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Environmental Medicine: Integrating a Missing Element into Medical Education
Gastrointestinal Effects
❑ Gastrointestinal effects may result after chlordane exposure by any route.
Anorexia, nausea, and vomiting can occur in acute or subacute chlordane poisonings by any exposure route, and anorexia and nausea may persist for months. In cases of inhalation and dermal exposure, these effects are most likely secondary to CNS effects. After deliberate ingestion in one case, chemical burns in the mouth, hemorrhagic gastritis, and hematochezia (passage of bloody stools) were reported; the material ingested may have been an older chlordane preparation that contained highly irritating hexachlorocyclopentadiene. Chlordane produced after 1951 does not contain this impurity and is nonirritating. Vomiting after ingestion of some chlordane preparations can result in pulmonary aspiration of the solvent vehicle, which may cause lipoid pneumonitis.
Carcinogenicity
❑ Because of experimental animal data, EPA considers chlordane a probable human carcinogen.
Results of various epidemiologic studies regarding chlordane’s carcinogenicity in humans are conflicting and inconclusive. Some studies have suggested a relationship between chlordane exposure and development of brain, blood, lung, or bladder cancers. However, studies of chlordane-manufacturing workers (theoreti cally the population that would receive the greatest exposure) do not confirm the relationship between chlordane exposure and cancer mortality.
Because of the increased incidence of hepatocellular carcinomas in some experimental animals exposed to chlordane in their diet, EPA has placed chlordane in its Class B2 (probable human carcinogen) category. The International Agency for Research on Cancer (IARC) considers the evidence for carcinogenesis induced by chlordane limited in animals and inadequate in humans.
Other Effects
❑ Various blood dyscrasias have been associated with environmental chlordane exposures, but the evidence is anecdotal and inconclusive.
Various blood dyscrasias have been associated with chronic environmental exposure to chlordane, but not with occupational exposure. The blood dyscrasias noted have included aplastic anemia, refractory megaloblastic anemia, thrombocytopenic purpura, acute lymphoblastic leukemia, and acute myelocytic leukemia. The low incidence of most blood dyscrasias limits the feasibility of an epidemiologic study, and the association between these diseases and chlordane has been made on the basis of case reports. A clear causal relationship has not been shown.
❑ No data on reproductive and developmental effects of chlordane in humans are available.
No studies regarding reproductive or developmental effects of chlordane in humans have been reported. When chlordane was administered by gavage to experimental animals, effects in offspring ranged from decreased fertility to hematopoietic and neurologic disorders.
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