# NIOSH Hazard Review: Carbonless Copy Paper

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​NIOSH Hazard Review
Carbonless Copy Paper
U.S. Department of Health and Human Services
Public Health Service • Centers For Disease Control and Prevention
National Institute for Occupational Safety and Health
December 2000
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DHHS (NIOSH) Publication No. 2001-107
Contents :
| Foreword | Foreword | Foreword | Foreword | Foreword | iii |
| Executive Summary | Executive Summary | Executive Summary | Executive Summary | Executive Summary | iv |
| Tables | Tables | Tables | Tables | Tables | xiii |
| Figures | Figures | Figures | Figures | Figures | xv |
| Abbreviations | Abbreviations | Abbreviations | Abbreviations | Abbreviations | xvi |
| Acknowledgments | Acknowledgments | Acknowledgments | Acknowledgments | Acknowledgments | xix |
| 1 | Introduction | Introduction | Introduction | Introduction | 1 |
| 1 | 1.1 | Background | Background | Background | 1 |
| 1 | 1.2 | Development and production of CCP | Development and production of CCP | Development and production of CCP | 1 |
| 1 | 1.3 | Reported health effects | Reported health effects | Reported health effects | 2 |
| 1 | 1.4 | Information sources and types | Information sources and types | Information sources and types | 4 |
| 2 | The Technology of CCP | The Technology of CCP | The Technology of CCP | The Technology of CCP | 5 |
| 2 | 2.1 | How CCP works | How CCP works | How CCP works | 5 |
| 2 | 2.2 | CCP production | CCP production | CCP production | 5 |
| 2 | 2.3 | Microcapsule production | Microcapsule production | Microcapsule production | 6 |
| 2 | 2.4 | CCP production process | CCP production process | CCP production process | 7 |
| 2 | 2.5 | Forms production | Forms production | Forms production | 8 |
| 2 | 2.6 | Other forms and variations of CCP technology | Other forms and variations of CCP technology | Other forms and variations of CCP technology | 8 |
| 2 | 2.7 | Desensitizing inks | Desensitizing inks | Desensitizing inks | 9 |
| 2 | 2.8 | Summary of chemical components of CCP | Summary of chemical components of CCP | Summary of chemical components of CCP | 9 |
| 2 | 2.9 | Brand names or trademarks for CCP | Brand names or trademarks for CCP | Brand names or trademarks for CCP | 12 |
| 3 | Exposure | Exposure | Exposure | Exposure | 13 |
| 3 | 3.1 | Introduction | Introduction | Introduction | 13 |
| 3 | 3.2 | Exposure data | Exposure data | Exposure data | 13 |
| 3 | 3.2 | 3.2.1 | Published studies | Published studies | 13 |
| 3 | 3.2 | 3.2.1 | Jujo Paper Company, Ltd. 1979 | Jujo Paper Company, Ltd. 1979 | 13 |
| 3 | 3.2 | 3.2.1 | Molhave and Grunnet 1981 | Molhave and Grunnet 1981 | 13 |
| 3 | 3.2 | 3.2.1 | Gothe et al. 1981 and Norback et al. 1983b | Gothe et al. 1981 and Norback et al. 1983b | 16 |
| 3 | 3.2 | 3.2.1 | Gockelet al. 1981 | Gockelet al. 1981 | 16 |
| 3 | 3.2 | 3.2.1 | Chrostek and Moshell 1982 | Chrostek and Moshell 1982 | 16 |
| 3 | 3.2 | 3.2.1 | Norback et al. 1983b | Norback et al. 1983b | 16 |
| 3 | 3.2 | 3.2.1 | Norback and Gothe 1983 | Norback and Gothe 1983 | 17 ​ |
| 3 | 3.2 | 3.2.1 | Olsen and Morck 1985 | Olsen and Morck 1985 | 19 |
| 3 | 3.2 | 3.2.1 | Apol and Thoburn 1986, Chovil et al. 1986, and Burton and Malkin 1993 | Apol and Thoburn 1986, Chovil et al. 1986, and Burton and Malkin 1993 | 19 |
| 3 | 3.2 | 3.2.1 | Omland et al. 1993 | Omland et al. 1993 | 19 |
| 3 | 3.2 | 3.2.1 | Zimmer and Hadwen 1993 | Zimmer and Hadwen 1993 | 19 |
| 3 | 3.2 | 3.2.1 | Thompson 1996 | Thompson 1996 | 20 |
| 3 | 3.2 | 3.2.2 | NIOSH docket submissions | NIOSH docket submissions | 21 |
| 3 | 3.2 | 3.2.2 | 3.2.2.1 | Winfield 1983 | 21 |
| 3 | 3.2 | 3.2.2 | 3.2.2.2 | Hazelton Laboratories 1985 | 21 |
| 3 | 3.2 | 3.2.2 | 3.2.2.2 | Product test methods | 21 |
| 3 | 3.2 | 3.2.2 | 3.2.2.2 | Product testing | 22 |
| 3 | 3.2 | 3.2.2 | 3.2.2.2 | Office activities | 24 |
| 3 | 3.3 | Conclusions | Conclusions | Conclusions | 25 |
| 4 | Health Effects | Health Effects | Health Effects | Health Effects | 28 |
| 4 | 4.1 | Introduction | Introduction | Introduction | 28 |
| 4 | 4.2 | Human studies | Human studies | Human studies | 29 |
| 4 | 4.2 | 4.2.1 | Published case reports and case series | Published case reports and case series | 29 |
| 4 | 4.2 | 4.2.1 | Magnusson 1974 | Magnusson 1974 | 30 |
| 4 | 4.2 | 4.2.1 | Hannuksela 1975 | Hannuksela 1975 | 30 |
| 4 | 4.2 | 4.2.1 | Wahlberg 1975 | Wahlberg 1975 | 30 |
| 4 | 4.2 | 4.2.1 | Hirvonen et al. 1976 | Hirvonen et al. 1976 | 30 |
| 4 | 4.2 | 4.2.1 | Maggio et al. 1978 | Maggio et al. 1978 | 36 |
| 4 | 4.2 | 4.2.1 | Andanson et al. 1979 | Andanson et al. 1979 | 36 |
| 4 | 4.2 | 4.2.1 | Calnan 1979, 1981 | Calnan 1979, 1981 | 36 |
| 4 | 4.2 | 4.2.1 | Cronin 1980 | Cronin 1980 | 37 |
| 4 | 4.2 | 4.2.1 | Dodds and Butler 1981 | Dodds and Butler 1981 | 37 |
| 4 | 4.2 | 4.2.1 | Marks 1981 | Marks 1981 | 37 |
| 4 | 4.2 | 4.2.1 | Menne' et al. 1981 | Menne' et al. 1981 | 37 |
| 4 | 4.2 | 4.2.1 | Chrostek and Moshell 1982 | Chrostek and Moshell 1982 | 38 |
| 4 | 4.2 | 4.2.1 | Levy and Hanoa 1982 | Levy and Hanoa 1982 | 38 |
| 4 | 4.2 | 4.2.1 | Roure et al. 1982 | Roure et al. 1982 | 39 |
| 4 | 4.2 | 4.2.1 | Certin and Zissu 1983 | Certin and Zissu 1983 | 39 |
| 4 | 4.2 | 4.2.1 | Norback et al. 1983a,b,c; 1988 | Norback et al. 1983a,b,c; 1988 | 39 |
| 4 | 4.2 | 4.2.1 | Jeansson et al. 1983, 1984 | Jeansson et al. 1983, 1984 | 40 |
| 4 | 4.2 | 4.2.1 | Marks et al. 1984; Trautlein et al. 1984 | Marks et al. 1984; Trautlein et al. 1984 | 40 |
| 4 | 4.2 | 4.2.1 | Messite and Baker 1984; Messite and Fannick 1980 | Messite and Baker 1984; Messite and Fannick 1980 | 40 |
| 4 | 4.2 | 4.2.1 | Menne' and Hjorth 1985 | Menne' and Hjorth 1985 | 41 |
| 4 | 4.2 | 4.2.1 | Olsen and Morck 1985 | Olsen and Morck 1985 | 41 |
| 4 | 4.2 | 4.2.1 | Apol and Thoburn 1986 | Apol and Thoburn 1986 | 41 |
| 4 | 4.2 | 4.2.1 | Bennett and Chrostek 1986 | Bennett and Chrostek 1986 | 42 |
| 4 | 4.2 | 4.2.1 | ChoViletal.1986 | ChoViletal.1986 | 42 ​ |
| 4 | 4.2 | 4.2.1 | Shehade et al. 1987 | Shehade et al. 1987 | 42 |
| 4 | 4.2 | 4.2.1 | LaMarte et al. 1988 | LaMarte et al. 1988 | 43 |
| 4 | 4.2 | 4.2.1 | Hammel 1990 | Hammel 1990 | 43 |
| 4 | 4.2 | 4.2.1 | Kanerva et al. 1990a,b; 1993 | Kanerva et al. 1990a,b; 1993 | 44 |
| 4 | 4.2 | 4.2.1 | Burton and Malkin 1993 | Burton and Malkin 1993 | 44 |
| 4 | 4.2 | 4.2.1 | Sim and Echt 1993 | Sim and Echt 1993 | 45 |
| 4 | 4.2 | 4.2.1 | Zimmer and Hadwen 1993 | Zimmer and Hadwen 1993 | 45 |
| 4 | 4.2 | 4.2.1 | Ziem and McTamney 1997 | Ziem and McTamney 1997 | 45 |
| 4 | 4.2 | 4.2.1 | Smith et al. 1999 | Smith et al. 1999 | 46 |
| 4 | 4.2 | 4.2.2 | NIOSH docket submissions | NIOSH docket submissions | 46 |
| 4 | 4.2 | 4.2.2 | 4.2.2.1 | Unpublished case reports and case series submitted by individuals | 46 |
| 4 | 4.2 | 4.2.2 | 4.2.2.2 | Inquires about health effects submitted by CCP manufacturers | 47 |
| 4 | 4.2 | 4.2.2 | 4.2.2.2 | Appleton Papers, Inc., 1987 | 47 |
| 4 | 4.2 | 4.2.2 | 4.2.2.2 | Moore Business Forms, Inc., 1987 | 47 |
| 4 | 4.2 | 4.2.2 | 4.2.2.2 | CCP Manufacturers 1998 | 47 |
| 4 | 4.2 | 4.2.3 | Cross-sectional studies | Cross-sectional studies | 48 |
| 4 | 4.2 | 4.2.3 | 4.2.3.1 | Cross-sectional studies of indoor air contaminants | 57 |
| 4 | 4.2 | 4.2.3 | 4.2.3.1 | Skov et al. 1987, 1989 | 57 |
| 4 | 4.2 | 4.2.3 | 4.2.3.1 | Zweers et al. 1992 | 58 |
| 4 | 4.2 | 4.2.3 | 4.2.3.1 | Mendell 1991 and Fiske et al. 1993 | 58 |
| 4 | 4.2 | 4.2.3 | 4.2.3.1 | Omland et al. 1993 | 58 |
| 4 | 4.2 | 4.2.3 | 4.2.3.1 | Jaakkola and Jaakkola 1999 | 58 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Cross-sectional studies of CCP exposures | 61 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Fristedt and Pettersson 1980 | 61 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Andersson et al. 1980 | 63 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Cberg 1980 | 63 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Sondergard 1981 | 63 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Menne' et al. 1981 | 63 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Gothe et al. 1981 and Norback et al. 1983b | 64 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Kolmodin-Hedman et al. 1981 | 66 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Kleinman and Horstman 1982 | 66 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Pryor et al. 1983 | 67 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Olsen and Morck 1985 | 67 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Omland et al. 1993 | 67 |
| 4 | 4.2 | 4.2.3 | 4.2.3.2 | Apol and Thoburn 1986 | 71 |
| 4 | 4.2 | 4.2.4 | Laboratory studies in humans | Laboratory studies in humans | 71 |
| 4 | 4.2 | 4.2.4 | 4.2.4.1 | Peer-reviewed literature studies | 71 |
| 4 | 4.2 | 4.2.4 | 4.2.4.1 | Nilzen 1975 | 71 |
| 4 | 4.2 | 4.2.4 | 4.2.4.1 | Jeansson et al. 1983, 1984 | 74 |
| 4 | 4.2 | 4.2.4 | 4.2.4.1 | Morgan and Camp 1986 | 75 ​ |
| 4 | 4.2 | 4.2.4 | 4.2.4.2 | NIOSH docket submissions | 75 |
| 4 | 4.2 | 4.2.4 | 4.2.4.2 | RIPT studies | 75 |
| 4 | 4.2 | 4.2.4 | 4.2.4.2 | Tests under simulated conditions of use | 98 |
| 4 | 4.2 | 4.2.4 | 4.2.4.3 | Summary | 99 |
| 4 | 4.3 | Animal Studies | Animal Studies | Animal Studies | 99 |
| 4 | 4.3 | 4.3.1 | Published studies | Published studies | 99 |
| 4 | 4.3 | 4.3.1 | Hasegawa et al. 1982a | Hasegawa et al. 1982a | 99 |
| 4 | 4.3 | 4.3.1 | Hasegawa et al. 1982b | Hasegawa et al. 1982b | 99 |
| 4 | 4.3 | 4.3.1 | Lofroth 1982 | Lofroth 1982 | 99 |
| 4 | 4.3 | 4.3.1 | Certin and Zissu 1983 | Certin and Zissu 1983 | 100 |
| 4 | 4.3 | 4.3.1 | Cameron et al. 1986 | Cameron et al. 1986 | 101 |
| 4 | 4.3 | 4.3.1 | Wolkoffet al. 1988 | Wolkoffet al. 1988 | 101 |
| 4 | 4.3 | 4.3.1 | Anderson 1992 | Anderson 1992 | 101 |
| 4 | 4.3 | 4.3.2 | NIOSH docket submissions | NIOSH docket submissions | 102 |
| 4 | 4.3 | 4.3.3 | Summary | Summary | 105 |
| 5 | Summary and Conclusions | Summary and Conclusions | Summary and Conclusions | Summary and Conclusions | 107 |
| 5 | 5.1 | Irritation of the skin, eyes, and upper respiratory tract | Irritation of the skin, eyes, and upper respiratory tract | Irritation of the skin, eyes, and upper respiratory tract | 107 |
| 5 | 5.1 | 5.1.1 | Strength of the association | Strength of the association | 110 |
| 5 | 5.1 | 5.1.2 | Consistency | Consistency | 110 |
| 5 | 5.1 | 5.1.3 | Specificity | Specificity | 110 |
| 5 | 5.1 | 5.1.4 | Relationship in time (temporality) | Relationship in time (temporality) | 111 |
| 5 | 5.1 | 5.1.5 | Biological gradient | Biological gradient | 111 |
| 5 | 5.1 | 5.1.6 | Biological plausibility | Biological plausibility | 111 |
| 5 | 5.1 | 5.1.7 | Coherence | Coherence | 112 |
| 5 | 5.1 | 5.1.8 | Experimental evidence | Experimental evidence | 112 |
| 5 | 5.1 | 5.1.9 | Reasoning by analogy | Reasoning by analogy | 113 |
| 5 | 5.1 | 5.1.10 | Summary | Summary | 113 |
| 5 | 5.2 | Allergic contact dermatitis | Allergic contact dermatitis | Allergic contact dermatitis | 113 |
| 5 | 5.3 | Systemic reactions | Systemic reactions | Systemic reactions | 114 |
| 5 | 5.4 | Conclusions | Conclusions | Conclusions | 114 |
| 6 | Recommendations | Recommendations | Recommendations | Recommendations | 117 |
| 6 | 6.1 | Historical recommendations in the scientific literature | Historical recommendations in the scientific literature | Historical recommendations in the scientific literature | 117 |
| 6 | 6.2 | NIOSH recommendations | NIOSH recommendations | NIOSH recommendations | 118 |
| References | References | References | References | References | 120 |
| Other publications examined | Other publications examined | Other publications examined | Other publications examined | Other publications examined | 129 |
This work is a work of the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention in the United States Department of Health and Human Services, taken or made as part of an employee's official duties. As a work of the U.S. federal government, it is in the public domain.
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