Metal fume fever and polymer fume fever

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 2015-05, Vol.53 (4), p.195-203
• Main Authors: Greenberg, Michael I., Vearrier, David
• Format: Article
• Language: English
• Subjects: Byssinosis - epidemiology; Byssinosis - etiology; Byssinosis - therapy; Humans; Inhalation; Inhalation Exposure - adverse effects; Lung; Metals - poisoning; Occupational Diseases - etiology; Occupational Diseases - therapy; Polymers - poisoning; Welding
• ISSN: 1556-3650; 1556-9519
• DOI: 10.3109/15563650.2015.1013548

Abstract Introduction. Inhalational exposure to metal-containing fumes generated by welding and related processes may result in the development of the clinical syndrome known as "metal fume fever." Polymer fume fever is a separate and distinct but related disorder that has been associated with inhalational exposure to specific fluorinated polymer products, such as polytetrafluoroethylene or Teflon®. We undertook a review of the peer-reviewed medical literature as it relates to these two disease entities in order to describe their epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, prevention, and prognosis. Methodology. We performed a search of the PubMed (www.pubmed.com) and Ovid MEDLINE (ovidsp.tx.ovid.com) databases for keywords "metal fume fever," "polymer fume fever," and "fume fever," covering the period 1946 to September 2014, which resulted in a total of 141 citations. Limiting the search to articles published in the English language yielded 115 citations. These 115 articles were manually reviewed for relevance. In addition, the reference lists in each article retrieved were reviewed for additional relevant references. This left 48 relevant citations. Epidemiology. Metal fume fever occurs most commonly as an occupational disease in individuals who perform welding and other metal-joining activities for a living. It is estimated that 1,500-2,500 cases of metal fume fever occur annually in the United States. Polymer fume fever was initially identified as an occupational disease but increased regulations have resulted in decreased incidence in the occupational setting. Overheating of Teflon®-coated cookware is one of the more common mechanisms for exposure. Pathophysiology. While the precise pathophysiology associated with the development of metal fume fever is yet to be elucidated, suggested pathophysiologic mechanisms include pro-inflammatory cytokine release, neutrophil activation, and oxygen radical formation. The pathophysiologic mechanism for polymer fume fever has not been definitively elucidated but may involve similar mechanisms to those proposed for metal fume fever. Clinical presentation. Metal fume fever typically presents with generally non-specific complaints including influenza-like symptoms, fever, shaking chills, arthalgias, myalgias, headache, and malaise. Onset of symptoms typically occurs 4-10 h following the exposure to metal-containing fumes. While metal fume fever is typically benign and self-limited, seve