UNITED
STATES
ENVIRONMENTAL
PROTECTION
AGENCY
WASHINGTON,
D.
C.
20460
OFFICE
OF
PREVENTION,
PESTICIDES
AND
TOXIC
SUBSTANCES
August
26,
2003
MEMORANDUM
SUBJECT:
Review
of
Cypermethrin
Incident
Reports
DP
Barcode
D293143,
Chemical
#
109702
FROM:
Jerome
Blondell,
Ph.
D.,
Health
Statistician
Chemistry
and
Exposure
Branch
Health
Effects
Division
(
7509C)

Monica
S.
Hawkins,
M.
P.
H.,
Environmental
Health
Scientist
Chemistry
and
Exposure
Branch
Health
Effects
Division
(
7509C)

THRU:
Francis
B.
Suhre,
Chief
Chemistry
and
Exposure
Branch
Health
Effects
Division
(
7509C)

TO:
Seyed
Tadayan,
Chemist
Reregistration
Branch
3
Health
Effects
Division
(
7509C)

BACKGROUND
The
following
data
bases
have
been
consulted
for
the
poisoning
incident
data
on
the
active
ingredient
benfluralin
(
PC
Code:
084301):

1)
OPP
Incident
Data
System
(
IDS)
­
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.
2)
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
2
Poison
Control
Centers
(
PCCs)
participate
in
a
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.

3)
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.

4)
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.

I.
Incident
Data
System
I8046­
8
A
pesticide
incident
occurred
in
1998,
when
a
worker
alleged
muscle
and
nerve
degeneration
as
part
of
a
law
suit.
No
further
information
on
the
disposition
of
the
case
was
reported.

I10710­
1
A
pesticide
incident
occurred
in
2000,
when
an
obese
250
lb.
male
collapsed
and
died
shortly
after
reentering
a
home
treated
with
6
foggers.
He
was
an
organ
donor
and
the
heart
was
not
available
to
determine
its
role
in
the
death.

I10819­
1
A
pesticide
incident
occurred
in
2000,
when
fogger
lit
up
like
a
flame
which
burnt
the
arms,
leg
and
head
of
the
woman
using
it.

I11161­
10
A
pesticide
incident
occurred
in
1999,
a
man
reported
fumigating
his
duplex
and
that
his
wife
developed
asthma
and
has
constant
sinus
problems
ever
since.
Timing
of
exposures
and
symptom
onset
not
clearly
presented.

I11265­
3
A
pesticide
incident
occurred
in
2001,
when
the
husband
applied
the
product
in
the
bedroom
and
the
wife
developed
respiratory
arrest
and
was
treated
in
a
critical
care
unit.
She
reportedly
became
ill
after
her
husband
applied
the
product
in
their
living
room
and
the
following
3
day
in
the
bedroom.

I11988­
2
A
pesticide
incident
occurred
in
1999,
when
a
man's
apartment
was
treated
by
a
PCO.
Thirty
minutes
later
the
man
reported
feeling
dizzy,
nauseous
and
fainted.
Apparently
the
fall
due
to
the
fainting
led
to
other
injuries
for
which
he
is
pursing
litigation.

I12080­
28
A
pesticide
incident
occurred
in
2001,
when
a
43­
year­
old
male
set
off
a
fogger
which
exploded.
He
sustained
second
and
third
degree
burns
on
right
arm,
right
side
of
face
and
right
side
of
both
legs.
Explosion
occurred
because
he
was
burning
garbage
which
contained
the
can.

I12290­
7
A
pesticide
incident
occurred
in
2001,
when
a
fogger
was
used
in
the
kitchen
and
an
explosion
occurred
causing
third
degree
burns
to
the
face,
arms
and
back
of
an
adult
male.

At
least
three
of
the
incidents
described
above
involved
serious
burn
injuries
that
resulted
from
foggers
that
exploded,
likely
due
to
nearby
flame.
Two
cases
(
I11161­
10
and
I11265­
3
)
involved
serious
respiratory
complaints,
suggesting
that
cypermethrin
products
could
induce
or
aggrevate
asthma
or
asthma­
like
illness
in
specially
susceptible
individuals.

II.
Poison
Control
Center
Data
­
1993
through
1998
Results
for
the
years
1993
through
1998
are
presented
below
for
occupational
cases,
nonoccupational
involving
adults
and
older
children,
and
for
children
under
age
six.
Cases
involving
exposures
to
multiple
products
or
cases
with
unrelated
outcome
are
excluded.
Tables
1­
4
present
the
hazard
information
for
cypermethrin
compared
with
all
other
pesticides
on
six
measures:
percent
with
symptoms,
percent
with
moderate,
major,
or
fatal
outcome,
percent
with
major
or
fatal
outcome,
percent
of
exposed
cases
seen
in
a
health
care
facility,
and
percent
hospitalized
and
percent
seen
in
a
critical
care
facility.
Table
1
reports
the
number
of
cases
on
which
the
data
derived
in
Tables
2­
4
are
based.
Table
2
presents
this
information
for
occupational
cases,
Table
3
for
non­
occupational
cases
involving
adults
and
older
children
(
six
years
or
older),
and
Table
4
for
children
under
age
six.

Table
1.
Number
of
cypermethrin
exposures
reported
to
the
Toxic
Exposure
Surveillance
System
(
AAPCC),
number
with
determined
outcome,
number
seen
in
a
health
care
facility
for
occupational
and
non­
occupational
cases
(
adults
and
children
six
years
and
older)
and
for
children
under
six
years
of
age
only,
1993­
1998
.
4
Subgroup
Exposures
Outcome
determined
Seen
in
Health
Care
Facility
Occupational:
adults
and
older
children
95
57
39
Non­
occupational:
adults
and
older
children
609
332
153
Children
under
age
six
341
208
84
Table
2.
Comparison
between
cypermethrin
and
all
pesticides
for
percent
cases
with
symptomatic
outcome
(
SYM),
moderate
or
more
severe
outcome
(
MOD),
life­
threatening
or
fatal
outcome
(
LIFE­
TH),
seen
in
a
health
care
facility
(
HCF),
hospitalized
(
HOSP),
or
seen
in
an
intensive
care
unit
(
ICU)
reported
to
Poison
Control
Centers,
1993­
1998
for
occupational
cases.

Pesticide
SYM*
MOD*
LIFE­
TH*
HCF*
HOSP*
ICU*

Cypermethrin
94.7%
33.3%
1.754%
41.0%
5.13%
2.56%

All
Pesticides
86.0%
18.8%
0.621%
47.0%
6.08%
2.36%

Ratio
1.10
1.77
2.82
0.87
0.84
1.08
*
Symptomatic
cases
based
on
those
cases
with
a
minor,
moderate,
major,
or
fatal
medical
outcome.
Denominator
for
SYM,
MOD,
and
LIFE­
TH
is
the
total
cases
where
medical
outcome
was
determined.
Denominator
for
HCF
is
all
exposures.
Denominator
for
HOSP
and
ICU
is
all
cases
seen
in
a
health
care
facility.

Table
3.
Comparison
between
cypermethrin
and
all
pesticides
for
percent
cases
with
symptomatic
outcome
(
SYM),
moderate
or
more
severe
outcome
(
MOD),
life­
threatening
or
fatal
outcome
(
LIFE­
TH),
seen
in
a
health
care
facility
(
HCF),
hospitalized
(
HOSP),
or
seen
in
an
intensive
care
unit
(
ICU)
reported
to
Poison
Control
Centers,
1993­
1998
for
non­
occupational
cases
involving
adults
and
older
children.

Pesticide
SYM*
MOD*
LIFE­
TH*
HCF*
HOSP*
ICU*

Cypermethrin
80.7%
16.3%
0.0%
25.1%
3.92%
0.65%

All
Pesticides
68.5%
10.5%
0.359%
16.5%
6.24%
2.67%

Ratio
1.18
1.55
0.0
1.52
0.63
0.24
*
Symptomatic
cases
based
on
those
cases
with
a
minor,
moderate,
major,
or
fatal
medical
outcome.
Denominator
for
SYM,
MOD,
and
LIFE­
TH
is
the
total
cases
where
medical
outcome
was
determined.
Denominator
for
HCF
is
all
exposures.
Denominator
for
HOSP
and
ICU
is
all
cases
seen
in
a
health
care
facility.
5
Table
4.
Comparison
between
cypermethrin
and
all
pesticides
for
percent
cases
with
symptomatic
outcome
(
SYM),
moderate
or
more
severe
outcome
(
MOD),
life­
threatening
or
fatal
outcome
(
LIFE­
TH),
seen
in
a
health
care
facility
(
HCF),
hospitalized
(
HOSP),
or
seen
in
an
intensive
care
unit
(
ICU)
for
adults
and
children
six
years
and
older
reported
to
Poison
Control
Centers,
1993­
1998
for
children
under
six
years
old..

Pesticide
SYM*
MOD*
LIFE­
TH*
HCF*
HOSP*
ICU*

Cypermethrin
42.3%
5.29%
0.481%
24.6%
7.14%
1.19%

All
Pesticides
21.8%
1.40%
0.120%
16.4%
4.78%
1.36%

Ratio
1.94
3.78
4.01
1.50
1.49
0.88
*
Symptomatic
cases
based
on
those
cases
with
a
minor,
moderate,
major,
or
fatal
medical
outcome.
Denominator
for
SYM,
MOD,
and
LIFE­
TH
is
the
total
cases
where
medical
outcome
was
determined.
Denominator
for
HCF
is
all
exposures.
Denominator
for
HOSP
and
ICU
is
all
cases
seen
in
a
health
care
facility.

There
was
some
indication
of
excess
risk
for
those
with
occupational
exposure
to
cypermethrin.
This
was
true
for
medical
outcome
where
the
more
severe
effects
were
more
common
for
cypermethrin
when
compared
to
all
pesticides.
However,
health
care
data
were
not
supportive
of
this
finding.
Workers
exposed
to
cypermethrin
had
about
the
same
likelihood
of
requiring
health
care,
hospitalization
and
critical
care
as
persons
exposed
to
all
pesticides.

Ratios
for
older
children
and
adults
exposed
non­
occupationally
were
not
consistent
either.
Persons
reportedly
exposed
to
cypermethrin
were
1.5
times
more
likely
to
exhibit
moderate
effects
and
to
be
seen
in
a
health
care
facility
than
those
exposed
to
other
pesticides.
But
the
same
group
was
much
less
likely
to
be
hospitalized
or
require
critical
care.
There
were
no
cases
with
major
or
life­
threatening
medical
outcome.

Children
under
six
years
of
age
showed
a
more
consistent
pattern
of
increased
hazard
when
compared
to
all
pesticides.
They
were
about
four
times
as
likely
to
have
moderate
or
major
medical
outcome
(
based
on
11
and
1
report,
respectively)
and
1.5
times
more
likely
to
be
seen
in
a
health
care
facility
and
to
be
hospitalized.
However,
once
seen
in
a
health
care
facility,
they
were
somewhat
less
likely
to
require
critical
care.

Review
of
symptoms
reported
for
all
groups
revealed
a
preponderance
of
dermal,
ocular
and
gastrointestinal
symptoms
among
the
minor
cases
(
e.
g.,
skin
or
eye
irritation,
nausea)
and
dermal
and
respiratory
effects
in
the
moderate
cases.
Of
the
dermal
and
ocular
symptoms,
irritation
or
pain
to
the
eye
or
skin
were
the
most
commonly
reported
symptoms
(
80
reported
eye
irritation
and
51
reported
skin
irritation).
Nine
of
the
80
eye
irritation
cases
and
6
of
the
51
skin
irritation
cases
occurred
among
cases
with
a
moderate
medical
outcome,
which
would
usually
require
medical
attention.
Gastrointestinal
symptoms
(
with
numbers
reporting
symptoms
in
parentheses
after
the
symptom)
most
commonly
reported
were
vomiting
(
66),
nausea
(
61),
throat
6
irritation
(
46),
oral
irritation
(
23),
abdominal
pain
(
19),
and
diarrhea
(
17).
Respiratory
symptoms
most
commonly
reported
included
cough/
choke
(
66),
difficulty
breathing
(
51),
and
bronchospasm
(
17).
There
was
one
case
of
respiratory
depression
combined
with
bronchospasm,
difficulty
breathing,
and
abdominal
pain
that
was
considered
a
major
medical
outcome
or
life­
threatening.
This
case
involved
a
24
year­
old
male
worker
admitted
for
critical
care
who
apparently
ingested
the
product.

The
respiratory
symptoms,
especially
bronchospasm,
difficulty
breathing,
and
the
one
case
of
respiratory
depression
were
the
most
common
moderate
or
major
symptoms
usually
requiring
medical
attention.
There
were
43
subjects
reporting
such
symptoms
suggesting
that
cypermethrin
can
be
a
cause
of
respiratory
problems
or
asthma­
like
symptoms
in
susceptible
persons.

III.
California
Data
­
1982
through
1999
Detailed
descriptions
of
179
cases
submitted
to
the
California
Pesticide
Illness
Surveillance
Program
(
1982­
1999)
were
reviewed.
In
91
of
these
cases,
cypermethrin
was
used
alone
or
was
judged
to
be
responsible
for
the
health
effects.
Only
cases
with
a
definite,
probable
or
possible
relationship
were
reviewed.
Cypermethrin
ranked
24th
as
a
cause
of
systemic
poisoning
in
California
based
on
data
for
1982
through
1994.
Table
5
presents
the
types
of
illnesses
reported
by
year.
Table
6
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
5.
Cases
Due
to
Cypermethrin
in
California
Reported
by
Type
of
Illness
and
Year,
1982­
2000.

Year
Illness
Type
Systemica
Eye
Skin
Respiratoryb
Combinationc
Total
1982­
1985
­
­
­
­
­
0
1986
­
­
1
­
­
1
1987
1
1
­
­
­
2
1988
12
­
1
­
­
13
1989
­
­
1
­
1
2
1990
21
­
­
1
3
25
1991
­
­
1
­
­
1
1992
2
1
­
­
­
3
7
Year
Illness
Type
Systemica
Eye
Skin
Respiratoryb
Combinationc
Total
1993
10
­
1
3
­
14
1994
5
2
2
­
­
9
1995
3
­
1
­
1
5
1996
2
­
­
­
­
2
1997
1
2
2
­
­
5
1998
­
1
­
­
­
1
1999
6
­
­
1
1
8
Total
63
7
10
5
6
91
a
Category
includes
cases
where
skin,
eye,
or
respiratory
effects
were
also
reported.
b
Category
not
used
until
1990.
Prior
respiratory
cases
classified
as
systemic.
c
Category
includes
combined
irritative
effects
to
eye,
skin,
and
respiratory
system.

Table
6.
Number
of
Persons
Disabled
(
taking
time
off
work)
or
Hospitalized
for
Indicated
Number
of
Days
After
Cypermethrin
Exposure
in
California,
1982­
2000.

Time
period
Number
of
Persons
Disabled
Number
of
Persons
Hospitalized
One
day
7
­

Two
days
5
­

3­
5
days
6
1
(
intentional
exposure)

6­
10
days
2
­

more
than
10
days
2
­

Unknown
6
­

Indefinite
1
­

A
variety
of
worker
activities
were
associated
with
exposure
to
cypermethrin
as
illustrated
in
Table
7
below.

Table
7.
Illnesses
by
Activity
Categories
for
Cypermethrin
Exposure
in
California,
1982­
2000
8
Activity
Category
Illness
Category
Systemica
Eye
Skin
Respiratoryb
Combinationc
Total
Applicator
1
3
1
1
­
6
Mixer/
Loader
­
3
1
1
2
7
Field
Residue
1
­
1
­
­
2
Outdoor
Drift
1
­
1
­
­
2
Building
Residue
49
1
5
2
3
60
Indoor
Drift/
spray
6
­
1
1
­
8
Other
5
­
­
­
1
6
Total
63
7
10
5
6
91
a
Category
includes
cases
where
skin,
eye,
or
respiratory
effects
were
also
reported.
b
Category
not
used
until
1990.
Prior
respiratory
cases
classified
as
systemic.
c
Category
includes
combined
irritative
effects
to
eye,
skin,
and
respiratory
system.

The
majority,
75%
of
the
California
illnesses
were
due
to
structural
use
of
cypermethrin
in
a
building
where
occupants
were
exposed
to
drift,
reside,
and
in
two
cases
direct
spray.
Forty
of
these
68
cases
were
due
to
just
four
incidents
described
below:

In
1988
nine
clothing
store
employees
and
two
video
store
employees
became
ill
over
9
days
after
the
clothing
store
was
treated
by
a
structural
pest
control
operator.
Symptoms
reported
include
nausea,
headache,
dizziness,
vomiting,
tightness
in
chest,
burning
nose,
and
eyes.

In
1990
a
structural
pest
control
operator
treated
about
9
square
feet
of
a
waiting
room
of
a
medical
clinic.
Only
a
few
workers
detected
an
odor.
Eight
employees
became
ill
and
sought
medical
attention
when
their
symptoms
became
worse
the
next
day
and
after
discussing
symptoms.
Symptoms
included
headache,
nausea,
cough,
chest
pain,
throat
irritation,
nausea,
shortness
of
breath
and
irritated
eyes.

In
1990,
a
structural
pest
control
operator
performed
drill
and
treat
application
to
an
office
building.
The
ventilation
system
became
contaminated
apparently
because
the
location
of
all
air
ducts
was
not
identified.
Two
days
later
employees
returned
and
noticed
a
strong
odor,
prompting
16
to
seek
medical
care,
14
with
symptoms.
Symptoms
included
watery
eyes,
cough,
chest
tightness,
burning
eyes
and
throat,
headache,
nausea,
diarrhea,
itching,
and
difficulty
breathing.
9
In
1993,
a
structural
pest
control
operator
treated
an
office,
including
the
exterior,
bath
and
break
rooms.
Occupants
of
the
treated
office
developed
symptoms
15­
60
minutes
after
entry.
Symptoms
included
headache,
nausea,
irritated
throat
and
eyes,
difficulty
breathing,
tingling,
and
numbness.
Three
of
these
seven
cases
had
a
history
of
asthma.

The
above
case
reports
suggest
that
sensitivity
to
odors
is
often
a
significant
factor
with
cypermethrin­
related
illness.
In
addition
to
the
cases
described
above,
two
cases
reported
allergy,
one
reported
hives,
and
a
fourth
reported
an
asthmatic
reaction
triggered
by
the
spray.
Less
than
25%
of
incidents
occurred
outdoors,
primarily
among
those
directly
handling
the
product.
There
were
no
more
than
two
cases
each
related
to
outdoor
spray
drift
or
field
residue.

IV.
Incident
reported
to
EPA
physician
consultant
In
August
2003,
a
woman
reported
using
a
36%
cypermethrin
product
at
her
residence.
She
stated
that
she
followed
label
directions
and
diluted
the
product
according
to
instructions.
She
applied
the
aerosol
throughout
her
residence
including
floors
and
corners
in
the
room
where
her
19
month
old
daughter
was
sleeping.
About
two
hours
after
the
application
her
daughter
awoke
wheezing.
She
had
no
prior
history
of
asthma,
allergies,
or
lung
problems.
The
mother
took
the
daughter
outside
for
fresh
air,
however
wheezing
persisted.
She
then
called
the
Poison
Control
Center
and
her
pediatrician,
who
advised
examination
if
symptoms
continued.
The
daughter
did
have
an
elevated
temperature
of
101
degrees
Fahrenheit.
The
next
morning,
symptoms
persisted
and
the
mother
took
the
child
to
an
urgent
care
facility,
where
she
was
admitted
for
24
hours
of
observation.
Although
some
fever
was
noted,
no
specific
infectious
cause
was
found.
The
child
was
discharged
with
an
inhaler
and
a
tapering
dose
of
prednisone.

Dr.
Sudakin,
EPA's
physician
consultant,
reviewed
this
case
with
the
mother
and
reported
that
high
levels
of
inhalation
exposure
to
cypermethrin
could
trigger
inflammation
of
the
airways,
producing
asthma­
type
symptoms.
Dr.
Sudakin
concluded:
This
case
is
of
importance
because
of
the
acute
onset
of
wheezing
symptoms
in
a
child,
which
were
temporally
related
to
the
aerosol
application
of
a
product
containing
a
relatively
high
concentration
of
cypermethrin.
Although
the
fever
suggests
the
possibility
of
an
infectious
etiology,
elevated
temperature
has
also
been
described
after
high
levels
of
exposure
to
cypermethrin.
The
case
is
also
of
relevance
because
of
the
mother's
report
of
the
labeling
instructions,
which
do
not
appear
to
provide
directions
as
to
whether
it
would
be
appropriate
to
apply
the
concentrated
product
in
an
area
where
people
(
a
child,
in
this
case)
may
be
sleeping.
V.
Scientific
literature
Very
few
incidents
involving
cypermethrin
alone
have
been
reported
in
the
literature.
Lessenger
(
1992)
reported
on
the
five
of
the
eight
cases
which
occurred
in
a
business
office
in
California.
The
contractor
used
2.75
gallons
of
the
chemical
mixed
with
275
gallons
of
water.
The
active
ingredient
was
about
25%
of
the
chemical
mixture,
so
the
resulting
dilution
was
0.25%.
Lessenger
reported
that
other
ingredients
included
an
aromatic
petroleum
solvent
based
10
on
xylene
and
trimethylbenzene
and
paraffinic
oils.
This
incident
appears
to
be
the
same
as
that
which
is
reported
in
1990
in
an
office
building
under
California
data.
Lessenger's
report
appears
to
cover
only
5
of
the
14
cases
which
sought
medical
treatment
for
symptoms.

The
treated
building
was
an
accounting
office
with
one
common
room,
four
offices,
and
a
conference
room,
consisting
of
about
1000
square
feet.
Inside
treatment
involved
drilling
into
the
slab
and
injecting
the
chemical
underneath.
Two
days
after
treatment
employees
entered
the
building
and
experienced
dizziness,
headaches,
nausea,
and
vertigo.
Turning
on
the
airconditioning
worsened
these
symptoms
and
the
building
was
vacated
after
about
five
minutes.
Some
employees
returned
inside
to
retrieve
personal
items
and
working
papers.
Six
days
after
treatment
fans
were
placed
inside
to
ventilate.
Then,
13
days
after
treatment
cypermethrin
levels
were
below
the
level
of
detection,
0.02
ppm.
At
this
time
employees
were
allowed
to
reenter,
however,
they
experienced
a
return
of
their
symptoms
which
was
exacerbated
by
turning
on
the
air­
conditioning
system.

Six
weeks
after
treatment
air
sampling
agin
demonstrated
levels
below
the
analytical
detection
limit.
The
highest
measurable
concentrations
were
found
in
wipe
samples
with
up
to
4,240
micrograms
per
square
foot
in
the
hallway
carpet.
Studies
found
that
the
applicator
inadvertantly
drilled
into
the
air
ducts,
which
accounted
for
the
increased
exposure
of
employees
when
the
air­
conditioning
was
turned
on.
Of
the
nine
cases
reviewed
by
Lessenger
(
1992),
five
were
examined
for
symptoms,
three
were
asymptomatic,
and
one
could
not
travel
for
examination
due
to
unrelated
health
problems.

The
five
cases
reported
by
Lessenger
are
summarized
below:

Case1:
29­
year­
old
female:
itching
of
the
eyes,
nausea,
sore
throat,
and
shortness
of
breath.
Two
weeks
later
when
returning
to
the
office
she
experienced
nausea,
dizziness,
numbness,
and
tingling.
A
month
later
she
reported
abdominal
discomfort,
fatigue
and
a
sore
throat
which
were
not
clearly
related
to
the
cypermethrin
exposure.

Case
2:
57­
year­
old
female:
blurred
vision,
itching
of
eyes,
shortness
of
breath,
congestion,
cough,
tightness
in
chest,
headache,
and
nausea.
Symptoms
completely
went
away
within
one
week,
but
she
subsequently
reported
joint
aches
and
pain.
She
also
reported
experiencing
nausea,
dizziness,
and
tingling
when
she
returned
to
the
office
and
handled
material
or
papers
there.

Case
3:
53­
year­
old
female:
shortness
of
breath,
wheezing,
burning
eyes,
cough,
congestion,
and
sinus
pain
and
drainage.
Her
private
physician
diagnosed
"
an
allergic
reaction
to
pesticide
spray".
Upon
returning
to
the
office
she
experienced
wheezing,
numbness,
and
tingling
when
handling
papers.
The
patient
subsequently
developed
shortness
of
breath
which
was
treated
with
bronchodilators
and
steroids.
This
patient
had
a
history
and
was
a
current
smoker,
but
did
not
report
any
respiratory
complaints
prior
to
the
cypermethrin
exposure.

Case
4:
46­
year­
old
female:
shortness
of
breath,
difficulty
breathing,
wheezing,
cough,
congestion,
burning
eyes,
and
copious
nasal
discharge.
Four
weeks
later
she
was
seen
by
her
11
private
physician
for
dyspnea
(
difficulty
beathing)
and
wheezing
and
was
treated
with
bronchodilators
and
steroids.
Both
this
case
and
the
one
above
(
Case
3)
reported
cough,
congestion,
and
wheezing,
seven
months
after
the
initial
exposure.
Case
4
also
reported
dyspnea
upon
exertion
and
shortness
of
breath.

Case
5:
30­
year­
old
female:
shortness
of
breath,
dyspnea
on
exertion,
sinus
burning,
and
itching
of
eyes.
Several
days
after
the
incident
she
was
diagnosed
as
having
"
allergic
reation
to
spray"
at
an
industrial
medicine
clinic.
She,
also,
was
treated
with
bronchodilators
and
steroids.
Seven
months
later
she
was
still
a
chronic
cigarette
smoker
and
complaining
of
shortness
of
breath
and
wheezing.

Dr.
Lessenger
reported
common
problems
among
these
five
patients.
All
experienced
shortness
of
breath,
cough
congestion,
burning
eyes,
and
itching
at
their
initial
exposure.
All
left
immediately
but
returned
repeatedly.
There
was
a
delay
before
seeing
their
own
physicians
and
during
this
time
they
"
developed
fears
about
their
problems,
and
extreme
anxiety
that
magnified
their
symptoms."
Dr.
Lessenger
recommended
that
workers
exposed
to
such
contamination
should
not
be
allowed
to
return
to
the
area
until
full
decontamination,
which
was
delayed
until
months
after
the
initial
exposure
in
this
incident.
He
also
recommended
rapid
referral
to
specialists
which
could
have
help
alleviate
the
anxieties
these
patients
experienced.

VI.
Conclusion
Pyrethroids,
like
cypermethrin,
have
relatively
low
toxicity.
Skin
and
eye
irritation,
nausea,
vomiting,
coughing
and
difficulty
breathing
were
the
most
commonly
reported
symptoms.
As
with
other
pyrethroids,
burning
or
tingling
sensations
are
often
reported
by
applicators
(
World
Health
Organization
1989).
The
occurrence
of
moderate
and
more
serious
symptoms
was
generally
more
prevalent
among
those
exposed
to
cypermethrin
than
those
exposed
to
other
pesticides.
A
few
reports
suggest
that
cypermethrin
can
cause
asthma
or
asthma
like
symptoms
in
certain
susceptible
individuals.

VII.
Recommendations
Skin
and
eye
protection
should
be
recommended
for
users
of
cypermethrin
that
are
likely
to
experience
extensive
exposure
(
other
than
spot
applications).
Bystanders
should
vacate
indoor
areas
receiving
widespread
treatment
(
e.
g.,
termite
or
area
treatments
rather
than
spot
applications)
and
the
area
should
be
appropriately
ventilated
afterwards
before
persons
reenter
the
premises.
Further
study
is
needed
to
determine
whether
labels
should
advise
of
potential
allergy
or
asthma­
like
problems
among
sensitive
individuals.

References
12
Lessenger
JE.
1992.
Five
office
workers
inadvertently
exposed
to
cypermethrin.
Journal
of
Toxicology
and
Environmental
Health
35:
261­
267.

World
Health
Organization.
1989.
Cypermethrin
(
see
especially
pages
107­
110).
Environmental
Health
Criteria
82.

cc:
cypermethrin
file
(
109702)
Donna
Davis
HED
(
7509C)
