INCIDENT
REPORTS
ASSOCIATED
WITH
PINE
OIL
(
PC
CODE:
067002,
067204
and
067205)

August
3,
2004
U.
S.
Environmental
Protection
Agency
Office
of
Pesticide
Programs
Antimicrobials
Division
TABLE
OF
CONTENTS
0.0
INTRODUCTION
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
1.0
INCIDENT
REPORT
DATA
ASSOCIATED
WITH
HEALTH
EFFECTS
OF
PINE
OIL
EXPOSURE
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
1.1
OPP's
Incident
Data
System
(
IDS)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
1.2
Poison
Control
Center
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5
1.3
California
Data
­
1982
through
2002
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
1.4
National
Pesticide
Telecommunications
Network
(
NPTN)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7
1.5
Incident
Reports
Associated
with
Toxic
Effects
of
Pine
Oil
Published
in
Scientific
Literature.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7
2
0
EPIDEMIOLOGIC
STUDIES
ASSOCIATED
WITH
CHRONIC
HEALTH
EFFECTS
OF
PINE
OIL
IN
HUMAN
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
8
3.0
SUMMARY
AND
CONCLUSION
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
8
4.0
REFERENCES
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
9
Page
3
of
9
0.0
INTRODUCTION
Pine
Oil
is
a
complex
combination
of
terpenes
produced
by
high
temperature
distillation
of
oil
of
turpentine
or
by
catalytic
hydration
of
terpenes.
Pine
oil
contains
a
minimum
of
60%
isomeric
secondary
and
tertiary
cyclic
terpene
alcohols
and
a
maximum
of
40%
non­
terpene
alcohol
components
consisting
of
terpene
hydrocarbons,
terpene
ether,
and
ketones.
This
complex
blend
forms
a
sole
active
ingredient
containing
no
impurities.

Pine
Oil
is
registered
for
use
as
a
disinfectant,
sanitizer,
microbiocide/
microbiostat,
virucide,
and
insecticide
for
indoor
food
use,
indoor
non­
food
use,
indoor
residential
use,
indoor
medical
use,
and
aquatic
non­
food
industrial
use.

This
reports
summarized
the
potential
health
effects
of
phenol
in
humans,
reported
as
incident
reports
from
different
sources.

Two
approaches
are
used
in
this
section:

°
The
potential
health
effects
of
phenol
in
humans,
reported
as
incident
reports
from
different
sources,
are
summarized.

°
A
literature
search
of
health
effects
associated
with
pine
oil
exposure,
including
results
of
epidemiological
studies,
are
summarized.

1.0
INCIDENT
REPORT
DATA
ASSOCIATED
WITH
HEALTH
EFFECTS
OF
PINE
OIL
EXPOSURE
The
following
databases
have
been
consulted
for
the
poisoning
incident
data
a.
OPP
Incident
Data
System
(
IDS)
­
The
Incident
Data
System
of
The
Office
of
Pesticide
Programs
(
OPP)
of
the
Environmental
Protection
Agency
(
EPA)
contains
reports
of
incidents
from
various
sources,
including
registrants,
other
federal
and
state
health
and
environmental
agencies
and
individual
consumers,
submitted
to
OPP
since
1992.
Reports
submitted
to
the
Incident
Data
System
represent
anecdotal
reports
or
allegations
only,
unless
otherwise
stated.
Typically
no
conclusions
can
be
drawn
implicating
the
pesticide
as
a
cause
of
any
of
the
reported
health
effects.
Nevertheless,
sometimes
with
enough
cases
and/
or
enough
documentation
risk
mitigation
measures
may
be
suggested.

b.
Poison
Control
Centers
­
as
the
result
of
a
data
purchase
by
EPA,
OPP
received
Poison
Control
Center
data
covering
the
years
1993
through
1998
for
all
pesticides.
Most
of
the
national
Poison
Control
Centers
(
PCCs)
participate
in
a
Page
4
of
9
national
data
collection
system,
the
Toxic
Exposure
Surveillance
System,
which
obtains
data
from
about
65­
70
centers
at
hospitals
and
universities.
PCCs
provide
telephone
consultation
for
individuals
and
health
care
providers
on
suspected
poisonings,
involving
drugs,
household
products,
pesticides,
etc.

c.
California
Department
of
Pesticide
Regulation
­
California
has
collected
uniform
data
on
suspected
pesticide
poisonings
since
1982.
Physicians
are
required,
by
statute,
to
report
to
their
local
health
officer
all
occurrences
of
illness
suspected
of
being
related
to
exposure
to
pesticides.
The
majority
of
the
incidents
involve
workers.
Information
on
exposure
(
worker
activity),
type
of
illness
(
systemic,
eye,
skin,
eye/
skin
and
respiratory),
likelihood
of
a
causal
relationship,
and
number
of
days
off
work
and
in
the
hospital
are
provided.

d.
National
Pesticide
Telecommunications
Network
(
NPTN)
­
NPTN
is
a
toll­
free
information
service
supported
by
OPP.
A
ranking
of
the
top
200
active
ingredients
for
which
telephone
calls
were
received
during
calendar
years
1984­
1991,
inclusive,
has
been
prepared.
The
total
number
of
calls
was
tabulated
for
the
categories
human
incidents,
animal
incidents,
calls
for
information,
and
others.

e.
Published
Incident
Reports
­
Some
incident
reports
associated
with
pine
oil
related
human
health
hazards
are
published
in
the
scientific
literature.

1.1
OPP's
Incident
Data
System
(
IDS)

A
total
of
114
individual
human
incident
cases
submitted
to
the
EPA
Office
of
Pesticide
Programs
is
associated
with
exposed
to
pine
oil
containing
products.
Oral,
dermal
and
inhalation
are
important
routes
of
exposure.
Ocular
exposure
is
also
reported
in
some
incident
cases.

It
maybe
because
the
pleasant
aroma
of
the
pine
oil
product,
mistakenly
ingestion
of
pine
oil
products
is
frequently
reported.
In
IDS,
there
are
31
pine
oil
involving
incident
cases
involve
oral
ingestion.
There
are
seven
death
incident
cases
after
ingestion
pine
oil
containing
products.
The
most
common
symptoms
reported
for
cases
of
oral
exposure
to
pine
oil
containing
products
are
coughing,
choking,
vomiting,
nausea,
abdominal
pain,
short
of
breath,
drowsiness,
lethargy,
and
unconsciousness.

The
most
common
symptoms
reported
for
cases
of
dermal
exposure
were
skin
irritation/
burning,
rash,
itching,
skin
discoloration/
redness.
Allergic
type
skin
reactions
including
blisters,
hives
also
been
reported
in
some
cases.

The
most
common
symptoms
reported
for
cases
of
inhalation
exposure
were
coughing,
choking,
sneezing,
respiratory
irritation/
burning,
asthma/
difficult
breathing,
shortness
of
breath/
respiratory
depression.
Headache,
shaking,
numbness,
drowsiness,
lethargy
and
unconsciousness
have
also
been
reported
when
expose
to
the
chemical
through
inhalation
exposure
routes.
Page
5
of
9
Eye
irritation
(
burning,
redness),
corneal
abrasion,
eye
swelling,
eye
discharge/
Infection
and
visual
defect/
blurred
vision
are
the
common
symptoms
reported
associated
with
ocular
exposure
to
the
pine
oil
containing
products.

1.2
Poison
Control
Center
During
1986,
5,102
exposures
to
pine
oil
cleaner
were
reported
to
the
American
Association
of
Poison
Control
Centers
(
PCC)
National
Data
Collection
System
(
Brook
et
al.,
1989).
In
2,792
patients
(
55%),
toxicity
did
not
occur.
Toxicity
was
classified
as
minor
in
1,194
patients
(
23%),
moderate
in
56
(
1%),
and
major
in
six
(
0.1%).

As
summarized
in
Table
1,
between
1993
­
1998,
a
total
of
55,882
incident
cases
has
been
reported
associated
with
pine
oil
containing
disinfectants
exposure
been
reported
in
the
PCC
Toxic
Exposure
Surveillance
System
(
TESS)
Around
60%
were
associated
with
no
effects
or
only
minor
effects.
Around
2
percent
of
the
cases
are
judged
to
be
not
related
to
the
chemical
exposure.
There
are
47
cases
are
associated
with
major
clinical
effects
and
death
is
involved
in
12
of
the
47
cases.
The
primary
symptoms
involved
in
these
major
incidences
were
GI
tract
effect,
neuro­
toxic
signs,
cardiovascular
effects,
and
respiratory
effects.

Table
1.
Medical
Outcome
of
Phenolic
Disinfectant
Related
Cases
in
American
Association
of
Poison
Control
Centers,
Toxic
Exposure
Surveillance
System
(
TESS)
1993­
1998
YEAR
0
1
2
3
4
5
6
7
8
Grand
Total
1993
3349
1892
138
5
1
1219
2060
359
165
9188
1994
3453
1937
154
10
1
1111
2197
314
196
9373
1995
3566
2097
156
9
1174
2283
194
193
9672
1996
3518
2086
158
2
1296
2483
173
200
9916
1997
3119
1813
123
9
1049
2083
113
184
8493
1998
3214
1908
111
6
4
927
2733
131
206
9240
Total
20219
11733
840
41
6
6776
13839
1284
1144
55882
Note:
0
­
No
Effect
1
­
Minor
Effect
2
­
Moderate
Effect
3
­
Major
Effect
4
­
Death
5
­
Not
Followed,
judged
as
nontoxic
exposure
(
clinical
effects
not
expected)
6
­
Not
followed,
minimal
clinical
effects
possible
(
no
more
than
minor
effect
possible)
7
­
Unable
to
follow,
judged
as
a
potentially
toxic
exposure
8
­
Unrelated
effect,
the
exposure
was
probably
not
responsible
for
the
effect(
s)

1.3
California
Data
­
1982
through
2002
Detailed
descriptions
of
360
cases
with
a
definite,
probable
or
possible
relationship
cases
Page
6
of
9
submitted
to
the
California
Pesticide
Illness
Surveillance
Program
(
1982­
1998)
were
reviewed.
Table
2
presents
the
types
of
illnesses
reported
by
year.
Table
3
gives
the
total
number
of
workers
that
took
time
off
work
as
a
result
of
their
illness
and
how
many
were
hospitalized
and
for
how
long.

Table
2:
Cases
Due
to
Pine
Oil
Exposure
in
California
Reported
by
Type
of
Illness
and
Year,
1985­
2002
Year
Illness
Type
Systemic
Oral
Irritation
Eye
Irritation
Skin
Irritation
Inhalation
Irritation
Comb.
a
Total
1985
­
­
1
­
­
­
1
1986
­
­
­
­
­
­
­

1987
­
­
10
­
1
­
11
1988
2
­
13
4
1
­
20
1989
3
­
12
2
2
1
17
1990
­
­
2
5
1
­
8
1991
3
1
16
3
5
3
22
1992
4
­
5
3
4
2
10
1993
1
1
4
4
3
2
10
1994
3
­
8
1
4
1
12
1995
21
12
7
1
25
14
30
1996
1
­
5
­
2
­
7
1997
­
­
4
1
2
1
5
1998
­
­
4
­
­
­
4
1999
­
2
7
­
­
­
9
2000
4
4
1
­
1
1
5
2001
1
2
3
­
­
1
4
2002
6
6
2
­
5
4
9
Total
49
28
104
24
56
30
184
a
Category
includes
combined
irritative
effects
to
eye,
skin,
gastrointestinal
and
respiratory
Page
7
of
9
systems.

Table
3:
Number
of
Persons
Disabled
(
taking
time
off
work)
or
Hospitalized
for
Indicated
Number
of
Days
After
Pine
Oil
Exposure
in
California,
1985­
2002.

Number
of
Persons
Disabled
Number
of
Persons
Hospitalized
One
day
18
1
Two
days
7
­

3­
5
days
5
1
6­
10
days
2
­

more
than
10
days
1
­

Unknown
11
1
1.4
National
Pesticide
Telecommunications
Network
(
NPTN)

There
is
no
incidence
reported
in
the
NPTN
database
related
to
pine
oil
exposure.

1.5
Incident
Reports
Associated
with
Toxic
Effects
of
Pine
Oil
Published
in
Scientific
Literature.

Several
papers
have
been
published
outlining
the
problems
associated
with
the
toxic
effects
associated
with
pine
exposure.

Brook
et
al.
(
1989)
summarized
incident
cases
involving
patients
were
hospitalized
in
the
Los
Angeles
County­
University
of
Southern
California
Medical
Center
for
pine
oil
cleaner
ingestion.
There
were
five
pediatric
patients.
All
children
were
previously
health
and
all
ingestion
were
accidental.
Emesis,
lethargy,
and
ataxia
were
findings
developed
within
90
minutes
after
ingestion.
Three
children
developed
respiratory
signs
and
diagnosed
as
chemical
pneumonia.
In
all
cases,
pneumonia
improved
or
resolved
within
24
hours.

Brooks
(
1989)
also
reported
30
cases
of
pine
oil
cleaner
ingestion
in
adults.
77%
were
suicide
attempts,
13%
were
accidental
exposures,
and
10%
occurred
through
use
of
pine
oil
cleaner
as
supplement
or
alternative
to
ethanol.
Among
the
30
cases,
17
patients
ingested
pine
oil
cleaner
alone.
Among
the
17
patients,
three
patients
had
an
initial
tachycardia
and
three
had
tachypnea.
Other
findings
including
decreased
breath
sounds,
slurred
speech,
abdominal
pain.
Three
adults
developed
acute
chemical
pneumonia
are
also
reported.
All
three
turns
into
comatose.
Two
Page
8
of
9
developed
secondary
bacteria
pneumonia
requiring
IV
antibiotics.

Welker
and
Zaloga
(
1999)
reported
a
case
an
elderly
woman
with
dementia
who
ingested
a
household
cleaning
solution
containing
pine
oil.
The
patient
developed
CNS
depression,
and
respiratory
failure
and
diagnosed
with
chemical
pneumonia.
The
patient
subsequent
developed
secondary
bacteria
pneumonia,
in
coma,
multiple
organ
failure
and
died.

Pine
oil
is
a
hydrocarbon
with
low
viscosity.
It
can
be
easily
absorbed
into
body
through
GI
tract.
After
systemic
absorption,
pine
oil
is
excreted
in
the
urine.
Evidence
also
indicated
that
lung
can
also
excrete
pine
oil
after
ingestion,
resulting
in
a
pine­
oil
like
odor
on
the
breath.
Brook
et
al.(
1989)
concluded
that
pine­
oil
related
chemical
pneumonia
may
be
caused
by
two
different
mechanisms:
(
1)
aspiration,
either
during
ingestion
or
associated
with
emesis;
and
(
2)
gastrointestinal
absorption
of
pine
oil
with
subsequent
deposition
in
lung
tissue.

2
0
EPIDEMIOLOGIC
STUDIES
ASSOCIATED
WITH
CHRONIC
HEALTH
EFFECTS
OF
PINE
OIL
IN
HUMAN
There
is
no
human
case
associated
with
chronic
health
effects
of
pine
oil.
A
study
was
conducted
in
which
eight
poison
control
centers
did
extensive
telephone
followup
of
all
human
and
animal
followup
of
all
human
and
animal
pine
oil
ingestion
incident
cases
they
encountered.
A
review
of
more
than
750
cases
collected
during
the
year
long
prospective
study
showed
a
wide
range
of
adverse
effect
are
associated
with
the
pine­
oil
exposure.
The
results
indicate
that
only
a
small
fraction
of
the
cases
appear
to
require
medical
attention.
There
were
no
observed
symptoms
indicative
of
delayed
toxicity
(
Bonfiglio
et
al.,
1987).

3.0
SUMMARY
AND
CONCLUSION
There
are
many
incident
reported
cases
associated
with
exposure
to
end­
use
products
containing
phenol.
Dermal,
and
ocular
are
the
primary
routes
of
exposure.
Inhalation
and
oral
ingestion
are
also
reported
in
some
cases.

Dermal
exposure
is
considered
as
a
very
important
route
of
exposure.
Most
of
the
incidences
are
related
to
irritation
and/
or
allergic
type
reaction.
The
most
common
symptoms
reported
for
cases
of
dermal
exposure
were
skin
irritation/
burning,
rash,
itching,
skin
discoloration/
redness
and
blistering.
Allergic
type
reaction
has
also
been
reported.

Eye
pain,
burning
of
eyes,
conjunctivitis,
blurring
vision,
and
acute
inflammation
has
been
reported
in
ocular
exposure
incidents.

The
most
common
symptoms
reported
for
cases
of
inhalation
exposure
were
respiratory
irritation/
burns,
irritation
to
mouth/
throat/
nose,
coughing/
choking,
shortness
of
breath,
dizziness,
nausea
and
headache.
Through
oral
routes,
pine
oil
ingestion
primary
cause
mucous
membrane
Page
9
of
9
and
gastrointestinal
irritation
(
gastritis,
chest
pain,
nausea,
vomiting,
and/
or
diarrhea)
and
CNS
depression
(
weakness,
lethargy,
ataxia
delirium)
and
chemical
pneumonia.
Although
pine
oil
ingestion
was
rarely
life
threatening,
death
is
happening
in
some
severe
cases.

4.0
REFERENCE
Bonfiglio,
JF;
Hintze
KL.;
and
Siegell,
LT.
1987.
A
Multi­
Center
Evaluation
of
the
Incidence
and
Severity
of
Pine­
Oil
Ingestion.
Presented
in
the
meeting
of
the
American
Academy
of
Clinical
Toxicity,
American
Association
of
Poison
Control
Centers,
American
Booard
of
Medical
Technology,
Canadian
Association
of
Poison
Control
Centers,
Vancouver,
British
Columbia,
Canada.
September27­
October
2,
1987.
Abstract
published
in
Vet.
Hum.
Toxicol.
29(
6):
481.

Brook,
M.;
McCarron,
M.;
and
Mueller,
JA.
1989.
Pine
Oil
Cleaner
Ingestion.
Annals
of
Emergency
Medicine.
18:
391­
395
Welker,
JA
and
Zaloga,
GP.
1999.
Pine
Oil
Ingestion
­
A
Common
Cause
of
Poisoning.
Chest:
1822­
1826.
