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INDIVIDUAL  SUSCEPTIBILITY: 

Occupational Health Physician,  Dr Chris Walls (Auckland)  states: “[Glutaraldehyde] goes on in common with a number of other chemicals to cause in some people quite bizarre and peculiar symptoms which don’t fit the defined textbook examples”.[1] Differences in individual susceptibility  play an important role in chemical sensitivity,  (for instance a specific gene, CYP2E1, is responsible for the metabolism of benzene in many body tissues.   Mice lacking the gene were protected from the toxic effects of benzene exposure. Humans also have this gene and human risk is likely to be a function of CYP2E1 expression.  (Medinsky M A et al.  CIIT Impact, Sept 1997).

Those with a mutation of CYP2D6 can detoxify the drug debrisoquine at only 0.5%-20% of the normal capacity.  In the Korean War, soldiers with G6PD deficiency were hypersensitive to an anti-malarial drug.  A genetic predisposition towards MCS and related disorders has long been suspected. There is a 40-fold variation in P450 1A2, one of the P450 enzymes necessary to detoxify various drugs and chemical substances.  Many MCS subjects are now known to be P450-compromised.   (ACTA update, Dec 98).  The debate is that these enzyme level deficiencies are not nearly as marked as in the genetic conditions causing similar symptoms.  NIEHS is looking at the enzymes which metabolise substances foreign to the body, to determine the basis for the wide variation in individual responsiveness to environmental toxicants.  (CIIT Impact Sept 1997).

PHARMACOGENETICS   

From  ACTA  UPDATE,  April 1999:  “Mispelled” genes are now known to be at the root of certain adverse reactions to otherwise lifesaving drugs.  Ventolin is ineffective for asthmatics with a specific genetic glitch.  Another prevents codeine from being converted to its active form...  while other glitches prevent ....Prozac from being metabolised.  Now the Mayo Clinic is charting genetic profiles before prescribing certain drugs.”

SYMPTOMS ASSOCIATED WITH

GLUTARALDEHYDE EXPOSURE / DARKROOM DISEASE

Glutaraldehyde-sensitised people will have many of the following symptoms   (most common symptoms from top).  The list of  symptoms is compiled  from:    Spicer, Hay,  Gordon  1986;  Society of Radiographers - Preventing the Darkroom Disease, 1991;  A. Bertino-Clark - W. Aust HSOA Survey, 1989;  Dr A.Vyas’ study,  NW Lung Centre,  Manchester,  England,  1997;  Prof  Bill Glass Exposure to Glutaraldehyde Alone or in a Fume Mix  Shadows 40, 2, 1997;  SNFTAAS  Case Histories.            

-headache

-sore throat,  constant hhumph,  catarrh  

-voice change or loss (eg loss of upper register singing mentioned; “my voice goes down” is often the first indication of an exposure reaction)    

-unexpected fatigue/exhaustion (most of us find the energy to do the things we want to do but with this fatigue you can’t.  Constantly falling asleep and sleeping for huge amounts of time is common ) 

-sore/watery eyes

-mood changes:  depression,  anxiety,  irritability,  personality changes,  emotional lability (inappropriate talking,  crying,  rapidly changing emotions)

-concentration difficulties,  reduced ability to learn new things,  memory loss,  (all extremely frustrating in intelligent people who have held professional positions and good jobs which they like doing),   spaced out feeling

           -tinnitus               

-blocked nose 

          -rhinitis

-bad/metallic taste in mouth, mouth ulcers, lip sores, 

-chest tightness,  shortness of  breath,  chest  pains,  asthma

          -sinusitis

-nasal discharge,  nose bleeds (epistaxis),  ulceration of nasal mucosa  

-skin irritation,  itchy burning skin,  rashes,  dermatitis      

-aching joints and muscles,  uncontrollable twitching,  fibromyalgia

          -cross sensitivity to other chemicals

-heart arrythmias,   palpitations,  Raynaud’s Syndrome

-menstrual irregularities          

-gastrointestinal symptoms incuding  nausea,  diarrhoea,  abdominal pain

-difficulty urinating/prostatitis

-earache,  ear infection

-pins and needles or numbness in fingers, toes or limbs                                           

-bruising

-irritant associated vocal chord dysfunction 

Glutaraldehyde can cause anaphylactic shock - (Kay Ball, Nurse Educator , <KayBall@AOL.COM>). 

Kim Crosby has been suffering intense bladder pain with the lining of her bladder fibrosing and scarring - her doctor has said this is an auto-immune response to her chemical injury.[2] (Ontario WSIB -Workplace Safety and Insurance Board - are refusing to say that she has developed occupational asthma from the chemicals though she never had any previous lung problems..they refuse to acknowledge her fibromyalgia and the autoimmune problems...The bladder wall is usually smooth; “mine looks like someone drew mountains along the inside wall.  This cause pulling and scarring which in turn causes frequent urination, because my bladder capacity is so small, pain because of the pulling (causes spasms) and pain on urination”. Kim says she gets help from DMSO (a medication that is injected into the bladder through a foley catheter).  The patient lies on their stomach, back, and both sides for 15 mins each. It seems to resolve the fibrosing.  Some patients take 1-2 treatments and others 5-6 once a year.  Contact Kim: <crosby.darkroomdisease@sympatico.ca> 

Several have Sjögren’s syndrome which  includes connective tissue disease, SLE, scleroderma, eye effects - lack of tears, thickening of corneal epithelium, itching and burning of eye, hyperemia (excess blood) of the conjunctiva), and reduced vision.  Sjögren’s syndrome usually occurs in middle aged women and is of unknown origin.  Two  SNFTAAS members have Hashimoto’s disease, a progressive autoimmune disease of the thyroid gland. 

One MRT in Canada, Monique Genton, has developed chronic tinnitus, dizziness, and nausea (in addition to asthma and MCS) since her exposure to processor fumes.  She was referred to a neuro-auditory specialist, not just an ENT doctor, by her allergist who noted a nystagmus (where the eyes do not track a moving object smoothly).  Although her hearing, balance and ENG tests were essentially normal, the neuro ear doctor feels that, based on her clinical history, she has a visual-vestibular disorder that comes from the brainstem, rather than the ear itself.  In this disorder, the information from the brain does not match that of the ear due to a brainstem irregularity, and this causes a kind of sea-sickness.  Monique often experiences nausea when travelling, even when driving her own car.  It is known that people exposed to solvents can develop this disorder, but no one has specifically examined this syndrome in radiographers.  (Personal communication, Feb 3, 1999,  akimbo@interchange.ubc.ca ).  A number of others are reporting similar symptoms.

Cancers,  reproductive effects, chemical sensitivities and health effects in children,  diabetes,  teeth and gum problems, effects on vision  (“toxic agents display a remarkable predilection for the retina” - Recent Advances in Nervous System Toxicology,  Golloi, Manzo & Spencer, Plenum),  inability to maintain body temperature,  lack of interest in sex, focal epilepsy are areas which have been little investigated to do with glutaraldehyde/chemical exposure in radiographers/MRTs/nurses.  Hair loss, photophobia, limb numbness, and flushing are extras mentioned by Kathleen Sperrazza in her list of symptoms in the Brigham nurses.[3]

Liver damage  (with raised LFT’s and  fatty changes in the liver) has been shown on scan in NZ radiographers.  Mice exposed for 24 hrs to activated solution showed no kidney or lung damage but the livers showed toxic hepatitis.[4]  Dr Adrienne Buffaloe in her paper on the development of asthma in three critical care nursesexposed to glutaraldehyde, ethylene oxide, formaldehyde, butyraldehyde, latex, carbon monoxide, carbon dioxide and other VOCs, describes the role of the liver:

“The liver is the organ primarily responsible for clearing chemicals from the body, with minor percentage of chemical clearance accomplished by the brain, kidneys, lungs and skin.  Phase I and Phase H Detoxification Pathways in the liver are comprised of a series of enzymatic reactions that progressively biotransform toxic chemicals which are fat soluble into non-toxic chemicals that are water soluble, so the chemicals can be excreted.  This process of biotransformation requires a combination of nutrient co-factors for the enzymes to operate. When these enzymes are saturated , the chemicals can no longer be biotransformed, and are stored.  [There seems significant potential for damage from long-term exposure to  a chemical like glutaraldehyde which has a predilection for denaturing/cross-linking protein and enzymes.  In histology,  glutaraldehyde inhibits enzyme activity more than formaldehyde, the inhibition increasing with time in the fixative.[5]]  These fat chemical reserves can then serve as a reservoir and an equilibrium between the fat stores and the blood stream and can result in ongoing chemical toxicity long after the initial chemical exposure.  Blood levels for toxic chemicals, when positive, demonstrate that there is a circulating quantity that the body has been unable to clear.  However the blood level is just a fraction of the total body chemical load, since the concentration in body fat is often 200-300 times the concentration of the chemical found in the blood.”[6]

Buffaloe covers the concepts of  “Total Allergic Load”,  “The Spreading Phenomenon” - as the chemical load accumulates, additional organ systems become recruited in the disease process.  She also discusses the allergies in a child of one of the nurses.

Her web site:    http://www.accessnewage.com/articles/health/chemical.htm  

“Researchers at UCLA have announced a breakthrough discovery:  weight loss releases toxic chemicals absorbed from the environment and hitherto stored in fat reserves, back into the bloodstream.  Roy Walford discovered this fact when he was an inhabitant of Biosphere 2.  Within the first year of their sojourn in that controlled environment, Biosphereans lost an average of 11 kgs, while their blood levels in DDE and PCB’s initially increased by up to five fold,  then subsided as fat reserves were depleted.”

(ACTA UPDATE, 47, April, 1999.)

It has been difficult to attribute fatty liver and raised LFTs because so many factors can be involved eg alcohol use, and medication.  Some cases accepted for compensation in NZ on this basis from GA exposure have been rescinded.

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