-, and 0.043-ppm classrooms), but the investigators reported that elevated levels of specific IgE did not correlate with the number and severity of symptoms. The children were moved to a new school without particle board paneling and were evaluated again, 3 mo after moving. Est formaldehyde concn in the new classrooms were 0.029, 0.023, and 0.026 ppm. The numbers of children reporting symptoms decr significantly compared with premoving reporting figures, and mean serum levels of formaldehyde-specific IgE, measured in 20 of the children, declined significantly compared with premoving mean levels.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 74 (1999)]**PEER REVIEWED**
... investigated the correlation between formaldehyde-induced contact dermatitis and granulocyte chemiluminescence resulting from free-radical release in healthy and formaldehyde-sensitive patients. Thirteen patients with contact dermatitis who were occupationally exposed to formaldehyde and five healthy volunteers participated in the study. All subjects underwent skin-prick tests for common allergens as well as a histamine inhalation provocation test. Subjects were exposed to 0.5 mg/m3 (0.41 ppm) formaldehyde for 2 hr, and peak expiratory flow was measured immediately before exposure, at 60 and 120 min of exposure, and at 6 and 21 hr after completion of exposure. In formaldehyde-sensitive patients, skin-prick tests and total serum IgE were normal; no antiformaldehyde IgE was detected. In formaldehyde-sensitive patients, peripheral blood granulocyte chemiluminescence significantly incr within 30 min of exposure commencement, and remained elevated 24 hr later, compared to initial values. Granulocyte chemiluminescence did not incr in healthy patients.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 75 (1999)]**PEER REVIEWED**
... measured the formation of DNA-protein cross links in peripheral white blood cells of occupationally exposed workers (n=12) & unexposed controls (n=8). The avg length of ... exposure was 13 yr. ... Venous blood samples were collected ... . Personal & room concn of formaldehyde were collected at various periods during the working day among the exposed subjects, with formaldehyde room concn ranging from 1.38-1.6 ppm. Personal monitoring devices indicated formaldehyde concn of 2.8-3.1 ppm during peak work & an avg concn of 1.46 ppm at times when work was usually completed. Exposure to formaldehyde resulted in a significant incr in the incidence of DNA-protein cross links. Mean ... incidences in exposed & nonexposed workers were 28 + or - 6 & 22 + or - 6%, respectively. Within the exposed workers group, technicians had significantly greater levels of DNA-protein cross links than physicians (32.3 + or - 4.3 & 26.3 + or - 4.4%, respectively). A linear relationship between yr of exposure & DNA-protein cross links formation was also detected. When the data were analyzed considering worker smoking habits, DNA-protein cross links was consistently elevated among formaldehyde-exposed versus corresponding controls (p=0.03).
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 86 (1999)]**PEER REVIEWED**
The finding of nasal tumors in rodents exposed to high levels of airborne formaldehyde in the early 1980s ... led to a concern for cancer effect in occupationally exposed workers. There are now more than 40 epidemiology studies examining the potential for occupational formaldehyde exposure to cause cancer in humans. The studies include cohort mortality studies of formaldehyde-exposed industrial workers, cohort mortality studies of formaldehyde-exposed professionals or medical specialists, & case-control studies that looked for assoc between occupational exposure to formaldehyde & cancers of the nose, pharynx, or lung. ... Although some of the epidemiological studies have found some scattered evidence for extra-respiratory site cancers in groups of formaldehyde-exposed workers, the data are not consistent across studies & adjustment for potential confounding cancer risk factors has not often been possible. Most, if not all reviewers, have agreed that cancer of the respiratory tract, particularly the upper respiratory tract, is more biologically plausible than formaldehyde-induced cancer at distant sites given the reactivity of formaldehyde, the capacity of tissues to metabolize formaldehyde, & the results from chronic rodent inhalation studies showing that formaldehyde-induced nonneoplastic & neoplastic effects are restricted to the upper respiratory tract with exposures to concn below 5-10 ppm. Accordingly, the meta-analyses of the human data have focused on the findings for respiratory cancer deaths in occupationally exposed humans.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 89 (1999)]**PEER REVIEWED**
... describe the case of a 58-yr old man who swallowed 4 ounces of formalin (517 mg formaldehyde/kg) in a suicide attempt. The man was found unconscious by a co-worker about 1 hr after his shift began. In the emergency room, the subject regained consciousness but was lethargic. Lab results indicated significant acidosis. Approx 3 hr after ingesting the formalin, the patient complained of abdominal pain & began retching without emesis; he was admitted for observation & treated with ethanol. The patient's abdominal pains became more severe & he had difficulty breathing. At 5.5 hr after ingestion, the patient became obtund, & both his respiratory rate & blood pressure fell significantly; he was intubated & placed on 100% oxygen. Shortly thereafter, the patient began to experience seizures; treatment with diazepam & phenytoin was unproductive, but pancuronium was effective in treating the seizures. IV bicarbonate & ethanol therapies were begun after the seizures started. The patient was transported for dialysis, but on arrival, had clinical signs of intravascular coagulopathy. He subsequently sustained a cardiac arrest from which he could not be revived. At autopsy, the patient's stomach was hard, white, & leathery; the esophagus & intestines appeared to be normal.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 113 (1999)]**PEER REVIEWED**
A 55-yr old woman and a 34-yr old man ingested, with suicidal intent, an unknown amt of what was reported to have been formalin ... . The female patient was found in a coma and admitted to the hospital with shock (systolic blood pressure 50 mm Hg), respiratory insufficiency, and metabolic acidosis. The male patient, who had a history of alcohol abuse, was also hospitalized with shock (systolic blood pressure 60 mm Hg), respiratory insufficiency, and metabolic acidosis. Both patients underwent hemodialysis and hemofiltration treatment. Analysis of the formaldehyde samples ingested by both patients showed no evidence that these products contained methanol, although it was expected to have been detected. A chemical-toxicological screening /of blood samples/ indicated that no drugs other than formaldehyde had been ingested ... . Three wk after ingestion of formaldehyde, the female patient died of cardiac failure refractory to catecholamine therapy. The male patient developed adult respiratory distress syndrome and died 8 wk after formaldehyde ingestion with signs of cardiac failure.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 113 (1999)]**PEER REVIEWED**
Human lymphoblast mutants at the X-linked hprt locus have been examined by Southern blot, Northern blot & DNA sequence analysis. A previous study had shown that approx a third of the spontaneously arising mutants & half those induced by formaldehyde showed no alteration in restriction fragment pattern & thus were classified as point mutation. In this report, these point mutants fall into 4 catagories: normal size & amount of RNA, normal size but reduced amounts, reduced size RNA or no RNA. Sequence analyses of cDNAs prepared from hprt mRNAs were performed on 1 spontaneous & 7 formaldehyde induced mutants were base substitutions, all of which occurred at AT base-pairs. There was an apparent hot spot, in that 4/6 independent mutants were AT----CG transversions at one specific site. The remaining mutant had lost exon 8.
[Liber HL et al; Mutat Res 226 (1): 31-7 (1989)]**PEER REVIEWED**
Human Toxicity Values:
The probable mean lethal adult dose is 1-2 oz.
[Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1214]**PEER REVIEWED**
Skin, Eye and Respiratory Irritations:
Contact with the skin causes irritation, tanning effect, and allergic sensitization. Contact with eyes causes irritation, itching, & lacrimation. ...
[Environment Canada; Tech Info for Problem Spills: Formaldehyde p.2 (1985)]**PEER REVIEWED**
Formaldehyde vapor is very irritating to the mucous membranes and toxic to animals, including man.
[Tomlin, C.D.S. (ed.). The Pesticide Manual - World Compendium. 10th ed. Surrey, UK: The British Crop Protection Council, 1994., p. 525]**PEER REVIEWED**
Medical Surveillance:
Consider the skin, eyes, & resp tract in any placement or periodic examination, esp if the patient has a history of allergies.
[Sittig, M. Handbook of Toxic and Hazardous Chemicals and Carcinogens, 1985. 2nd ed. Park Ridge, NJ: Noyes Data Corporation, 1985., p. 464]**PEER REVIEWED**
PRECAUTIONS FOR "CARCINOGENS": Whenever medical surveillance is indicated, in particular when exposure to a carcinogen has occurred, ad hoc decisions should be taken concerning ... /cytogenetic and/or other/ tests that might become useful or mandatory. /Chemical Carcinogens/
[Montesano, R., H. Bartsch, E.Boyland, G. Della Porta, L. Fishbein, R. A. Griesemer, A.B. Swan, L. Tomatis, and W. Davis (eds.). Handling Chemical Carcinogens in the Laboratory: Problems of Safety. IARC Scientific Publications No. 33. Lyon, France: International Agency for Research on Cancer, 1979., p. 23]**PEER REVIEWED**
... No biologic monitoring techniques exist at present, either for the reliable determineation of formaldehyde levels in tissue or for the determination of formaldehyde adducts formed with macromolecules. Techniques are under development for nonspecific monitoring of exposure through periodic assessment of chromosome damage (micronucleus formation or sister chromatid exchange frequency) in workers exposed to formaldehyde.
[Rom, W.N. (ed.). Environmental and Occupational Medicine. 2nd ed. Boston, MA: Little, Brown and Company, 1992., p. 868]**PEER REVIEWED**
Preemployment baseline data should be recorded for the respiratory tract, liver, and skin condition of any worker who will be exposed to formaldehyde. Thereafter, periodic monitoring should be conducted to detect symptoms of pulmonary or skin sensitization or effects on the liver.
[Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1217]**PEER REVIEWED**
The assessment of formaldehyde exposure can be accomplished through measurement of the metabolite formic acid. Formic acid is also an endogenously produced substance formed by the degradation of glycine. There was no information in the literature that showed a correlation between urinary formic acid levels & formaldehyde exposure levels. This measurement is also a poor indicator of the extent of formaldehyde absorption, due to the high endogenous levels of formic acid. Urine Reference Ranges: Normal- normal population level: 21 mg/l (endogenously produced formic acid); Exposed- not established; Toxic- not established.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 714]**PEER REVIEWED**
Respiratory Symptom Questionnaires: Questionnaires published by the American Thoracic Society (ATS) & the British Medical Research Council have proven useful for identifying people with chronic bronchitis. Certain pulmonary function tests such as the FEV1 have been found to be better predictors of chronic airflow obstruction.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 716]**PEER REVIEWED**
Chest Radiography: Chest radiographs are widely used to assess pulmonary disease. They are useful for detecting early lung cancer in asymptomatic people, & especially for detecting peripheral tumors such as adenocarcinomas. However, even though OSHA mandates this test for exposure to some toxicants such asbestos, experts' views on the risk-to-benefit ratio in detection of pulmonary disease conflict, so routine annual chest x-rays are not recommended for all people.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 716]**PEER REVIEWED**
Pulmonary Function Tests: The tests that have been found to be practical for population monitoring include: Spirometry & expiratory flow-volume curves; Determination of lung volumes; Diffusing capacity for carbon monoxide; Single-breath nitrogen washout; Inhalation challenge tests; Serial measurements of peak expiratory flow; Exercise testing.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 717]**PEER REVIEWED**
Urine Albumin: Albuminuria has been shown to be a specific marker of glomerular dysfunction. Tubular damage, however, can also result in increased levels of albumin in the urine.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 715]**PEER REVIEWED**
Urinary Beta-2-Microglobulin &/or Retinal Binding Protein: Measurements for the presence of either of these low molecular weight proteins are useful in detection of early impairment of proximal tubular function. However, beta-2-microglobulin is unstable at urinary pH <6, & may degrade in the bladder prior to collection & subsequent neutralization of the urine sample. Measurement of retinal binding protein appears to be a better marker for early tubular dysfunction due to its stability in the urine subsequent to collection & analysis. However, retinal binding protein is produced in the liver & not a constitutive protein of the kidney, so that its presence in the kidney provides only indirect evidence of tubular damage.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 715]**PEER REVIEWED**
Urinary Enzyme N-Acetylglucosaminidase: This lysosomal enzyme has shown promise in assessment of subclinical nephrotoxic injury. This enzyme is not normally filtered at the glomerulus due to its high molecular weight. In the absence of glomerular injury, this enzyme will be detected in the urine as a result of leakage or exocytosis from damaged, stimulated, or exfoliated renal cells. The sensitivity of measurement for this enzyme has not been thoroughly studied, but it's usefulness has shown some promise. However, this enzyme is unstable at urinary pH >8, which could diminish the sensitivity of the measurement due to enzyme degradation.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 716]**PEER REVIEWED**
DNA-Protein Crosslinks: Measurement of DNA-protein crosslinks in white blood cells may be a useful test for assessing formaldehyde exposure. In addition, measurement of these crosslinks in other formaldehyde sensitive tissues, such as the upper respiratory tract, may be a useful indicator of formaldehyde exposure. However, other toxicants may cause similar crosslinks, so that the specificity of this test for assessing only formaldehyde exposure is questionable.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 715]**PEER REVIEWED**
Routine Urinalysis: Performing a routine urinalysis including parameters such as specific gravity, glucose, & microscopic exam may be useful for assessing renal toxicity.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 716]**PEER REVIEWED**
Urinary Alpha & Pi Isoenzymes of Glutathione S-Transferase: Radio-immunological & Elisa techniques have been developed for quantitation of /alpha/ & /pi/ isoenzymes of glutathione S-transferase, which are constitutive proteins in the kidney. The /alpha/ isoenzyme is located only in the proximal tubule, while the /pi/ isoenzyme is located in the distal convoluted tubule, the loop of Henle, & the collecting ducts of the kidney. Damage to epithelial cell membranes can result in the increased excretion of these isoenzymes in the urine. This test for assessing renal tubular damage appears to have many advantages over other available tests, such as: (1) the /alpha/ & /pi/ isoenzymes are constitutive proteins in the kidney; (2) these isoenzymes are stable in the urine; (3) the test is simple & reproducible; & (4) due to selective localization of the isoenzymes, differential diagnosis of specific tubular damage is possible. In addition, increased levels of these isoenzymes were seen in patients previously exposed to nephrotoxicants where conventional tests for kidney function were normal, indicating a high degree of sensitivity.
[Ryan, R.P., C.E. Terry, S.S. Leffingwell (eds.) Toxicology Desk Reference 5th ed. Volumes 1-2. Taylor & Francis Philadelphia, PA. 2000, p. 716]**PEER REVIEWED**
Populations at Special Risk:
Mean formaldehyde levels are highest in hospital autopsy rooms compared with other commercial settings. /Hospital autopsy workers are possibly exposed/.
[Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1214]**PEER REVIEWED**
Release of /formaldehyde/ vapors in mobile homes has been associated with headache & pulmonary & dermal irritation. /Occupants of mobile homes are possibly exposed/.
[Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1214]**PEER REVIEWED**
Two populations of humans have received considerable attention in the literature as being particularly sensitive to formaldehyde exposure following inhalation and/or dermal routes. The first population is asthmatics, and concern focuses on the changes in lung function parameters that formaldehyde may produce ... . Most of these studies concluded that there is no evidence of incr airway reactivity as a result of formaldehyde exposure in either normal or asthmatic individuals. ... The second population of potential concern is people with dermal sensitization ... Formaldehyde liquid, but neither the gaseous phase nor formalin, is considered to be a dermal sensitizer ... . Anaphylactic reactions have been reported ... . Dermal allergic reactions have also been reported in doctors and nurses exposed to formaldehyde ... as well as in fiberglass workers ... .
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 236 (1999)]**PEER REVIEWED**
Workers in industries where formaldehyde is used or released may receive potentially high exposures. Members of the general population who live in newly constructed homes or homes where pressed wood products have recently been installed may be exposed to high levels of formaldehyde by inhalation for short periods of time until the latent formaldehyde has been released. Exposure in mobile homes are expected to be higher than conventional homes due to their lower rate of air exchange ... . Members of the general population that handle large amt of permanent press fabrics treated with formaldehyde-releasing resins may also receive potentially high exposures. The use of some cosmetics, such as nail hardeners, may result in high short-term exposure.
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 311 (1999)]**PEER REVIEWED**
Smokers and persons who live in a home with a cigarette smoker also may be exposed to higher levels of formaldehyde. Environmental tobacco smoke, which is a combination of diluted sidestream smoke released form a cigarette's burning end and mainstream smoke exhaled by an active smoker, can contribute 10-25% (0.1-1 mg/day) of the total average indoor exposure to formadehyde ... .
[DHHS/ATSDR; Toxicological Profile for Formaldehye p. 311 (1999)]**PEER REVIEWED**
Probable Routes of Human Exposure:
... /VAPORS/ GIVEN OFF DURING HOT MOLDING OF SYNTH RESINS (/IS A/ COMMON SOURCE OF EXPOSURE) ... A SURVEY OF 6 FUNERAL HOMES ... REVEALED MEAN CONCN, IN DIFFERENT ESTABLISHMENTS, BETWEEN 0.25 & 1.39 PPM. ... /EXPOSURES ARE ENCOUNTERED/ IN PHENOL-FORMALDEHYDE RESIN MOULDING PLANT ... /FROM WHICH/ CHRONIC AIRWAY OBSTRUCTION LOWERED FORCED EXPIRATORY VOL/FORCED VOL CAPACITY RATIO & EYE, NOSE & THROAT IRRITATION & LOWER RESP TRACT SYMPTOMS /HAVE BEEN OBSERVED/.
[American Conference of Governmental Industrial Hygienists. Documentation of the Threshold Limit Values and Biological Exposure Indices. 5th ed. Cincinnati, OH: American Conference of Governmental Industrial Hygienists, 1986., p. 276]**PEER REVIEWED**
... /EXPOSURES TO/ FORMALDEHYDE VAPOR EMISSIONS IN PERMANENT-PRESS FABRICS INDUSTRY (8 PLANTS) /HAVE BEEN REPORTED IN WHICH/ CONCN RANGING ... FROM 0.3 TO 2.7 PPM (IN SEWING AREA) WITH AVG OF 0.68 PPM /WERE DETECTED/. COMPLAINTS CONSISTED OF ANNOYING ODOR (ODOR THRESHOLD, BELOW 1.0 PPM), CONSTANT PRICKLING IRRITATION OF MUCOUS MEMBRANES & DISTURBED SLEEP.
[American Conference of Governmental Industrial Hygienists. Documentation of the Threshold Limit Values and Biological Exposure Indices. 5th ed. Cincinnati, OH: American Conference of Governmental Industrial Hygienists, 1986., p. 276]**PEER REVIEWED**
NIOSH (NOES Survey 1981-1983) has statistically estimated that 1,329,322 workers (441,902 of these are female) are potentially exposed to formaldehyde in the US(1). The NOES Survey does not include farm workers(SRC). Occupational exposure to formaldehyde may occur through inhalation and dermal contact with this compound at workplaces where formaldehyde is produced or used(2). Monitoring data indicate that the general population may be exposed to formaldehyde via inhalation of ambient air, ingestion of food, and dermal contact with cosmetic and aerosol products containing formaldehyde(2).
[(1) NIOSH; National Occupational Exposure Survey (NOES) (1983) (2) IARC; Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva, Switzerland: WHO 62: 243 (1995)]**PEER REVIEWED**
Humans are exposed to formaldehyde from a variety of sources. The major source of atmospheric discharge is from combustion processes specifically from auto emissions and also from the photooxidation of hydrocarbons in auto emissions(1,2). Additional exposure to formaldehyde emissions comes from its use as an embalming fluid in anatomy labs, morgues, etc and its use as a fumigant and sterilant(1). Resin treated fabric, rugs, paper, etc and materials such as particle board and plywood which use resin adhesives and foam insulation release formaldehyde which may build up in homes and occupational atmospheres(1,2). Contact with industrial waste water, especially from lumber related operations where formaldehyde is used in adhesives, has resulted in the Pacific Northwest, Northeast, parts of Texas, and lumber areas of the south(1)(SRC). The estimated daily intake of formaldehyde among exposed Finnish workers is 3000 ug, whereas heavily exposed workers (particle-board and glue production, foundry work) is 10,000 ug(3).
[(1) Kitchens JF et al; Investigation of Selected Potential Environmental Contaminants: Formaldehyde p. 22-98 USEPA 560/2-76-009 (1976) (2) National Research Council; Formaldehyde and Other Aldehydes p. 2-1 to 5-96 USEPA 600/6-82-002 (1982) (3) Hemminki K, Vainio H; Human Exposure to Potentially Carcinogenic Compounds. IARC Sci Publ 59: 37-45 (1984)]**PEER REVIEWED**
In a 12-week study of exposure in a gross anatomy lab of a medical school, 44% of breathing room samples and 11% of ambient air samples were >1.0 ppm the ceiling recommended by ACGIH; Half the breathing zone samples were between 0.6-1.0 ppm and the range was 0.3-2.63 ppm(1). A 1976 report estimates that 8000 US workers were potentially exposed to formaldehyde during its production(3). A more recent estimate of the number of exposed workers in industries producing and using formaldehyde and its derivatives range from 1.4-1.75 million(2). Concentrations of formaldehyde in occupational areas dating from the 1960's and early 1970's are: textile plant 0-2.7 ppm, 0.68 ppm avg; garment factory 0.9-2.7 ppm; clothing store 0.9-3.3 ppm; laminating plant 0.04-10 ppm; funeral homes 0.09-5.26 ppm, 0.25-1.39 ppm avg; resin manufacture and paper production 16-30 ppm; paper conditioning 0.9-1.6 ppm; wood processing 31.2 ppm max(2). Concns in occupational settings dating from the late 70's are: textile plants 0.1-0.5 ppm, 0.2 ppm avg; shoe factory 0.9-2.7 ppm, 1.9 ppm avg; particle board plant 0.1-4.9 ppm, 1.15 ppm avg; plywood plant 0.1-1.2 ppm, 0.35 ppm avg; wooden furniture manufacturing plant 0.1-5.4 ppm, 1.35 ppm avg; adhesive plants 0.8-3.5 ppm, 1.75 ppm avg; foundries 0.05-2.0 ppm, 0.6 ppm avg; construction sites 0.5-7.0 ppm, 2.8 ppm avg; hospitals and clinics 0.05-3.5 ppm, 0.7 ppm avg(2). More recent survey results for occupational environments include: fertilizer production 0.2-1.9 ppm; dyestuffs <0.1-5.8 ppm; textile manufacture <0.1-1.4 ppm; resins (foundry) <0.1-5.5 ppm; bronze foundry 0.12-0.8 ppm; iron foundry <0.02-18.3 ppm; treated paper 0.14-0.99 ppm; hospital autopsy room 2.2-7.9 ppm; plywood industry 1.0-2.5 ppm; urea-formaldehyde foam applicators <0.08-2.4 ppm(4).
[(1) Skisak, CM; Amer Ind Hyg Assoc J 44: 948-50 (1983) (2) IARC; Monograph. Some Industrial Chemicals and Dyestuffs 29: 345-89 (1982) (3) National Research Council; Formaldehyde and other Aldehydes p.2-1 to 5-96 USEPA 600/6-82-002 (1982) (4) Bernstein RS et al; Am Ind Hyg Assoc J 45: 778-85 (1984)]**PEER REVIEWED**
Potential occupational exposure to formaldehyde are as follows: agricultural workers, anatomists, beauticians, biologists, bookbinders, botanists, chemical production workers, cosmetic formulators, crease-resistant textile finishers, disinfectant makers, disinfectors, dress-goods shop personnel, electrical insulation makers, embalmers, embalming fluid makers, fireproofers, formaldehyde production workers, formaldehyde resin makers, foundry employees, fumigators, fur processors, furniture makers, glue and adhesive makers, hide preservers, histology technicians (including necropsy and autopsy technicians), ink makers, lacquerers and lacquer makers, medical personnel (including pathologists), mirror manufacturers, paper makers, particle-board makers, photographic film makers, plastic workers, plywood makers, rubber makers, taxidermists, textiles mordanters and printers, textiles waterproofers, varnish workers, wood preservers(1).
[(1) IARC; Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva, Switzerland: WHO 62: 225 (1995)]**PEER REVIEWED**
The avg concn of formaldehyde in workroom air in formaldehyde and resin manufacturing plants ranged from 0.1-14.2 mg/cu m(1). The avg concn of formaldehyde in workroom air of plywood mills, particle-board mills, furniture factories, other wood product and paper mills ranged from 0.08-7.4 mg/cu m(1). The avg concn of formaldehyde in workroom air in textile mills and garment factories ranged from 0.1 to 1.9 mg/cu m(1). The avg concn of formaldehyde in workroom air in foundries and other industrial facilities ranged from 0.04 to 38.2 mg/cu m(1). The avg concn of formaldehyde in workroom air in mortuaries, hospitals, and laboratories ranged from 0.05 to 4.2 mg/cu m(1). The avg concn of formaldehyde in workroom air in building sites, agriculture, forestry, and misc other activities ranged from <0.1 to 4.3 mg/cu m(1).
[(1) IARC; Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva, Switzerland: WHO 62: 226-41 (1995)]**PEER REVIEWED**
Cigarette smoke and products of combustion contain formaldehyde(1). Cigarette smoke contains 15 to 20 mg formaldehyde per cigarette(1). Avg formaldehyde exposure from passive smoking is between 0.23 to 0.27 ppm(1). A 'pack-a-day' smoker may inhale as much as 0.4-2.0 mg formaldehyde(1).
[(1) Bingham E et al, eds; Patty's Toxicology. 5th ed. NY, NY: John Wiley & Sons Inc. 5: 980-3 (2001)]**PEER REVIEWED**
Several studies have been conducted to determine exposure of students in laboratories(1). The concn of formaldehyde in the breathing zone at dissecting tables and in the ambient air in a medical school in the United States was found to be >1.2 mg/cu m in 44% of the breathing zone samples and 11 ambient air samples; 50% of the breathing zone samples contained 0.7-1.2 mg/cu m, with a range of 0.4-3.2 mg/cu m(1). During the 1982-82 academic year, the airborne concn of formaldehyde at a university in the US was 7-16.5 ppm in the laboratory, 1.97-2.62 ppm in the stockroom, and <1 ppm in the public hallway(1). In another study, of 253 samples of air taken during laboratory dissection classes at a university in the US, 97 contained concns above the detection limit of 0.01 mg/cu m; all but four samples had levels <1.2 mg/cu m(1). The avg concn detected was 0.5 mg/cu m(1).
[(1) IARC; Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva, Switzerland: WHO 62: 226-41 (1995)]**PEER REVIEWED**
Average Daily Intake:
AIR INTAKE: Assume 1 to 100 ug/cu m(1), 20 ug to 2,000 ug formaldehyde(SRC).
[(1) IARC; Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva, Switzerland: WHO 62: 242 (1995)]**PEER REVIEWED**
In Sweden between Dec 1986 to Aug 1987, the mean yearly exposure to formaldehyde from air pollution was 1.2 ug/cu m(1). The estimated daily exposure of the Finnish population to formaldehyde from community air is 100 ug and from the home environment, 1,000 ug(2).
[(1) Bostrom CE et al; Environ Health Perspect 102: 39-47 (1994) (2) Hemminki K, Vainio H; Human Exposure to Potentially Carcinogenic Compounds. IARC Sci Publ 59: 37-45 (1984)]**PEER REVIEWED**
Minimum Fatal Dose Level:
Approximate Minimum Lethal Dose (MLD) (150-lb man): 30 ml
[Arena, J. M. Poisoning: Toxicology, Symptoms, Treatments. Fourth Edition. Springfield, Illinois: Charles C. Thomas, Publisher, 1979., p. 97]**PEER REVIEWED**
Male single oral ingestion 517 mg/kg
[DHHS/ATSDR; Toxicological Profile for Formaldehyde p. 116 (1999)]**PEER REVIEWED**
Emergency Medical Treatment:
Antidote and Emergency Treatment:
Decontamination: Dilute with milk or water in alert patients as a first aid measure may reduce corrosive effects at the scene. If ingestion has occurred within 1 hr before presentation, gentle gastric aspiration with a soft nasogastric tube may limit systemic absorption. There is little evidence to support the use of activated charcoal to absorb formate or formaldehyde. ... Elimination enhancement: Severe acidosis & deteriorating vital signs are indications for considering dialysis, but the literature does not contain adequate case studies to guide treatment. Aggressive sodium bicarbonate therapy & frequent monitoring of arterial blood gases may be useful. There are no antidotes. Supportive care: 1. Monitor electrolytes, fluids, acid-base, & kidney function closely. 2. Watch for signs of GI hemorrhage & perforation with serial vital signs, abdominal exams, & complete blood counts. 3. Check blood methanol levels & treat accordingly in formalin ingestions. 4. Fibrosis of stomach has required partial gastrectomy in the past.
[Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1217]**PEER REVIEWED**
Irrigate eyes with water. Wash contaminated areas of body with soap and water. Gastric lavage (stomach wash), if swallowed, using 1% ammonium carbonate and followed by saline catharsis. Oxygen, if indicated.
[ITII. Toxic and Hazardous Industrial Chemicals Safety Manual. Tokyo, Japan: The International Technical Information Institute, 1988., p. 250]**PEER REVIEWED**
Basic Treatment: Skin- Treated as any burn to prevent allergic contact dermatitis, exposure to formaldehyde or formaldehyde-containing products should be minimized. Inhalation- Patients should be removed from exposure. If symptoms persist, hospitalization may be required. Very high levels (100 ppm) may be lethal. Pulmonary damage may occur. Oral- high concn of formaldehyde may be irritating to the GI tract. Ingestion can result in metabolic responses similar to methanol poisoning. Hemodialysis is efficacious just as in methanol poisoning & should be considered if metabolic acidosis occurs.
[Sullivan, J.B. Jr., G.R. Krieger (eds.). Hazardous Materials Toxicology-Clinical Principles of Environmental Health. Baltimore, MD: Williams and Wilkins, 1992., p. 978]**PEER REVIEWED**
Basic treatment: Establish a patent airway. Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if necessary. Aggressive airway management may be necessary. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Anticipate
