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approximately 3000 chemicals used in the manufacture of fragrances. Most of these chemicals are synthetic and derived from petroleum. Many of these chemicals are not tested leaving no understanding of the potential health affects that the chemicals present to those who are exposed to the fragrance. Known chemicals found in fragrance formulations include toluene, alcohols, formaldehyde, styrene, benzene, limonene, phthalates, and musk. An individual fragrance formula may contain over 100 chemicals, but their identity is protected as a trade secret. Fragrances do not have to be tested for safety before they are put on the market (2).

Fragrances can affect the brain and nervous system in a matter of seconds, either by their presence in the brain or via stimulation of olfactory nerves. The effects of some neurotoxic substances may appear only after repeated exposures over weeks or even years. The presence of perfume, cologne, scented cleaners, and other scented products contributes to poor indoor air quality and is one of the major access barriers for Americans with health disabilities like asthma and chemical intolerance.

The Operations & Maintenance Committee for the U.S. Access Board identified pesticides (indoors & outdoors), fragrances (especially fragrance-emitting devices/FEDS, air fresheners and deodorizers), and volatile cleaners (including citrus & pine) as the biggest access barriers for people with chemical intolerance related to operations and maintenance of a building (3).

Additionally, exposure to fragrances can trigger asthma attacks, migraine headaches, and can aggravate sinus conditions, all of which can range from mild to disabling. In those who have chemical intolerance, fragrance exposures can also cause irregular heartbeat, memory loss, confusion, fatigue, and neurological, vascular, and other problems. In addition, some fragrance chemicals are implicated in causing cancer and/or damaging the liver, kidneys, and central nervous system. Fragrance chemicals can enter the body via inhalation, skin absorption, or nasal passageways.

According to a 1986 U.S. House of Representatives Report: "In 1986, the National Academy of Sciences targeted fragrances as one of the six categories of chemicals that should be given high priority for neurotoxicity testing. The other groups include insecticides, heavy metals, solvents, food additives, and certain air pollutants. The report states that 95 percent of chemicals used in fragrances are synthetic compounds derived from petroleum. They include benzene derivatives, aldehydes, and many other known toxics and sensitizers, which are capable of causing cancer, birth defects, central nervous system disorders, and allergic reactions. "(4)

Some sources of fragrances in school and other buildings include; fragrance-emitting devices (FEDS), sprays, and deodorizers, other scented cleaning and maintenance products, as well as potpourri, incense and scented candles (even when incense or scented candles are not burning). Sometimes fragrance is added to and dispersed by a building's ventilation system.

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Many people with asthma and other medical conditions that can be exacerbated by fume from fragrances are ordered by their health care provider to avoid fragrances as part of their medical protocol. Avoidance of fragrance products entails avoiding products that list fragrance as an ingredient or may have a fragrant odor. Caution should be used because even if "fragrance" is not listed as an ingredient, fragrance chemicals may have been added to a product for another purpose, or claimed to be added for another purpose – such as an anti-microbial stabilizer, blending agent, or enhancer.

Many toxic chemicals are found in janitorial cleaning supplies as well. They often emit volatile organic compounds (VOC's) (5), contribute to poor indoor air quality (IAQ), and create access barriers for people with asthma, allergies, and/or other chemical intolerance. Some of these chemicals are associated with human health effects, including cancer, damage to major organs, interference with normal reproduction and development, and even death (6).

Some cleaning products also contain disinfectants. The U.S. EPA notes that one major concern from a health standpoint is the increased incorporation of antimicrobial agents and fragrances in cleaners and air fresheners marketed to reduce indoor air contamination (7).

Many commonly used disinfectant or sanitizer products contain chlorine, phenol, quaternary ammonium compounds, and isopropyl and other alcohols. These produce hazardous fumes and present access barriers for people with chemical intolerance and other health conditions.

Even "greener cleaners" may contain volatile substances, like citrus or pine, that can cause adverse health effects in building occupants. "Greener cleaners" often promoting the use of citrus- and/or pine-based products, can react with even low levels of oxidants, such as ozone, to produce hazardous byproducts, as well as make buildings inaccessible for many people with chemical intolerance.

Indoor air in schools is often a "chemical soup" made up of a variety of chemicals emitted by building materials, cleaning products, pesticides, personal care and consumer products, emissions from building equipment and activities, etc. While individual chemicals may be hazardous, combinations of chemicals can be even more hazardous through additive or synergistic effects. Synergistic effects occur when the health impacts of a chemical combination is greater than the sum of the impacts of the individual chemicals.

In the school environment, chemicals in the indoor air can react with one another to form other compounds that are more hazardous than the original chemicals. Increasing evidence has shown that ozone and hydroxyl radicals formed by other oxidants can react with alkenes (such as limonene found in citrus and fragrance formulations, as well as terpenes emitted by many wood products) to generate secondary pollutants, including formaldehyde, as well as hydroxy radicals that can react with organics to form other potentially toxic air pollutants. The toxicity of many of these secondary pollutants is well-established while for others it has yet to be evaluated (8, 9, 10, 11).
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Deodorizers/Re-odorizers may contain higher concentrations of quaternary ammonia than disinfectants. They also frequently contain strong fragrances and/or masking agents that diminish the sense of smell. Paradichlorobenzene and naphthalene are common ingredients in fragrance-emitting devices. Deodorizer products are often used in public bathrooms. The use of deodorizer/re-odorizer products can be avoided by increasing ventilation/air flow and thoroughly cleaning with mildly alkaline non-surfactant detergents followed by the use of disinfectants, preferably peroxide-based ones. Inspection by ultraviolet light is recommended after all intensive cleaning to verify that surfaces have been adequately cleaned.

In order to avoid limiting access to individuals with asthma, allergies, chemical intolerance and other health concerns and to keep our nation’s children, who are a vulnerable population by nature out of harm’s way, best practice recommendation for “green” cleaning in schools would best be modeled after the National Institute of Building Sciences and The Architectural and Transportation Barriers Compliance Board (Access Board) Accessibility Guidelines for Indoor Environmental Quality. http://ieq.nibs.org/om/bi_intro.php It is my hope that this information will be shared among the green cleaning committee members and the Board of Education for educational purposes and for consideration of a generic, cost-effective, health oriented, all inclusive, best practices in green cleaning recommendation for schools.
Sincerely,

William J. Rea, M.D.


References

1. U.S. Congress, Office of Technology Assessment, Neurotoxicity: Identifying and Controlling Poisons of the Nervous System, OTA-BA-436 (Washington, D.C. Government Printing Office, April 1990).
2. Bridges, B, Fragrance: emerging health and environmental concerns, Flavour and Fragrance Journal 2002; 17: 361-371.
3. NIBS IEQ committee: Indoor Environmental Quality, Report by The Architectural and Transportation Barriers Compliance Board (Access Board), National Institute of Building Sciences, 2006 http://ieq.nibs.org/om/bi_intro.php
4. Neurotoxins: At Home and the Workplace, Report by the Committee on Science and Technology, U.S. House of Representatives, Sept. 16, 1986, Report 99-827
5. McCampbell A, Pesticide Sensitivities, pp. 606-609, in Encyclopedia of Pest Management, Pimentel D, Ed., New York: Marcel Dekker, 2002.
6. Initial Statement of Reasons for Proposed Amendments to the California Aerosol Coating Products, Antiperspirants and Deodorants, and Consumer Products Regulation, Test Method 310, and Airborne Toxic Control Measure for Para-dichlorobenzene Solid Air Fresheners and Toilet/Urinal Care Products, Volume I: Executive Summary, Air Resources Board, State of California.
7. Program Needs for Indoor Environments Research (PNIER), U.S. EPA, 402-B-05-001, March 2005
8. Nazaroff WW, Weschler CJ, Cleaning products and air fresheners: exposure to primary and secondary air pollutants, Atmospheric Environment 38 (2004) 2841-2865.
9. Nojgaard JK, Christensen KB, Wolkoff P, The effect on human eye blink frequency of exposure to limonene oxidation products and methacrolein, Toxicology Letters 156 (2005) 241-251.
10. Weschler CJ, Reactions Among Indoor Pollutants: What's New, Paper #291, Proceedings of the Annual Meeting of the Air and Waste Management Association, Orlando, FL, June, 2001.
11. Weschler, CJ, Ozone in Indoor Environments: Concentration and Chemistry, Indoor Air 2000;10: 269-288.

Additional information about Dr. Rea, M.D.
About Dr. Rea:
William J. Rea, M.D., is a thoracic and cardiovascular surgeon with a strong passion for the environmental aspects of health and disease. Founder of the Environmental Health Center-Dallas (EHC-D), Dr. Rea is currently director of this highly specialized Dallas based medical facility. The center also has a clinic in Chicago, Illinois.

In 1988, Dr. Rea was named to the world's first professorial chair of environmental medicine at the Robens Institute of Toxicology at the University of Surrey in Guildford, England. He was also awarded the Jonathan Forman Gold Medal Award in 1987 and the Herbert J. Rinkel Award in 1993, both by the American Academy of Environmental Medicine, as well as named Outstanding Alumnus by Otterbein College in 1991.He was also named to the Mountain Valley Water Hall of Fame for work in the field of study of clean water and, in 1995, he received the F.A.M.E. Award for pioneering work in environmental and preventive medicine. In 1997 he was named International Man of the Year and in 2002 Dr. Rea received the O. Spurgeon English Humanitarian Award from Temple University.

Author of the medical textbooks, Chemical Sensitivity, Vol. 1-4, a home building book Optimum Environments for Optimum Health and Creativity, and co-author of Your Home, Your Health and Well-Being, Dr. Rea has published more than 100 peer-reviewed research papers related to the topic of thoracic and cardiovascular surgery and environmental medicine.

Born in Jefferson, Ohio, Dr. Rea graduated from Otterbein College in Westerville, Ohio, and Ohio State University College of Medicine in Columbus, Ohio. He then completed a rotating internship at Parkland Memorial Hospital in Dallas, Texas. He held a general surgery residency from 1963-67 and a cardiovascular surgery fellowship and residency from 1967-69 with The University of Texas-Southwestern Medical School system, which includes Parkland Memorial Hospital, Baylor Medical Center, Veterans Hospital and Children's Medical Center.
From 1984-85, Dr. Rea held the position of adjunct professor of environmental sciences and mathematics at the University of Texas, while from 1972-82, he acted as clinical associate professor of thoracic surgery at The University of Texas Southwestern Medical School. He has also served as chief of thoracic surgery at Veterans Hospital and as adjunct professor of psychology and guest lecturer at North Texas State University.

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