Awesome note Melanie!  Warner

 

 

 

While I think we all intuitively would reject the hypothesis that incidental inhalation of saccharin from 2 fit tests per week is a likely cause of steatohepatitis, I realize you need actual data. So after a good chuckle I asked Dr. Google and found a few things that might help:

 

1.       The safe daily dose of saccharine is pretty huge. According to the International Agency for Research on Cancer issued a monograph on the health effects of saccharin: https://monographs.iarc.fr/ENG/Monographs/vol73/mono73-24.pdf in which they say “An acceptable daily intake (ADI) of 5 mg/kg bw for saccharin (including its sodium, calcium and potassium salts) was established in 1993 by the WHO/FAO Joint Expert Committee on Food Additives (WHO, 1993a) and in 1995 by the Scientific Committee for Food of the European Union (International Sweeteners Association, 1998). Before these dates, the ADI was 2.5 mg/kg bw”

2.       To figure out how much she could potentially get exposed to, you could either monitor this if such a monitor exists, or you could do some back-of-the envelope calculations to see how much of the solution she’d actually have to drink every day to exceed this exposure. The 3M fit test solution is 1g/ml, so the imaginary 70kg person would have to drink .35 ml of nebulizer fluid daily to exceed the ADI.

3.       Even if one did get a high exposure, the MSDS sheets for saccharin don’t list liver toxicity at all:

a.       http://www.tsi.com/uploadedFiles/_Site_Root/Products/Literature/MSDS/6003029A-SaccharinSolutions.pdf

b.      http://www.msanet.com/prism/pdfMSDS/SDSother/SDS017.pdf

c.       http://multimedia.3m.com/mws/mediawebserver?mwsId=SSSSSuUn_zu8l00x4xtZ58tGnv70k17zHvu9lxtD7SSSSSS--

4.       With apologies to Larry, Gwen, and all my other New Jersey buds, when all else, fails, NJ probably has some regulation about it. Here is their fact sheet on saccharin, which does not list any liver toxicity: http://nj.gov/health/eoh/rtkweb/documents/fs/1641.pdf

 

Good luck, Linda!

-Melanie

 

 

 

 

I am working with a nurse at a health center who performs on average 2-3 qualitative fit tests a week using saccharin. She uses her office for the sensitivity testing and then another room for the fit test.  Her doctor has noticed a gradual increase in her LFTs (don’t know exact values) and she is curious about whether the fit testing could be the cause – infectious causes ruled out, she has limited her ETOH and retested without change, and her doctor feels she has a mild fatty liver.  No bx yet.

 

I’ve asked her to use two other rooms besides her office for the testing as a precaution, especially since now when she smells the saccharin, she has a belief that it may be causing harm. I think the only other choice with the system we have is Bitrex, which we decided to only use on those not able to taste the saccharin.  She is only fit testing N95 respirators.

In doing  a literature search, I’ve seen that ingestion may have some impact on LFTs in rats…  Does anyone else have a similar experience, especially with those doing high volume testing?  Any other suggestions for reducing exposure to saccharin?

 

Linda L. Clark, MD, MS

Occupational and Preventive Medicine

(585) 227-0072 P

(585) 227-9585 F

lclark@doctorclark.org