July 2022
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129 Reads
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10 Citations
The term aerotoxic syndrome has been proposed to describe a constellation of symptoms reported by pilots and cabin crew following exposure to possible (neuro)toxic substances in cabin air. Several organ systems are involved. Potentially toxic chemicals emanate from hydraulic fluids and engine oil and include organophosphate compounds, solvents and carbonmonoxide. Oil contamination in the compressor will result in nanoparticles in bleed air under most operating conditions. Overfilling of oil or faulty seals lead to oil leaks which permit ultrafine particles to cross oil seals. Extremely high temperatures in aircraft engines may alter the composition of the original oil and create new toxic compounds. De-icing fluids and the use of insecticides may also contaminate cabin air. Regulatory authorities estimate fume events (incidental smells, smoke or mist inside an airplane) happen on 0.2–0.5% of flights. Objective evidence of exposure is often lacking and indirect proof in the form of biomarkers is scarce. The underlying mechanisms leading to chronic symptoms, extend beyond cholinesterase inhibition. Individual genetic differences in the ability to metabolize solvents and organophosphates may explain why long-term intermittent low-level exposure causes ill health in some people. We discuss the current evidence for central nervous system injury in aerotoxic syndrome and propose diagnostic criteria to argue for its recognition as occupational disorder. Prospective studies and a proactive attitude of authorities are required. Nano-aerosols as vehicles for toxic compounds should stimulate the development of bleedless aircraft. Until then the “aircraft cabin of the future” should have continuous cabin air monitoring and filter technology to make flying safe for everyone.