Acute Respiratory Illness Linked to Use of Aerosol Leather Conditioner -- Oregon, December 1992

At 8 a.m. on December 27, 1992, the Oregon Poison Center (OPC) notified the Oregon Health Division (OHD) that 13 persons in one household became ill following the use of an aerosol leather conditioner and that this report was similar to two reports received on December 26 that also involved use of this product. A review of telephone logs identified similar calls on December 23 and 24, for a total of 29 persons in six households who reported illness associated with use of this spray. By midday on December 27, the product producer issued a voluntary nationwide recall of this product. Following the public announcement of the recall, as of December 31, the number of preliminary reports to the OHD and the OPC of illness associated with use of this spray increased to 400 and involved approximately 550 persons. This report summarizes the preliminary findings of the ongoing investigation of this problem by the OHD.

Among persons who reported seeking medical attention, reported symptoms typically began within a few minutes to several hours after applying the conditioner to leather products. Manifestations of the illness most commonly reported included prolonged cough, shortness of breath, and pleuritic chest pain. Many persons also reported headache, malaise, chills, and fever as high as 104F (40 C). At least three persons exhibited signs of pulmonary infiltrates based on radiographic examination; one person was admitted to a hospital with a diagnosis of adult respiratory distress syndrome. At least four other persons were admitted to hospitals for observation or treatment. For many persons, the symptoms appeared to resolve in less than 24 hours. Information on the age and sex of persons who reported symptoms was not immediately available.

From December 27 through December 31, following publicity and contact by the OHD, OPC, and CDC, poison control centers in at least 17 other states reported persons who experienced symptoms associated with this spray. CDC received reports from California, Colorado, Georgia, Idaho, Maine, Massachusetts, Minnesota, New Hampshire, New York, Ohio, Pennsylvania, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin.

Following the prompt voluntary recall, by December 31, all cans of the leather conditioner were reported to have been removed from stores and distribution channels. The cans are not marked with specific lot identifiers. The OHD and CDC are conducting epidemiologic investigations to further define the association between illness and use of this product, and the specific cause for this problem. CDC is also working with the Consumer Product Safety Commission (CPSC) regarding the CPSC-administered Federal Hazardous Substances Act, which requires hazardous household products to bear appropriate cautionary labeling.

Reported by: MJ Smilkstein, MD, BT Burton, MD, Oregon Poison Center; W Keene, PhD, M Barnett, MS, K Hedberg, MD, D Fleming, MD, State Epidemiologist, Oregon Health Div, Dept of Human Resources. CM Jacobson, Consumer Product Safety Commission, Bethesda, Maryland. Air Pollution and Respiratory Health Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Preliminary information indicates this outbreak is associated with the use of Wilsons Leather Protector, distributed nationally by Wilsons, the Leather Experts, headquartered in Minneapolis. Leather Protector is sold nationally at more than 550 stores owned by Wilsons; the stores are operated under several names. Typically, one or two applications of the protector are intended to be applied to new leather garments. This investigation suggests that in most households where persons developed symptoms, the product had been used indoors or in other areas with limited ventilation. The new product was distributed to Wilsons stores in late November 1992; however, stores did not begin to sell the new product until the old product supply was exhausted. Sales of the product in Oregon began after December 18.

The product is packaged in 5-ounce black aerosol cans with red and white lettering. The cans are a new formulation of Wilsons Leather Protector that had previously been sold in a 7-ounce can. The product is sold exclusively by Wilsons. The product changes involved the propellant (from carbon dioxide to propane), the solvent (from 1-1-1 trichloroethane to isooctane), and an active ingredient (from 1% FC-905 to 1.2% FC-3537 {which are both fluoroalkyl polymers in different solvents}).

The most commonly reported symptoms suggest an acute chemical pneumonitis (1) or a hypersensitivity pneumonitis (2). Some patients have had symptoms consistent with inhalation fevers such as polymer-fume fever (e.g., chest tightness, headache, shivering, fever, weakness, and shortness of breath). This syndrome is caused by inhalation of fumes containing pyrolytic products released when fluoropolymers are heated to high temperatures. In most cases, patients with polymer-fume fever have been cigarette smokers (3,4). However, it is also possible that an unknown contaminant in the leather spray may be causing this illness.

Consumers should be warned against using Wilsons Leather Protector. In addition, any spray containing polymers or solvents should be used only in areas where there is adequate ventilation.

A provisional case definition used by the OHD includes any two of three pulmonary symptoms (i.e., pleuritic chest pain, shortness of breath, and nonproductive cough), with the onset of at least one symptom within 6 hours after exposure to this spray and at least one symptom lasting 12 hours or more; or any pulmonary symptom with onset within 6 hours of exposure to the spray and pulmonary infiltrates on radiographic examination. CDC has requested that state health departments report to CDC cases that involved persons being hospitalized, using a standardized case report form available from CDC's Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, telephone (404) 488-7320. Further consumer information regarding this product is available from the CPSC Hotline, telephone (800) 638-2772.

References

1. Woo OF, Healy KM, Sheppard D, Tong TG. Chest pain and hypoxemia from inhalation of a trichloroethane aerosol product. J Toxicol Clin Toxicol 1983;20:333-41.

2. Fink JN. Hypersensitivity pneumonitis. In: Epler GR, ed. Clinics in chest medicine: occupational lung diseases. Philadelphia: WB Saunders, 1992.

3. Lewis CE, Kerby GR. An epidemic of polymer fume fever. JAMA 1965;191:375-8.

4. Albrecht WN, Bryant CJ. Polymer fume fever associated with smoking and use of a mold- release spray containing polyterafluoroethylene. J Occup Med 1987;29:817-9.

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