Wednesday, September 5, 2007

Story of the Day-Popcorn Lung

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Bronchiolitis obliterans is a disease of the lungs in which the bronchioles are plugged with granulation tissue. Bronchiolitis obliterans, a rare and life-threatening form of fixed obstructive lung disease, is known to be caused by exposure to noxious gases in occupational settings.

Because of similar names, it is often confused with bronchiolitis obliterans organizing pneumonia (BOOP), a completely different pulmonary disorder.

Sporadic cases of bronchiolitis obliterans have been reported in the published scientific literature in unrelated industries that have not previously been linked to this disease. This includes nylon-flock workers, workers who spray prints onto textiles (with polyamide-amine dyes), battery workers (exposure to thionyl chloride fumes) and workers in the food flavoring industry. [3]

While it may occur as a manifestation of transplant rejection or as the result of exposure to toxic gases, bronchiolitis obliterans has been nicknamed "popcorn lung" or "popcorn workers' lung" due to onset of this disease from inhalation of airborne diacetyl — a butter flavoring used in popcorn and in many other food flavorings such as those used in candy and even potato chips. Similar fixed obstructive lung disease has also occurred in workers at other plants that use or manufacture flavorings [NIOSH 1986; Lockey et al. 2002]. In animal tests, inhaling vapors from a heated butter flavoring used in microwave popcorn production caused severe injury to airways [Hubbs et al. 2002a].The disease is initiated by damage to the epithelium of the small conducting airways and progresses to inflammation of the airways, frequently to the adjacent alveolar tissue as well.

The Pump Handle
Popcorn Lung Coming to Your Kitchen? The FDA Doesn’t Want to Know

Popcorn Lung Diacetyl Danger: Answers to your Questions

Lung Disease in Workers
Who Use or Make Flavorings

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Diacetyl ban in California?

ConAgra said it will drop popcorn chemical linked to lung ailment
The nation's largest microwave popcorn maker, ConAgra Foods, says it will change the recipe for its Orville Redenbacher and Act II brands over the next year to remove a flavoring chemical linked to a lung ailment in popcorn plant workers.

ConAgra spokeswoman Stephanie Childs said the Omaha-based company decided to remove diacetyl (die-ASS-eh-til) from its popcorn because of the risk the chemical presents to workers who handle large quantities.

The chemical diacetyl has been linked to cases of a rare life-threatening disease often called popcorn lung.

ConAgra's announcement comes a week after another popcorn manufacturer, Weaver Popcorn of Indianapolis, said it would replace the butter flavoring ingredient because of consumer concern.

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Could Microwave Popcorn Be Toxic?
Chemical in Popcorn Could Pose Health Risk
Microwave popcorn is one of America's favorite couchside snacks, but the butter flavor is raising questions about whether the crunchy treat could be dangerous to something other than the waist.

The chemical that helps create microwave popcorn's buttery aroma has been linked to serious health issues for workers who make the snack.

After working for 10 months at a St. Louis, Mo., flavoring company, 53-year-old Jerry Blaylock developed a life-threatening disease commonly called popcorn lung, which is linked to the chemical diacetyl. Now his once healthy lungs can hold just 45 percent of breathing capacity.

"I've got grandkids and we used to go to the zoo and amusement parks, but I no longer can do it," Blaylock said.

Experts believe when heated in a factory setting, diacetyl produces a toxic and potentially lethal gas. David Michaels, a former assistant secretary of energy, has been studying the issue for the last four years.

"Workers who mix the chemical as a liquid or powder breathe in small amounts of this chemical and it just devastates their lungs," Michaels said.

Snacking Safe at Home
Now the comfort food is coming under scrutiny from those who want to be sure that ripping open a bag at home is not a hazard.

The Food and Drug Administration has never studied the effects of diacetyl, but Conagra Foods, which makes Orville Reddenbacher, told ABC News that it was confident that everyday use of its popcorn was safe for consumers.

"When it comes to diacetyl, the focus of concern is workplace exposure," the company said.

Connecticut state Rep. Rosa Delauro is asking the FDA to ban the chemical until it can be proven safe to consumers.

"We need to revoke its designation, test it further and protect the public health," Delauro said.

Flavoring manufacturers have paid more than $100 million as a result of suits brought by workers affected by popcorn lung. In California, a bill is being considered to ban its use in the state.

For now, the health risk at home remains up in the air. Though there's no proof that home exposure to diacetyl is toxic, Michaels said it might be wise for consumers to take precautions.

"I know in my home when we make microwave popcorn, we open it up under the vent over the stove so no one breathes the fumes," he said. "I'd like to see some branch of the federal government actually go out and test what's coming out of these bags."

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Popcorn Co. Drops Chemical Tied To Illness
Weaver Popcorn Ends Use Of Butter-Flavoring Chemical Blamed For Lung Ailments Among Workers
Weaver Popcorn Co., one of the nation's top microwave popcorn makers, has switched to a new butter flavoring, replacing a chemical linked to a lung ailment in popcorn plant workers.

The Indianapolis-based company began shipping new butter-flavored microwave popcorn a few weeks ago that contain no diacetyl, a chemical undergoing national scrutiny because of cases of bronchiolitis obliterans, a rare life-threatening disease often called popcorn lung.

Company President Mike Weaver said that while his workers have experienced no such cases, the family-owned business wanted to lead the popcorn industry and allay consumer fears by eliminating the chemical for its product line.

"There's a growing awareness and concern among consumers about diacetyl and as that is talked about or reported on consumers listen, and our concern was how does that effect how they look at this product?" he said Wednesday. "We felt this was the prudent thing to do."

Weaver said his company sells about 600 million bags of microwave popcorn a year, giving it about a 20 percent share of the U.S. market.

Concerns about diacetyl have been growing for years as have the number of lawsuits filed by workers suffering from the progressive lung disease, which can force sufferers to undergo lung transplants.

Several flavor manufacturers are either researching alternatives to diacetyl or are already marketing butter flavors free of the chemical, said John Hallagan, general counsel for the Flavor and Extract Manufacturers Association, based in Washington, D.C.

He said there's no evidence that eating products containing diacetyl can be harmful. The concern instead focuses on workers inhaling it in manufacturing settings - either in making the flavoring or adding it to food products ranging from popcorn to pound cakes.

Weaver Popcorn is the first popcorn manufacturer to replace diacetyl with another butter flavoring, said David Michaels, associate chairman of George Washington University's Department of Environmental and Occupational Health.

He said breathing even low levels of diacetyl can be dangerous.

"It's a very dangerous chemical. We know there are people who are sick in factories where they make diacetyl and where they apply the flavors," he said. "There are cases not just in popcorn factories but at least one potato chip factory."

The federal Occupational Safety and Health Administration has been looking at the use of diacetyl in manufacturing settings, particularly popcorn plants, for about two years, said Deirdre Flynn, executive director of the Popcorn Board, a Chicago-based industry group.

Legislation before California lawmakers would ban the chemical's use in that state. And U.S. Rep. Rosa L. DeLauro, D-Conn., asked the U.S. Food and Drug Administration in May to ban the flavoring chemical until it can be thoroughly studied.

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Do Food Flavorings Cause Lung Disease?
Lung Disease Linked to Artificial Flavors
Popcorn plant workers are suing companies supplying or manufacturing popcorn butter flavoring, and they are winning.

Artificial Flavors Caused Bronchiolitis Obliterans
Over 150 former popcorn plant workers have filed suit, and have won over $100 million, claiming the artificial flavors used in the manufacture of popcorn products have cause them to develop a lung disease, called bronchiolitis obliterans.

What is Bronchiolitis Obliterans?
Bronchiolitis obliterans is a lung disease that causes the airways to swell, obstructing the airflow in and out of the lungs. The swelling occurs because the airways become thick and excessively scarred. Bronchiolitis obliterans is a irreversible, progressive lung disease that eventually turns fatal unless the patient undergoes a lung transplant.

Diacetyl -- The Food Flavor Causing Lung Disease
In 2000, bronchiolitis obliterans emerged as a lung disease common to food industry workers.
The National Institute of Occupational Safety and Health (NIOSH) discovered the disease was widespread throughout the Midwest in popcorn manufacturing plants. Investigators traced the cause of the lung disease cases back to a substance called diacetyl. Although diacetyl is found naturally in some foods, food companies make it artificially for flavoring popcorn and other foods, such as chips.

Where the Food Flavoring is Used
The NIOSH's investigation found that this food flavoring was causing lung disease in the workers of food plants that manufacture it and use it to flavor foods, such as popcorn. However, the food flavoring is used in other food plants besides popcorn. In addition to the lung disease cases discovered in the workers at popcorn manufacturing plants and the plants that make the food flavorings, the NIOSH also discovered cases of lung disease in food industry workers who worked in chip plants and candy making plants.

Exposure to Food Flavorings
NIOSH investigators are concerned that the necessary safety precautions are not being taken to protect food industry workers. They plan to investigate these plants further to find out how widespread the exposures to the food flavorings may be, if, in fact, manufacturers and uses of the food flavorings are doing everything possible to prevent exposure to diacetyl, and what actions need to be taken, if any, to remedy the situation.

Food Flavorings Lawsuits Are Growing
With tens of thousands of workers exposed to the manufacture or use of food flavorings, the NIOSH has a long road ahead of them in the investigation. To date, over 150 popcorn plant workers have sued food flavoring manufacturers and users, and over $100 million have already been awarded. Currently, there are approximately 30 lawsuits pending.

Some defendants believe the Flavor and Extract Manufacturing Association is conspiring with other lawsuit defendants to "fraudulently conceal information about the health risks of butter flavoring."

The Flavor and Extract Manufacturing Association
John Hallagan, the trade association's lawyer and former science director, refutes the accusations and stands firmly in his belief that they have informed workers about the risks. Hallagan also told reporters that respiratory health and safety information for its workers is posted on the association's Web site.

In 1985, the trade association hired consultants in to investigate the effects of diacetyl on human health. They reported to its workers that diacetyl "is harmful to the respiratory tract and is capable of producing systemic toxicity."

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Chemical Culprit In 'Popcorn Worker's Lung' Identified

Researchers in the Netherlands have identified a chemical agent that may be a, if not the, culprit in bronchiolitis obliterans syndrome (BOS), or "popcorn worker's lung," a severe occupational lung disease first noted in 2001 among workers at an American plant that makes microwaveable popcorn.
The research, which examined a population of workers at a chemical plant that produced diacetyl (a key component of butter flavoring), was reported in the first issue for September of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

"Our study found a cluster of [previously undiagnosed] BOS cases in a diacetyl production plant," said lead author Frits G. B. G. J. van Rooy, M.D., of the Division of Environmental Epidemiology at the Universiteit Utrecht in the Netherlands. "This supports the conclusion that an agent in the diacetyl production process has caused BOS."

Diacetyl was identified early on as a marker for exposure among popcorn workers. Its specific role, if any, however, in the development of BOS was not known. No cases of BOS had previously been identified outside of North America or in chemical production plants related to flavoring. By investigating the BOS status of former workers of the diacetyl plant, researchers hoped to determine whether there was a link between diacetyl exposure and the development of BOS.

With the help of the human resources department, Dr. van Rooy and colleagues traced 196 former workers who were still living and who had been employed at the diacetyl production plant between 1960 and 2003, when the plant closed. They identified 175 who consented to complete exposure and respiratory health questionnaires and undergo lung function tests and clinical assessments. Of the 102 process workers considered to be at the highest risk for exposure, researchers positively identified three cases of BOS, and later, a fourth, in a worker who had initially declined to participate in the research.

"This is the first study where cases of BOS were found in a chemical plant producing diacetyl," wrote Dr. van Rooy.

While the researchers were unable to rule out contributions of other chemicals to the development of BOS, the study significantly narrows the field of suspects to diacetyl and the components and byproducts of its manufacturing process.

"The spectrum of exposures is much smaller in this production plant compared with the popcorn processing plants where a wide range of chemicals was identified," the researchers wrote. "This population-based survey establishes the presence of BOS, or popcorn worker's lung, in chemical workers manufacturing a flavoring ingredient with exposures to diacetyl, acetoin and acetyldehyde. Any or all of these exposures may contribute to the risk of this emerging occupational disease."

The novel finding of four cases of BOS in workers at the diacetyl plant has important implications for practicing physicians and public health officials.

"None of the four cases had been recognized as bronchiolitis obliterans or as occupationally related," wrote Kathleen Kreiss, M.D., in the accompanying editorial in the same issue of the journal. "To identify flavoring-related bronchiolitis obliterans, physicians need to consider the diagnosis," she noted. Dr. Kreiss, of the Field Studies Branch of the National Institute for Occupational Safety and Health, was one of the first investigators on the scene when "popcorn worker's lung" arose as a public health issue.

Furthermore, she writes, "the collective evidence for diacetyl causing a respiratory hazard supports action to minimize exposure to diacetyl, even if contributions by other flavoring chemicals exist."

Chemical Clue to 'Popcorn Workers Lung'
Excessive Exposure to the Butter-Flavoring Chemical Diacetyl May Harm Flavor Makers' Lungs
Scientists have new clues about the roots of a rare, life-threatening lung disease called bronchiolitis obliterans in workers in the flavor industry.

Bronchiolitis obliterans is a form of fixed obstructive lung disease, an irreversible condition which makes it difficult for air to flow out of the lungs.

A new European study suggests that workers in flavor factories who get excessive exposure to a butter-flavor chemical called diacetyl may be particularly likely to develop bronchiolitis obliterans, or "popcorn workers lung," as the condition is sometimes called.

The researchers included Frits van Rooy, MD, of the environmental epidemiology division of the Institute for Risk Assessment Sciences, located in the Dutch city of Utrecht.

They interviewed and gave checkups (including lung function tests) to some 200 people who had worked at a chemical plant that makes diacetyl in the Netherlands.

People with suspected bronchiolitis obliterans got additional lung tests. A total of four people were found to have bronchiolitis obliterans.

All of those workers had worked directly with diacetyl. Three of them were nonsmokers.

The researchers can't rule out the possibility that other chemicals -- or other factors -- may have caused those cases of bronchiolitis obliterans. But van Rooy and colleagues argue that diacetyl appears to be a likely factor.

This isn't the first time that diacetyl has been linked to popcorn workers lung. In April, the CDC reported seven cases of the disease at four California flavor factories between 2002 and 2006.

The CDC notes no known risk to consumers from diacetyl or other flood flavorings.

The Dutch cases are the first reports of the condition in European flavor factories, according to van Rooy and colleagues.

Their study doesn't show whether the Dutch flavor factory had adequate ventilation or other appropriate conditions.

An editorial accompanying van Rooy's report states that although diacetyl's hazards aren't in question, "uncertainties do remain."

However, "the collective evidence for diacetyl causing a respiratory hazard supports action to minimize exposure to diacetyl [in workers], even if contributions by other flavoring chemicals exist."

That editorial comes from Kathleen Kreiss, MD, of the U.S. National Institute for Occupational Safety and Health (NIOSH).

The study and editorial appear in the American Journal of Respiratory and Critical Care Medicine.

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Consumer's lung illness is linked to popcorn
Man who ate several bags a day shared symptoms with factory workers who make the microwaved snack.
DENVER - A 53-year-old Colorado man, who microwaved and ate two to three bags of extra-butter-flavored popcorn a day for a decade, has come down with a dangerous lung disease - apparently the first consumer case of "popcorn lung."

Popcorn lung, or broncheolitis obliterans, permanently scars airways, eventually leaving victims fighting for breath and dependent on oxygen.
When federal safety experts identified the disease in workers at popcorn flavoring and packaging factories in 2002, they said consumers were not at risk because of the relatively low exposure to butter-flavor fumes and powders.

But after treating the furniture salesman earlier this year, doctors at National Jewish Medical and Research Center in Denver sent letters describing the case to four federal regulatory agencies.

"We cannot be sure that this patient's exposure to butter-flavored microwave popcorn … has caused his lung disease," wrote Cecile Rose, head of environmental and occupational health sciences at National Jewish. "However, we have no other plausible explanation."

In response to the news, the Flavor and Extract Manufacturers Association on Tuesday recommended that members who make butter flavors with diacetyl consider cutting the chemical's concentration in flavors.

The association made clear that the new information does not suggest any risk from eating popcorn.

"No, it's inhalation," Rose said. "This patient described enjoying the smell so much he was actually inhaling the steam."

Rose said she was initially perplexed by the man's case. His symptoms didn't fit his first diagnosis, and he wasn't responding to treatment from inhalers or steroids.

Rose, who has consulted with the popcorn and flavoring industry for the past four years, was surprised to see in the man's lungs some of what she saw among factory workers.

"So I turned to him and apologized and said, `This is a really weird question … but are you around a lot of popcorn?' His jaw dropped, and he said, `How did you know to ask me that? I am popcorn."'

Rose said she's still not certain that the man's disease came from his popcorn habit, but his lungs have stabilized since he gave up the treat, and, she estimates, he has lost more than 30 pounds.
Rose said she's still not certain that the man's disease came from his popcorn habit, but his lungs have stabilized since he gave up the treat, and, she estimates, he has lost more than 30 pounds.

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Doctor warns consumers of popcorn fumes;_ylt=AtdnST9EEhJh.Kis9DeKbfCs0NUE

Consumers, not just factory workers, may be in danger from fumes from buttery flavoring in microwave popcorn, according to a warning letter to federal regulators from a doctor at a leading lung research hospital.

A pulmonary specialist at Denver's National Jewish Medical and Research Center has written to federal agencies to say doctors there believe they have the first case of a consumer who developed lung disease from the fumes of microwaving popcorn several times a day for years.

"We cannot be sure that this patient's exposure to butter flavored microwave popcorn from daily heavy preparation has caused his lung disease," cautioned Dr. Cecile Rose. "However, we have no other plausible explanation."

The July letter, made public Tuesday by a public health policy blog, refers to a potentially fatal disease commonly called popcorn lung that has been the subject of lawsuits by hundreds of workers at food factories exposed to chemicals used for flavoring.

In response to Rose's finding, the Flavor and Extract Manufacturers Association issued a statement Tuesday recommending that its members reduce "to the extent possible" the amount of diacetyl in butter flavorings they make. It noted that diacetyl is approved for use in flavors by the federal Food and Drug Administration.

One national popcorn manufacturer, Weaver Popcorn Co. of Indianapolis, said last week it would replace the butter flavoring ingredient because of consumer concern. Congress has also been debating new safety measures for workers in food processing plants exposed to diacetyl.

The FDA said in an e-mail it is evaluating Rose's letter and "carefully considering the safety and regulatory issues it raises."

Fred Blosser, spokesman for the National Institute for Occupational Safety and Health, said it is the first case the institute has seen of lung disease apparently linked to popcorn fumes outside the workplace.

The occupational safety arm of the Centers for Disease Control and Prevention said it is working on a response to the letter.

William Allstetter, spokesman for National Jewish Medical, confirmed the letter was sent by Rose, a specialist in occupational and environmental lung diseases and director of the hospital's Occupational and Environmental Medicine Clinic.

"There have been no other cases that we know of other than the industrial occupational ones," Allstetter said.

Rose acknowledged in the letter that it is difficult to confirm through one case that popping buttered microwave popcorn at home can cause lung disease.

However, she said she wanted to alert regulators of the potential public health implications.

Rose said the ailing patient, a man whom she wouldn't identify, consumed "several bags of extra butter flavored microwave popcorn" every day for several years.

He described progressively worsening respiratory symptoms of coughing and shortness of breath. Tests found his ability to exhale was deteriorating, Rose said, although his condition seemed to stabilize after he quit using microwave popcorn.

She said her staff measured airborne levels of diacetyl in the patient's home when he cooked the popcorn. The levels were "similar to those reported in the microwave oven exhaust area" at the quality assurance unit of the popcorn plant where the affected employees worked, she said.

David Michaels, of the George Washington University School of Public Health, who first published Rose's letter on his blog, The Pump Handle, said the finding is another reason for federal regulators to crack down on diacetyl exposure by workers and consumers.

"This letter is a red flag, suggesting that exposure to food flavor chemicals is not just killing workers, but may also be causing disease in people exposed to food flavor chemicals in their kitchens," Michaels wrote on his public health policy blog.
Diacetyl Popcorn butter flavor dangers

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