April 30, 2013 Celeste Monforton, DrPH, MPH 0Comment

I take mine black, but millions of U.S. coffee drinkers love their java beans flavored to taste like hazelnut, buttered toffee, french toast and amaretto.   One supplier in Florida boasts of 47 different flavors.   Fans of flavored coffee beans pay a premium for them, but some workers in the bean processing plants are paying a steeper price: their health.

This week’s Morbidity and Mortality Weekly Report describes cases of obliterative bronchiolitis diagnosed in two individuals who worked at a Texas coffee-processing company.    Bronchiolitis obliterans is a rare and serious obstructive lung disease with no cure, except for a lung transplant.   One of the individuals, a 34 year old woman (non-smoker), worked at several jobs in the plant, including the “flavoring room.”  The report explains:

“There, whole roasted coffee beans were mixed with liquid flavorings in an open process, ground, and packaged. Her primary tasks included operating the grinding and packing machines for these flavored coffee beans.”

The other individual, a 39 year old man (non-smoker) also worked in the flavoring room.

“His job involved open bench-top weighing of liquid flavorings, which he poured into barrels of roasted coffee beans.  A machine rotated these open barrels while he stood nearby to monitor the process.”

This is not the first time we’ve heard of workers exposed to flavoring agents and then developing this irreversible lung disease.  Not quite 10 years ago, another MMWR described cases of bronchiolitis obliterans in workers who’d been employed at microwave popcorn manufacturing plant in Missouri.  They too were exposed to the flavoring chemicals, including a ketone called diacetyl.

The workers’ illnesses didn’t attract much attention until Denver resident Wayne Watson developed the same disease.  He never worked at a microwave popcorn factory, but developed it by inhaling several times a day the hot butter-smelling vapors from his favorite snack.   Popcorn manufacturers quickly removed the butter-flavoring agent diacetyl from their microwave products, but some of the substitutes may pose similar risk of respiratory damage (see studies: here, here)  A 2013 study found workers at the microwave popcorn plants had a higher rates of respiratory disease mortality than the general population.

Now come this report of the same disabling respiratory disease in other workers exposed to flavoring agents.   The coffee-bean production workers first developed a cough and shortness of breath on exertion.  Treatment with steroids did not resolve their symptoms and eventually, both were referred to a pulmonologist.  Additional testing and lung biopsies resulted in the diagnosis of obliterative bronchiolitis related to their work.   The authors of the MMWR piece write:

“Especially of note is the short employment tenure of affected workers and their apparent rapid decline in lung function.  Although these patients were symptomatic within <18 months of work, their illness initially was unrecognized, leading to a diagnostic delay of 8–14 months.  This is consistent with the natural history of obliterative bronchiolitis, which differs significantly from much chronic obstructive lung disease, where decline is slow and risk factors more apparent.”

The authors correctly report that there is no specific federal workplace safety regulation designed to protect workers exposed to diacetyl or other flavoring agents.   There wasn’t one 10 years ago when the microwave popcorn workers were afflicted, and there’s still not one on the books.

After the popcorn workers’ lung cases came to light, worker organizations in July 2006 petitioned Labor Secretary Elaine Chao for an emergency standard from the Occupational Safety and Health Administration (OSHA) to protect workers from the flavoring hazard.  The petition was denied.  Shortly after taking office in March 2009, Obama’s Labor Secretary Hilda Solis suggested that OSHA would move expeditiously to protect workers from this hazard.  She announced:

“I am alarmed that workers exposed to food flavorings containing diacetyl may continue to be at risk of developing a potentially fatal lung disease. Exposure to this harmful chemical already has been linked to the deaths of three workers.  These deaths are preventable, and it is imperative that the Labor Department move quickly to address exposure to food flavorings containing diacetyl…”

The National Institute for Occupational Safety and Health (NIOSH) prepared a draft risk assessment and technical document to assist OSHA in developing a proposed rule.  Although the NIOSH document was peer reviewed about a year ago, OSHA’s not on a fast track to address the hazard of diacetyl or other food flavoring agents with a new regulation.  The agency’s most recent agenda of regulatory priorities lists this hazard under the category “long-term action.”

But even without a federal regulation, shouldn’t the users of these flavoring agents be aware of the inhalation risk for their workers?  Didn’t coffee bean processors read or hear the coverage about popcorn workers’ lung and its relationship to butter flavor??  Don’t the firms that sell these flavoring agents, such as Flavor & Fragrance Specialties Inc.Carmi Flavor and Fragrance Co. Inc. and Mission Flavors & Fragrances Inc., post warnings on their products about the health risks of inhalation exposure?  What have the flavor manufacturers done to ensure that users of their products are not harmed by them?

And then there’s the Food and Drug Administration.  Diacetyl and other flavoring agents are technically regulated by FDA as food additives.  FDA takes a hands-off view about these flavoring agents because they carry a long-standing designation “generally recognized as safe” (GRAS).   But that GRAS label pertains only to the flavoring additive when eaten.  For workers exposed to these compounds in food manufacturing—from microwave popcorn and coffee beans, to snack food, candy and dog food—-it’s more clear than ever that flavor additives of this sort are anything but safe.

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