What is Polymer Fume Fever (Teflon Flu)?
Polytetrafluoroethylene, or PTFE for short, is a man-made substance made from a gas called tetrafluoroethylene. Its discovery was made by accident in 1938 by a group of scientists at DuPont. They noticed that the tetrafluoroethylene gas had turned into a polymer (a chain of small molecules joined together) in uncoated metal containers under high pressure. This finding sparked more research and eventually led to the creation of a new material with numerous uses.
At room temperature, PTFE is nonreactive, repels water, and has low friction. These capabilities mean it can be used widely across different fields. You’ll find it in products like Teflon®, where it provides a nonstick surface for pans, and Gore-Tex®, where it makes outdoor clothing breathable and highly water-resistant. It’s also used in various medical devices like the coatings for stents, certain types of grafts used in bypass surgery, and meshes used in hernia repair.
In the beginning, people believed that PTFE was quite safe because of its stability and lack of reactivity. But this idea was challenged in 1951 when the first report of polymer fume fever appeared, recorded in workers exposed to PTFE. There have been other instances since then that indicate bad effects on health from overheating products made from fluorocarbon polymers like PTFE.
What Causes Polymer Fume Fever (Teflon Flu)?
Polymer Fume Fever is caused by breathing in fumes that result from the breakdown of fluoropolymers when they’re heated. Perhaps the most well-known fluoropolymer is polytetrafluoroethylene (PTFE), largely recognized because of its widespread industrial use. However, this condition can also be caused by other related materials like fluorinated polyethylenepropylene.
Similar situations have been reported due to overheating of chloropolymers, another type of polymer. However, the exact compound causing the condition couldn’t be identified in those instances.
Now, while PTFE can begin releasing fumes as low as 260 °C (or 500 °F), people generally don’t start experiencing symptoms until the temperature reaches around 350 °C (662 °F). The breakdown process of the material intensifies at 400 °C (752 °F).
Several compounds like Perfluoroisobutylene, fluoroethylene, hexafluoroethane, octafluorocyclobutane, and hexafluoropropylene have all been found during the breakdown of fluoropolymers and are believed to be the main substances causing Polymer Fume Fever. If fluoropolymers are heated to even higher temperatures, over 500 °C, they release potentially harmful gases called hydrogen fluoride and carbonyl fluoride.
Risk Factors and Frequency for Polymer Fume Fever (Teflon Flu)
Polymer fume fever is not fully understood and is likely often not reported. Initially, this condition was seen in people who worked with PTFE (a type of polymer) or products coated with PTFE. It was identified that poor industrial hygiene was the main cause, with cases often linked to workers who smoked without washing their hands after working with raw PTFE. Breathing in the contaminated smoke could then trigger the condition.
It was also found that inhaling the air where PTFE-coated items had been burned or fused could cause similar issues. Today, most cases occur in domestic environments due to fumes from overheated PTFE-coated pans. The risks are higher when the pans are dry because water or oil can have a protective effect.
- Exposures to PTFE usually happen at home, often from using pans coated with PTFE that get too hot.
- The risk of inhaling harmful vapors is higher when the pan is dry.
- PTFE exposure is less common once cooking oils are on the pan, as these oils generally don’t reach high enough temperatures to produce harmful PTFE fumes.
Other less common ways the fumes might be inhaled include breathing in hairspray that contains fluorocarbons, or inhaling smoke from using mold-release sprays and dry lubricants.
Between 2006 and 2012, an average of 9 cases of polymer fume fever each year were reported to US regional poison control centers. However, these figures are likely inaccurate due to underreporting.
- A study found only 10% of workers who had symptoms sought medical assistance.
- Many patients do not tell their healthcare provider about their exposure to PTFE or fluorocarbon-coated items.
- Healthcare providers may not be aware of the link between inhaling fumes and the symptoms their patient is experiencing.
- Not all cases are reported to the poison control center even when the connection to the exposure is made.
Recent research has also suggested that long-term exposure to PTFE aerosols (even when they’re not heated) could potentially put workers at risk for a type of lung disease called granulomatous lung disease.
Signs and Symptoms of Polymer Fume Fever (Teflon Flu)
Polymer fume fever is a condition that can make you feel like you have the flu. Symptoms generally kick in within 12 hours of being exposed to certain substances, but sometimes they may not show up for up to 24 hours. Common signs of this condition include a fever, muscle aches, shortness of breath, chest tightness, a dry cough, and a headache. Despite these symptoms, people with polymer fume fever are unlikely to have low levels of oxygen or abnormal blood pressure or heart rate.
During a physical examination, doctors might not notice anything out of the ordinary except possibly some abnormal lung findings – like a dry, non-productive cough, bronchospasm (tightening of the muscles that line the lungs’ airways), or crackling sounds in the lungs. Sometimes, you might even have fluid build-up in the lungs that is not linked to heart problems.
To be diagnosed with polymer fume fever, you must have been exposed to particular substances called fluorocarbon degradation products. This can happen if you accidentally overheat nonstick cookware or if you smoke after working with certain materials like PTFE particles. Exposures at work are less common these days thanks to improved safety controls, but it might be worth mentioning if you forgot to wash your hands before smoking.
Testing for Polymer Fume Fever (Teflon Flu)
If your doctor suspects that you may have polymer fume fever – a condition caused by inhaling certain types of smoke or fumes – they may ask for a blood test and chest X-ray. The blood test can show an increased number of white blood cells, a sign that your body might be fighting an infection. On the other hand, the chest X-ray is often normal, but in severe cases, it might show signs of fluid in your lungs, similar to what you might see in a condition called pulmonary edema.
Additionally, your doctor might order lung function tests, which measure how well you can breathe out and how much air your lungs can hold. These tests might not be very helpful in diagnosing or treating polymer fume fever. This is because some patients with this condition can have normal lung function results, while others can show a mild issue with the flow of air through the lungs that might be worse than their usual test results. It’s also crucial to be aware that these results can be influenced if the patient has a history of smoking. This is because smoking can also affect the lungs, making it more challenging to understand the lung function results.
Treatment Options for Polymer Fume Fever (Teflon Flu)
Depending on its severity, the effects of polymer fume fever, a type of illness caused by inhaling certain plastic fumes, typically improve on their own over a short period of time. Treatment focuses on the symptoms a person is experiencing. For example, medication like acetaminophen (a common over-the-counter pain reliever) or nonsteroidal anti-inflammatory drugs (also known as NSAIDs, these reduce pain and inflammation) can help manage fever. In cases where the airways become narrow and tight – a condition known as bronchospasm – inhaled medications such as beta-agonists or glucocorticoids can offer relief. If a person’s oxygen levels are low, they may need additional oxygen.
If the condition worsens to become acute respiratory distress syndrome (ARDS) or if the lungs fill with fluid – a condition known as severe non-cardiogenic pulmonary edema – more intensive treatment like bilevel-positive airway pressure (BiPAP) or a ventilator support via a procedure called endotracheal intubation may be necessary. A BiPAP machine helps by increasing the pressure of the air breathed in thereby easing their efforts to breathe. An endotracheal intubation involves inserting a tube through the mouth or nose and into the windpipe to allow a ventilator machine to support breathing.
Whether someone should be admitted to the hospital depends on when they were exposed to the fumes and the severity of their symptoms. For example, people who have been exposed to overheated PTFE (a type of plastic) – such as that found in non-stick cookware – for a long period may need to be observed in the hospital, especially as their symptoms could get worse over time.
What else can Polymer Fume Fever (Teflon Flu) be?
To diagnose polymer fume fever, it’s necessary to identify exposure to a certain type of plastic, known as a fluoropolymer, in a patient’s history. We also need to rule out other potential causes.
Several conditions can have symptoms similar to polymer fume fever and must be considered as well. These can be divided into two categories: non-infectious and infectious.
The non-infectious conditions include:
- Metal fume fever
- Trimellitic flu
- Farmer’s lung
- Various types of hypersensitivity pneumonitis
The infectious conditions that could mimic polymer fume fever include some common respiratory diseases caused by bacteria or viruses such as:
- Influenza
- Sars-cov-2
- Parainfluenza
- Respiratory syncytial virus
However, polymer fume fever does not typically come with common upper respiratory symptoms like nasal congestion, runny nose, and ear pain. If a patient with suspected polymer fume fever also has diarrhea, this suggests a different cause for their symptoms.
What to expect with Polymer Fume Fever (Teflon Flu)
Polymer fume fever typically isn’t severe, and most people who get it recover completely and quickly. Usually, the symptoms reach their highest intensity within 24 hours of being exposed to the polymer fumes. After that, they start to lessen over the next 24 to 48 hours. Even in more serious cases, where patients might experience pulmonary edema (a condition where fluid fills up the lungs), they are expected to recover fully in around 5 to 10 days. Death from polymer fume fever is incredibly rare. Also, unlike metal fume fever, polymer fume fever doesn’t cause tachyphylaxis – a rapid decrease in response to a drug after repeated doses.
Possible Complications When Diagnosed with Polymer Fume Fever (Teflon Flu)
Most people recover completely. Lasting damage to the lungs, like scarring (pulmonary fibrosis), is seldom mentioned and seems limited to those repeatedly exposed.
Key Points:
- Most people recover completely
- Lasting lung damage is rare
- Repeated exposure may increase risk of damage
Preventing Polymer Fume Fever (Teflon Flu)
If your polymer fume fever – a condition caused by inhaling certain types of toxic fumes – has been linked to using cookware coated with PTFE (a type of plastic often used in non-stick surfaces) and heated beyond its limit, it’s important to remember the dangers of cooking with pans unattended. Considering cookware made from enameled cast iron or stainless steel may be a good alternative, as they don’t produce harmful vapors if accidentally overheated.
If you believe your polymer fume fever was caused by fumes encountered in the workplace, it’s key to have the environment evaluated by a professional who specializes in health and safety, called an industrial health hygienist. A detailed evaluation of the workplace could reveal areas and practices that need to be improved for better safety, even if the issue seems as simple as needing to wash your hands more thoroughly. Identifying these issues not only helps prevent future problems, but also checks if other workers are showing symptoms but may be unwilling to seek help.
Healthcare providers will also advise workers to wear the correct personal safety equipment and wash their hands properly until a formal workplace review is done.
In the US, you have the right to a safe workplace. You can request a Health Hazard Evaluation (HHE), a detailed safety assessment of your workplace, from organizations like the National Institute of Occupational Health and Safety (NIOSH) or the Occupational Health and Safety Administration (OSHA). If you’re worried about backlash, OSHA rules give you the option to request an investigation anonymously.
