title: Toxicity from fluoropolymer-containing grout, tile and stone floor sealants reported to the UK National Poisons Information Service 2009-2015.
abstract: BACKGROUND
  Grout, tile and floor stone sealants contain a solvent, a water-repelling agent and in the case of aerosols a propellant. The water-repelling agent used is typically a fluoropolymer resin, a silicon-based resin, or a combination of both.
  
  
  OBJECTIVE
  To report the clinical course in patients exposed to fluoropolymer-containing sealants referred to the United Kingdom National Poisons Information Service.
  
  
  METHODS
  A retrospective analysis was performed of telephone enquiries received between 2009 and 2015.
  
  
  RESULTS
  101 enquiries involving 96 exposures were received. The majority of the exposures (n = 88) occurred when the sealant was delivered from an aerosol. Twelve patients were exposed occupationally and the remainder were exposed while using the product at home. Eighty-nine exposures were as a result of inhalation alone, two followed ingestion, three skin contact and one eye contact; one involved inhalation and eye contact. All 90 patients exposed by inhalation developed clinical features: 31 had a World Health Organisation/International Programme on Chemical Safety/European Commission/European Association of Poison Centres and Clinical Toxicologists Poisoning Severity Score of 1 (minor toxicity), 51 patients had features of moderate toxicity (PSS 2) and eight were graded PSS 3 (severe poisoning). The most common features were dyspnea (n = 52; 57.8%; 95% CI = 47.0-68.5), chest pain/tightness (n = 34; 37.8%; 95% CI = 27.2-48.4), coughing (n = 27; 30.0%; 95% CI = 20.0-40.0) and sinus tachycardia (n = 11; 12.2%; 95% CI = 4.1-18.2); hypoxemia was present in 20 (22.2%; 95% CI = 13.1-31.4). At the time of the enquiry a chest X-ray had been performed on 15 patients: in eight patients (all of whom were PSS 3) the X-ray was reported as being abnormal and showed bilateral shadowing.
  
  
  CONCLUSIONS
  This study demonstrates that if fluoropolymer-containing sealants are inhaled then clinical features may occur and in a small proportion (9%) these features may be severe.
authors.affiliation: a NPIS (Birmingham Unit) , City Hospital , Birmingham , UK.
authors.forename: Des
authors.initials: D
authors.lastname: Henke
authors.affiliation: a NPIS (Birmingham Unit) , City Hospital , Birmingham , UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Campbell
authors.affiliation: a NPIS (Birmingham Unit) , City Hospital , Birmingham , UK.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Bradberry
authors.affiliation: b NPIS (Edinburgh Unit) , Royal Infirmary , Edinburgh , UK.
authors.forename: Euan A
authors.initials: EA
authors.lastname: Sandilands
authors.affiliation: c NPIS (Newcastle Unit) , Newcastle upon Tyne NHS Foundation Trust and Medical Toxicology Centre, Newcastle University , Newcastle-Upon-Tyne , UK.
authors.forename: Simon H L
authors.initials: SHL
authors.lastname: Thomas
authors.affiliation: d NPIS (Cardiff Unit) , University Hospital Llandough , Cardiff , UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Thompson
authors.affiliation: a NPIS (Birmingham Unit) , City Hospital , Birmingham , UK.
authors.forename: J Allister
authors.initials: JA
authors.lastname: Vale
mesh_terms: D000293:Adolescent; D000328:Adult; D000335:Aerosol Propellants / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005465:Fluorocarbon Polymers / Q000506:poisoning*; D006795:Household Products / Q000506:poisoning*; D006801:Humans; D007223:Infant; D019570:Inhalation Exposure / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D011039:Poison Control Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012997:Solvents / Q000506:poisoning*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000335:Aerosol Propellants; D005465:Fluorocarbon Polymers; D012997:Solvents
keywords: Fluoropolymer; respiratory features; sealants