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FLAVORINGS-RELATED LUNG DISEASE

	Green coffee beans in a burlap bag  	Freshly roasted coffee beans in a large storage container.

Coffee Processing Facilities

Main Points

  • Obliterative bronchiolitis, an irreversible lung disease, was previously identified in flavoring manufacturing workers and microwave popcorn workers who worked with diacetyl (2,3-butanedione) or butter flavorings containing diacetyl.
  • Workers at coffee processing facilities also may be at risk. NIOSH investigators published a paper in the American Journal of Industrial Medicine about a health hazard evaluation at a coffee processing facility that had five former workers with obliterative bronchiolitis (Bailey et al. 2015).
  • Diacetyl and 2,3-pentanedione, a chemical similar to diacetyl, are volatile organic compounds known as alpha-diketones. These chemicals can be manufactured to make different flavorings that are sometimes added to food products.
  • Diacetyl and 2,3-pentanedione are also naturally produced and released during the coffee roasting process (Daglia et al. 2007). Grinding roasted coffee beans produces greater surface area for the off-gassing of these and other chemicals (Akiyama et al. 2003).
  • NIOSH has published proposed recommended exposure limits (RELs) for diacetyl and 2,3-pentanedione in workplace air (NIOSH 2011a). If elevated levels of diacetyl (2,3-butanedione) or 2,3-pentanedione are detected in workplace air, workplace interventions should be put in place to reduce the levels. The effectiveness of these interventions (e.g., engineering controls, ventilation changes) should be verified by follow-up air sampling. NIOSH has published a best practices document that describes work interventions and exposure monitoring for occupational exposures to diacetyl and 2,3-pentanedione (NIOSH 2015).
  • Employees may need to wear appropriate fit-tested respirators until workplace interventions can be put in place to reduce air levels of diacetyl and/or 2,3-pentanedione. A medical surveillance program that includes health questionnaires and breathing tests (e.g., spirometry) also may be indicated to screen for respiratory symptoms or abnormalities in employees.
  • NIOSH is working with a number of coffee processing facilities through the Health Hazard Evaluation Program.

Occupational asthma was thought to be the main respiratory risk for workers in coffee processing facilities. Previous studies identified green and roasted coffee bean dusts and castor bean dusts from contaminated shipping bags as asthmagens (Figley and Rawling 1950; Karr et al. 1978; Zuskin et al. 1979, 1985; Thomas et al. 1991). Asthmagens are substances that can cause asthma. In 2013, a severe lung disease called obliterative bronchiolitis was reported in former workers of a coffee processing facility that roasted, ground, and flavored coffee (CDC 2013).

Obliterative Bronchiolitis (Lung Disease)

Obliterative bronchiolitis is a severe, non-reversible lung disease that involves scarring of the very small airways called bronchioles in a patchy distribution throughout the lung. Symptoms may include cough, shortness of breath on exertion, and/or wheeze (NIOSH 2012a). In addition to coffee processing workers, this severe lung disease has been identified in flavoring manufacturing workers and microwave popcorn workers who worked with flavoring compounds like diacetyl (2,3-butanedione) or butter flavorings containing diacetyl (Kim et al. 2013; Kreiss 2013; Kanwal et al. 2006). 2,3-Pentanedione is a chemical similar to diacetyl that is sometimes used in place of diacetyl in the manufacturing of flavorings (Day et al. 2011; Boylstein 2012). Diacetyl and 2,3-pentanedione likely share the same mechanism of toxicity. Airway damage has been observed in laboratory animals after exposure to diacetyl or 2,3-pentanedione (Hubbs et al. 2008, 2012; Morgan et al. 2012). NIOSH has developed a pamphlet for healthcare providers about flavoring-related lung disease (NIOSH 2012a).

Alpha-Diketones 

(click on the boxes below for more information)

Air Sampling and Analysis for Diacetyl (2,3-Butanedione) and 2,3-Pentanedione

Air sampling at a coffee processing facility for diacetyl and 2,3-pentanedione can help determine if control measures are needed to reduce airborne concentrations of alpha-diketones. Both area and personal air sampling are important to characterize exposures. At one coffee processing facility evaluated, NIOSH found high mean area concentrations of diacetyl and 2,3-pentanedione in the grinding/packaging room and flavoring room. The hazard potential may increase when these chemicals occur in combination with each other, since having exposure to chemicals with the same functional alpha-diketone group may result in additive effects. The sum of the means of diacetyl and 2,3-pentanedione exposure in personal samples for grinders in the grinding/packaging room was 283 parts per billions (ppb), similar to the sum for mixers of 227 ppb and packer/helpers of 244 ppb in the flavoring room (Bailey et al. 2015). The American Conference of Governmental Industrial Hygienists (ACGIH) is a professional, not-for-profit, nongovernmental scientific association that reviews existing published, peer-reviewed scientific literature and publishes exposure guidelines. ACGIH notes that when two or more hazardous substances have a similar toxicological effect on the same system or organ (e.g., lungs), their combined effect should be given primary consideration rather than individually (ACGIH 2015).

Air sampling during specific tasks, such as roasting, grinding, opening storage bins or containers with roasted coffee beans, and pouring and adding flavorings, is important. There is potential for workers to have a low average personal exposure but high peak exposures to diacetyl and/or 2,3-pentanedione during certain tasks. For example, at a coffee processing facility, a 15-minute air sample collected at a small open hatch in the lid of a grinding/packaging room mezzanine hopper holding unflavored ground coffee above an active packaging line measured concentrations of 14,300 ppb diacetyl and 18,400 ppb 2,3-pentanedione; workers opened these hatches momentarily to monitor coffee levels in the hoppers (Bailey et al. 2015).

The Occupational Safety and Health Administration (OSHA) has published validated methods for air monitoring for diacetyl and 2,3-pentanedione. OSHA method 1013 is validated for diacetyl and acetoin (OSHA 2008a). OSHA method 1016 is validated for 2,3-pentanedione (OSHA 2010). OSHA method 1012 is validated for diacetyl (OSHA 2008b) but has a lower limit of detection; this method can also detect 2,3-pentanedione.

In addition to using the standard OSHA methods 1013/1016 and 1012, NIOSH has been using a modified OSHA method 1013/1016 that uses a mass spectrometer for improved detection limits (Simmons 2015). NIOSH has also been using evacuated canisters (LeBouf et al. 2012) with flow controllers to collect air samples for diacetyl and 2,3-pentanedione in workplaces.

Real-time or Near Real-Time Sampling for Diacetyl (2,3-Butanedione) and 2,3-Pentanedione

Some sampling methods can provide real-time or near real-time results of volatile compounds such as diacetyl and 2,3-pentanedione. These techniques can help identify sources of alpha-diketones (e.g., diacetyl and 2,3-pentanedione) and tasks associated with exposure; this information can be useful in identifying appropriate work practices and the development of exposure controls (NIOSH 2011a, NIOSH 2015).

A photoionization detector (PID) is an example of a real-time monitor that can be used to measure total volatile organic compound (VOC) concentrations in air. The PID is a non-specific detector that will see a range of chemical compounds in air, including diacetyl and 2,3-pentanedione, that interact with the light source in the instrument. PIDs do not provide concentrations specific to any particular compound. They are often calibrated for isobutylene and can commonly detect total VOC concentrations from 1 to 2000 parts per million. Modern PIDs can be programmed to measure the concentration of VOCs at fixed time intervals (NIOSH 2011a).

Fourier-transform infrared (FTIR) spectroscopy is another technique that is more selective allowing for multiple target chemicals to be simultaneously measured in air. The amount of infrared radiation absorbed over a range of wavelengths is indicative of the chemical concentration in air. FTIR analysis can produce real-time quantitation of flavoring chemicals in air although interferences can pose analytical difficulties in quantifying specific flavoring ingredients in environments with multiple organic chemicals present (NIOSH 2011a).

NIOSH Proposed Exposure Limits for Diacetyl (2,3-Butanedione) and 2,3-Pentanedione

NIOSH has published proposed RELs for diacetyl and 2,3-pentanedione in workplace air (NIOSH 2011a). The NIOSH objective in establishing RELs for diacetyl and 2,3-pentanedione is to reduce the risk of respiratory impairment (decreased lung function) and the severe irreversible lung disease obliterative bronchiolitis associated with occupational exposure to these chemicals. On this basis, NIOSH proposed a REL of 5 ppb for diacetyl and 9.3 ppb for 2,3-pentandione (as a time-weighted average for up to 8 hours/day during a 40-hour workweek).The NIOSH proposed 15-minute STELs are 25 ppb for diacetyl and 31 ppb for 2,3-pentanedione (NIOSH 2011a). The NIOSH proposed exposure standards do not differentiate between natural and synthetic chemical origin of diacetyl or 2,3-pentanedione.

Currently, there are no occupational exposure limits for 2,3-hexanedione or 2,3-heptanedione.>

Workplace Interventions

If elevated levels of diacetyl (2,3-butanedione) or 2,3-pentanedione are detected in workplace air, interventions should be put in place to reduce the levels. The effectiveness of these interventions should be verified by follow-up air sampling. Serial air sampling for diacetyl and 2,3-pentanedione can help evaluate the impact of interventions on exposures and identify where to prioritize any future interventions. In 2015, NIOSH published a best practices document that describes work interventions such as engineering controls, work practices, and exposure monitoring for occupational exposures to diacetyl and 2,3-pentanedione (NIOSH 2015).

Examples of workplace interventions include the following (click on the boxes below for more information):

NIOSH Health Hazard Evaluation Program

NIOSH has a health hazard evaluation program (NIOSH 2009) in which we respond to requests from employers, employees, or their authorized representatives (i.e., unions) to investigate possible workplace hazards and make recommendations. Often requests are handled by phone consultations and report reviews. When situations arise that are not already understood based on prior health hazard evaluations, site visits are often conducted that can include exposure and/or health evaluations to better understand potential hazards. NIOSH currently has ongoing health hazard evaluations at some coffee processing facilities to learn more about potential exposures to workers. NIOSH investigators published an article in the American Journal of Industrial Medicine about a health hazard evaluation at a coffee processing facility (Bailey et al. 2015). The investigators found elevated levels of butter flavoring chemicals diacetyl and 2,3-pentanedione in the air at the facility and identified three sources: 1) flavoring chemicals added to roasted coffee beans in the flavoring area; 2) grinding and packaging unflavored ground and whole bean roasted coffee in a distinct area of the facility, and 3) storing roasted coffee in hoppers, on a mezzanine above the grinding/packaging process, to off-gas. The current workers had excess shortness of breath and obstruction on spirometry, both consistent with undiagnosed lung disease. Respiratory morbidity was associated with exposure and not limited to the flavoring area.

References

ACGIH (American Conference of Governmental Industrial Hygienists) [2015]. 2015 TLVs® and BEIs®: threshold limit values for chemical substances and physical agents and biological exposure indices. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.

Akiyama M, Murakami K, Ohtani N, Iwatsuki K, Sotoyama K, Wada A, Tokuno K, Iwabuchi H, Tanaka K [2003]. Analysis of volatile compounds released during the grinding of roasted coffee beans using solid-phase microextraction. J Agric Food Chem 51(7):1961–1969.

Bailey RL, Cox-Ganser JM, Duling MG, LeBouf RF, Martin SB Jr, Bledsoe TA, Green BJ, Kreiss K [2015]. Respiratory morbidity in a coffee processing workplace with sentinel obliterative bronchiolitis cases. Am J Ind Med 58(12):1235-1245. 

Boylstein R [2012]. Identification of diacetyl substitutes at a microwave popcorn production plant. J Occup Environ Hyg 9(2):D33-4. 

CDC (Centers for Disease Control and Prevention) [2013]. Obliterative bronchiolitis in workers in a coffee-processing facility - Texas, 2008–2012. MMWR Morb Mortal Wkly Rep 62:305–307 [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6216a3.htm]. Date assessed: January 2016.

CFR (Code of Federal Regulations). Washington, DC: U.S. Government Printing Office, Office of the Federal Register.

Daglia M, Papetti A, Aceti C, Sordelli B, Spini V, Gazzani G [2007]. Isolation and determination of alpha-dicarbonyl compounds by RP-HPLC-DAD in green and roasted coffee. J Agric Food Chem 55(22):8877–8882.

Day G, LeBouf R, Grote A, Pendergrass S, Cummings K, Kreiss K, Kullman G [2011]. Identification and measurement of diacetyl substitutes in dry bakery mix production. J Occup Environ Hyg 8(2):93-103.

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Hubbs AF, Goldsmith WT, Kashon ML, Frazer D, Mercer RR, Bateeilli LA, Kullman GJ, Schwegler-Berry D, Friend S, Castranova V [2008]. Respiratory toxicologic pathology of inhaled diacetyl in Sprague-Dawley rats. Toxicol Pathol 36(2):330-344.

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Kanwal R, Kullman G, Piacitelli C, Boylstein R, Sahakian N, Martin S, Fedan K, Kreiss K [2006]. Evaluation of flavorings-related lung disease risk at six microwave popcorn plants. J Occup Environ Med 48(2):149-57.

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Kim TJ, Materna BL, Prudhomme JC, Fedan KB, Enright PL, Sahakian NM, Windham GC, Kreiss K [2010]. Industry-wide medical surveillance of California flavor manufacturing workers: Cross-sectional results. Am J Ind Med 53(9):857-865.

Kreiss K [2013]. Occupational causes of constrictive bronchiolitis. Curr Opin Allergy Clin Immunol 13(2):167-72.

LeBouf RF, Stefaniak AB, Virji MA [2012]. Validation of evacuated canisters for sampling volatile organic compounds in healthcare settings. J Environ Monit 14(3):977-983.

Morgan DL, Jokinen MP, Price HC, Gwinn WM, Palmer SM, Flake GP [2012]. Bronchial and bronchiolar fibrosis in rats exposed to 2,3-pentanedione vapors: implications for bronchiolitis obliterans in humans. Toxicol Pathol 40(3):448-465.

NIOSH (National Institute for Occupational Safety and Health) [2009]. Health hazard evaluation program. Cincinnati, OH: US Department of Health and Human Services, CDC, National Institute for Occupational Safety and Health. DHHS (NIOSH) Publication No. 2009-167 [http://www.cdc.gov/niosh/docs/2009-167/]. Date assessed: January 2016.

NIOSH [2010]. NIOSH pocket guide to chemical hazards. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2010-168c [http://www.cdc.gov/niosh/npg/]. Date accessed: January 2016.

NIOSH [2011a]. Draft criteria for a recommended standard: occupational exposure to diacetyl and 2,3-pentanedione. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 20XX-XXX. August 12, 2011 External Review Draft [http://www.cdc.gov/niosh/docket/archive/pdfs/NIOSH-245/0245-081211-draftdocument.pdf]. Date assessed: January 2016.

NIOSH [2011b]. Get valid spirometry results every time. Morgantown, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, DHHS (NIOSH) Publication No. 2011-135 [http://stacks.cdc.gov/view/cdc/5900/]. Date accessed: January 2016.

NIOSH [2011c]. OSHA - NIOSH worker info: Protect yourself - spirometry breathing test. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, DHHS (NIOSH) Publication No. 2011-132 [http://www.cdc.gov/niosh/docs/2011-132/]. Date accessed: January 2016.

NIOSH [2012a]. Flavoring-related lung disease. Information for healthcare providers. Department of Health and Human Services, Centers for Disease Control and Prevention, DHHS (NIOSH) Publication No. 2012-148 (supersedes 2012-107) [http://www.cdc.gov/niosh/docs/2012-148/]. Date accessed: January 2016.

NIOSH [2012b]. Spirometry quality assurance: Common errors and their impact on test results. Morgantown, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. DHHS (NIOSH) Publication No. 2012-116 [http://www.cdc.gov/niosh/docs/2012-116/]. Date accessed: January 2016.

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NIOSH [2015]. Best practices: engineering controls, work practices and exposure monitoring for occupational exposures to diacetyl and 2,3-pentanedione. By Dunn KH, McKernan LT, Garcia A. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication 2015-197 [http://www.cdc.gov/niosh/docs/2015-197/default.html]. Date accessed: January 2016.

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Simmons M [2015]. CS-404-08 Using gas chromatography mass spectrometry in single ion monitoring mode for analysis of diacetyl and 2,3-pentanedione. OSHA Salt Lake Technical Center. AIHce 2015, CS-404-08.

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