Conference Paper

On the need for a standardized human biomonitoring protocol for in-flight incidents (called “fume events”)

  • L'Istituto Ramazzini
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In-flight incidents called “Fume Events” are associated with a range of symptoms among those exposed, mostly among susceptible airline crew members. Despite currently ongoing ambient monitoring studies, there are no systematic investigations using clinical or human biomonitoring data to evaluate the direct impact of possible harmful substances on human health and well-being. With respect to exposures, we discuss chemicals and mixtures of engine oils, hydraulic and deicing fluids, kerosene and pyrolysis / combustion products contaminating bleed air in normal or accidental failure conditions

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... Urine and blood samples should be obtained without delay after a fume event and strict technical requirements should be mandatory [1]. A standardized protocol to properly approach cases suspected of AS is currently drawn up by a team of international experts on the subject [34]. Besides, since more than two million people fly in commercial aircrafts every day all over the world, there is a need to raise awareness on this entity [1]. ...
... In conclusion, our report of three cases of AS aims at raising awareness on this unknown disease, particularly on the respiratory symptoms, and calls for the implementation of standardized protocols to manage AS [1][2][3][4][5][6][7][8][9]34]. Further research is warranted to clarify which chemical substances are potentially causative of this syndrome, which populations are more susceptible, and which preventive and therapeutic measures should ideally be implemented [1,[3][4][5][6][7][8][9]. ...
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PurposeCase series on respiratory features of Aerotoxic Syndrome (AS). The term AS has been coined to describe the spectrum of clinical manifestations after aircraft fume events. Among these manifestations, neurological and respiratory symptoms are the most frequently reported complaints.Methods Three cases of AS with relevant respiratory features are presented.ResultsCough and shortness of breath for 6 to12 months were the predominant symptoms in the first two cases. The first case also developed neurological symptoms affecting his central nervous system. In the third case, the patient complained for nine years about an unbearable cough triggered by odors, smells, and a variety of indoor and outdoor irritants, among other symptoms of multiple chemical sensitivity. In all three cases, the respiratory symptoms resolved after appropriate treatment.Conclusion Our report aims at raising awareness on AS and calls for actions to improve the management of patients suffering from this syndrome.
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A broad overview of the subject is presented, covering all salient aspects including the technical history, a discussion of the compounds involved in the contamination, the frequency of occurrence, a survey of attempts to measure the contamination, safety considerations, health considerations, and possible technical solutions to the problem of contamination.
In modern aviation, so-called fume events such as exposure to an unknown mixture of chemicals introduced into the aircraft cabin with bleed air drawn off at the engines may occur. Human exposure may result in (neuro)toxic symptoms described as so-called “aerotoxic syndrome.” Currently, among other agents organophosphates (OP) are regarded as a likely cause of the observed adverse effects. After fume events 11 flight crew members (9 female/2 male; ages 23–58 yr) were admitted for a medical examination within 5 d post exposure. Individual acetylcholinesterase (AChE) and neuropathy target esterase (NTE) activities were determined. Anamnesis and clinical findings confirmed prominent symptoms of an intoxication, including headache, cognitive difficulties, and neurological disorders, among others. Patient AChE activities ranged from 37 to 50 U/g hemoglobin (reference values: 26.7–50.9 U/g hemoglobin). Ten individuals showed NTE activities ranging from 3.14 to 6.3 nmol phenyl valerate/(min × mg protein) (reference values: 3.01–24), with one patient exhibiting low NTE activity of 1.4. Biochemical effect monitoring was applied to encompass a broad range of AChE-inhibiting compounds such as OP, carbamates, and isocyanates, or to detect inhibition of NTE. The measured AChE activities indicated a subordinate contribution of OP or related compounds to the observed symptoms. All noted NTE activities were clustered at low levels. Our data suggest a likely inhibition of NTE activities in patients after fume events, which warrants further investigation. The observed symptoms may be linked to known chemical compounds in fume events, and it is not possible to infer a direct correlation between manifestations and AChE -inhibiting compounds at this time.
Background: Concern exists about the potential chronic neurological effects among aircrew of exposure to chemical contaminants from engine oil in aircraft cabin air. We evaluated mortality from neurodegenerative diseases among 11,311 former US flight attendants. Methods: Vital status was ascertained through 2007, and life table analyses were conducted to obtain standardized mortality ratios (SMRs). Results: Amyotrophic lateral sclerosis (ALS) mortality was over twice as high in the cohort as in the US general population, based on nine observed ALS deaths. There was no clear pattern in risk when SMRs for ALS were stratified by exposure duration. Mortality from other neurodegenerative diseases was not elevated. Conclusions: Our findings are limited due to small numbers of observed deaths and reliance on mortality data, but suggest that flight attendants may have an increased risk of ALS. Additional research is needed. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
AEROTOXIC SYNDROME: A NEW OCCUPATIONAL DISEASE? Journal of the WHO regional office for Europe
  • S Jonathan Michaelis
  • C Burdon
  • Howard
Michaelis, S Jonathan Burdon, C. Vyvyan Howard. AEROTOXIC SYNDROME: A NEW OCCUPATIONAL DISEASE? Journal of the WHO regional office for Europe. 2017 3 (2) 141-365