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Lung Disease Outbreak Tied to Fake Butter

Flavoring chemical endangers popcorn plant workers; snack safe to eat

THURSDAY, Oct. 4, 2001 (HealthDayNews) -- An outbreak of a rare and life-threatening lung disorder at a microwave popcorn plant in Missouri has prompted a wider inquiry into the issue of safety in the artificial-flavoring industry, health officials say.

They stress that the danger lies in the process of making the additive, and that the snack is still safe to eat.

At least nine people in Jasper, Mo., and one worker in Nebraska suffered what appears to be bronchiolitis obliterans, or chronic scarring of the airways that can lead to permanent damage, after enduring prolonged exposure to artificial butter flavoring. Several of the patients are severely ill and are now awaiting lung transplants.

Officials investigating the Missouri outbreak say the damage appears to be the result of workers breathing a virtual mist of salt, hot oil and artificial flavoring containing the volatile chemical diacetyl. Health officials are also investigating an unrelated case of apparent bronchiolitis obliterans involving a butter-flavoring worker in Nebraska.

"Perhaps this thing is bigger than just one plant in [Jasper]," says Dr. Eduardo Simoes, Missouri's state epidemiologist, who is involved in the investigation. "This looks like a strong case for regulating a whole industry."

Regulators have examined popcorn plants in Iowa, Indiana and Nebraska to get a sense of whether the problem is isolated or endemic to that industry. Tom Carney, a spokesman for the Iowa Department of Health, says investigators didn't find any reason for alarm in the factories they inspected in his state. Nor have disease officials there received reports of bronchiolitis obliterans.

Dr. Kathleen Kreiss, a lung disease specialist at the National Institute for Occupational Safety and Health (NIOSH) and leader of the investigation, says "it's too early to think about regulation" at this stage of the inquiry.

"There's no question in our mind that there's a hazard [involving butter flavoring], but we haven't translated that into counsel that could lead to regulation," she adds.

Kreiss says NIOSH first got word of a potential problem with flavoring about 15 years ago after young, nonsmoking workers at a bakery-products packaging plant developed bronchiolitis. "That had been sitting on the shelf all those years," she says.

Officials are now trying to determine whether diacetyl or some other flavoring agent of the many pastes, powders and liquids mixed at the Missouri factory is to blame in the lung damage. "We don't know whether some flavorings are worse than others," she says.

The New York Times reports that Gilster-Mary Lee, of Chester, Ill., which owns the Jasper facility, has been named in a workers compensation lawsuit on behalf of 16 current and former employees at the plant. And lawyers have filed a class-action claim against International Flavors and Fragrances, of New York City, which makes diacetyl. Neither company would return calls seeking comment on the cases. The Joplin (Mo.) Globe first reported the investigation.

Simoes says a Kansas City doctor concerned about the sudden surge first alerted state officials to a cluster of cases of apparent bronchiolitis obliterans in May 2000. A quick check of the medical literature showed that so many cases from such a small area as Jasper County was "maybe 10,000 times" higher than would normally be expected, he says. In fact, says Simoes, he had never seen a case prior to the alert.

Investigators soon linked the patients to the popcorn plant, and suspected that the mixing room was the source of the problem. "The air [in the room] is basically a mist of that stuff. You can smell butter flavoring outside the plant. The amount of concentration is enormous," Simoes says.

Overwhelmed and without adequate resources to tackle the inquiry, the state turned to NIOSH for help. NIOSH held a workshop on the outbreaks late last August, and released a preliminary report on its inquiry. The report shows that the odds of a factory worker over 40 having abnormal lung function was 11 times higher than expected. For those under 40, the rate was 8.3 times higher than normal, Simoes says.

Workers at the popcorn plant who were not afflicted by bronchiolitis have also been at significantly increased risk of such breathing problems as wheezing, chronic cough and shortness of breath, as well as lung disease, he says.

But Simoes stresses that it's still safe to consume microwave popcorn.

"There's no indication whatsoever that the use of popcorn in a microwave would" cause lung problems, he says.

Since the outbreak, however, Missouri health officials have asked Gilster-Mary Lee to make three rounds of safety changes to its Jasper facility, which employs about 130 people. These include mandatory respirators for workers in the mixing room as well as optional breathing devices for those in the rest of the factory. Some mixing room workers who fell ill did wear respirators, but did so inconsistently, Simoes says.

In July, officials instructed the company to completely seal off the mixing room from the rest of the plant, says Simoes, who adds that the firm has been "very forthcoming" in accepting his office's recommendations.

Although bronchiolitis obliterans is exceedingly uncommon among young, healthy people, it's quite frequent in patients who undergo lung or heart-lung transplants, says Dr. Jonathan Orens, director of the lung transplant program at Johns Hopkins University.

Orens, a member of the NIOSH panel who reviewed the pathology samples of the popcorn patients, says he's not convinced the condition is indeed bronchiolitis. "At this point it's unclear if this is truly the same disease," Orens says. "It appears similar, but it's unclear if it's exactly the same disease."

Rat studies in the wake of the outbreak have shown that animals that inhale large amounts of flavoring like that used in popcorn production can develop lung damage similar to that suffered by the workers.

But bronchiolitis obliterans usually results from massive exposures to a gas or other substance --in an industrial accident, for instance-- and none of the patients from the Missouri factory reported any acute lung injury, Kreiss says.

Bronchiolitis in transplant patients seems to be related to rejection of the new organs, suggesting that the condition is at least partly linked to the immune system. If that's true for other people with the disease, Orens says, it's possible that the factory workers afflicted in the outbreak may have shared an infection of some kind that put them at increased risk of lung damage. Such a connection has yet to be made, he adds.

What To Do

For more on workplace health and safety, try NIOSH. To learn more about lung disorders, visit the American Lung Association or the National Heart, Lung, and Blood Institute.

SOURCES: Interviews with Kathleen Kreiss, M.D. chief, field studies branch, division of respiratory disease studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, W.Va.; Eduardo Simoes, M.D., M.Sc., state epidemiologist, Missouri Department of Health and Senior Services, Jefferson City; Jonathan Orens, M.D. medical director, lung transplantation program, Johns Hopkins University, Baltimore; Tom Carney, spokesman, Iowa Department of Health, Des Moines; National Institute of Occupational Safety and Health; Joplin Globe; New York Times
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