title: Fluoropolymer-associated illness.
abstract: BACKGROUND
  Isolated outbreaks of respiratory illness associated with fluoropolymer-containing products, such as waterproofing agents and sealants, have occurred for many years in many different countries. Despite this, an assured mechanism of illness is not defined, representing a barrier to the prevention of future occurrences.
  
  
  OBJECTIVE
  To discuss the epidemiology of the respiratory illness outbreaks, proposed mechanisms of toxicity and clinical outcomes from exposure to these products.
  
  
  METHODS
  We performed a literature review using OVID Medline (January 1946 through December 2012) and PubMed (January 1950 through December 2012) using the search terms "fluoropolymer", "fluorochemical", "leather proofing", "leather protectant", "weatherproofing agent", and "waterproofing agent". Bibliographies of identified articles were screened for additional relevant studies, including non-indexed reports.
  
  
  RESULTS
  Fluoropolymer-associated respiratory illnesses often resemble polymer fume fever: acute respiratory symptoms predominate and are accompanied by flu-like symptoms. Outbreaks occasionally follow marketing of a new or reformulated product. Treatment with basic and supportive measures is sufficient in many cases, including fresh air and supplemental oxygen. Inhaled beta-2 adrenergic agonists and corticosteroids have been used. Toxicity may result from the fluoropolymer itself or the solvent in which it is delivered. Factors which may influence toxicity include fluoropolymer particle size, emission rate, methods of application, environmental conditions, and personal health.
  
  
  CONCLUSIONS
  Exposure to fluoropolymer-containing waterproofing agents can cause lung injury and usually produce abrupt onset of respiratory and flu-like symptoms. Most victims improve with supportive care and supplemental oxygen. Serious outcomes, including acute respiratory distress syndrome and death, are uncommon. Proprietary information on the exact composition of most fluoropolymer-containing products is often unavailable, and this hinders identification of an exact cause of disease. The etiology is most likely multifactorial. Future research should focus on determining the exact mechanism of illness and establishing safe exposure limits.
authors.affiliation: Department of Toxicology, Nationwide Children's Hospital , Columbus, OH , USA.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Hays
authors.forename: Henry
authors.initials: H
authors.lastname: Spiller
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004781:Environmental Exposure / Q000009:adverse effects*; D017611:Fluorine Compounds / Q000737:chemistry* / Q000633:toxicity*; D006801:Humans; D011108:Polymers / Q000737:chemistry / Q000633:toxicity*; D012120:Respiration Disorders / Q000139:chemically induced / Q000473:pathology*
chemical_list: D017611:Fluorine Compounds; D011108:Polymers
keywords: Fluorochemical; Fluoropolymer; Fluororesin; Leather proofing; Waterproofing agent; Weatherproofing agent