Flight attendant uniforms

 

Across industries, the most talked about factors to consider when selecting an employee uniform are comfort, durability, fabric care instructions, and style. Within aviation, flammability is also important. For flight attendants, until 2011, the primary uniform-related health issue reported to AFA-CWA was the need for airlines to offer a non-wool uniform option to the small number of crews who have a wool allergy. Starting in early 2011, though, hundreds of AFA-CWA members at Alaska Airlines reported symptoms caused by exposure to chemical contaminants in employee uniform fabrics manufactured by TwinHill (a subsidiary of Men’s Wearhouse). From 2016-2020, AFA received a similar pattern of reports from our members at PSA, Piedmont, and Envoy Air. And in 2018, we started to receive uniform reaction reports from Delta Airlines flight attendants. A short summary of these outbreaks is provided here. These reports have led AFA-CWA to research the literature regarding chemical contaminants in fabrics sold in the US, the chemical additives in these uniform fabrics, and recommendations for uniform garment selection to prevent these types of outbreaks in the first place.

 

In 2018, researchers at the Harvard School of Public Health published their study into the symptoms reported by Alaska Airlines flight attendants before, during, and after the new uniforms. They formally recognized “a relationship between health complaints and the introduction of new uniforms.” And there are other examples of chemical-contaminated uniform clothing generating reaction reports amongst flight attendants, ambulance employees, and TSA officers.

 

This webpage is intended to provide basic information to our flight attendant members who are experiencing uniform-related symptoms and are seeking information to bring to their doctors. Some of the information is airline-specific, but the lessons learned from our research into fabric contaminants and reported symptoms apply system-wide. Thus, beyond trying to serve the needs of individual members with relevant information, we provide recommendations for union representatives and airline management to facilitate the selection of safe fabrics and establish a means for crewmembers to report any problems, especially during the early months of a new uniform “roll out.” The goal is to prevent, or at least quickly identify and remedy, uniform-related ill health. Comfort, durability, fabric care, and style all matter, but health and safety must be number one.

 

Nov. – Dec. 2023 – NIOSH evaluated uniform reaction reports documented at Delta Airlines: In November 2023, NIOSH released its HHE report. In December 2023, AFA responded. 

 

July 3, 2023 – Are your clothes making you sick? The opaque world of chemicals in fashion

 

2016-2020: Uniform reactions reported at four US airlines: Flight attendants at Piedmont Airlines, PSA Airlines, Envoy Air, and American Airlines documented symptoms coincident with the introduction of new TwinHill uniforms in the spring/summer of 2016 until the uniforms were replaced in early March 2020. As with the reports reported at Alaska Airlines, most of the symptoms were irritant and allergenic (primarily dermal), with some reports of other effects such as hair loss, menstrual irregularities, and chronic headaches. The symptoms were consistent with the chemical compounds found in the fabrics. NIOSH evaluated this outbreak and published a report in Jan. 2018.

 

Nov. 2012 -- Bigger picture on toxins in clothes: Greenpeace International commissioned an investigation that delves even further into the hazardous chemicals used in the production of high street fashion. You can read the Greenpeace report “Toxic threads: The big fashion stitch up” and a related op ed article. 

  

2011-2014: Uniform reactions reported at Alaska Airlines: Flight attendants at Alaska Airlines documented symptoms coincident with the introduction of new TwinHill uniforms in early 2011 until the garments were replaced in Feb. 2014. In total, AFA received written reports from 794 of its approximately 2,900 flight attendants. Of these, the reports from 753 flight attendants cited at least one symptom of either irritancy or sensitization (i.e., skin, eyes, or respiratory effects; primarily skin effects). Other reported symptoms included menstrual irregularities and chronic headaches. Also, 137 flight attendants reported hair loss. The symptoms were consistent with the chemical compounds measured in the fabrics.

 

Oct. 24, 2011: Letter from AFA-CWA to Consumer Product Safety Commission, plus attachments - AFA-CWA asked CPSC to investigate and recall TwinHill employee uniforms at Alaska Airlines in light of the hundreds of reports of uniform-related illness.  CPSC did not respond to our request, but the Agency did respond to individual reports from flight attendants, stating that it does not have jurisdiction over employee uniforms, so CPSC forwarded the reports to the FAA. Interestingly, FAA sent the reports to OSHA. Then OSHA questioned whether it had jurisdiction, so told the flight attendants to contact NIOSH instead.

 

Aug. 2012: Heavy metals testing of TwinHill uniform fabric commissioned by Alaska Airlines reported that 13 of 35 fabric samples appeared to contain excess levels of arsenic and lead, 6 of 35 samples appeared to contain excess levels of chromium (not hexavalent), and one sample contained excess hexavalent chromium, all as compared to the Oeko-Tex 100 fabric standard.

 

Oct. 22, 2012: NIOSH publishes Health Hazard Evaluation into uniform-related symptoms at Alaska Airlines (HETA 2012-0075). AFA-CWA responded to NIOSH HETA 2012-0075. Despite its serious flaws, this NIOSH HHE report was the basis for a 2016 court ruling against the flight attendants’ claims of ill health which their doctors attributed to the uniform garments. TwinHill affirmed the NIOSH report and promoted their win.

 

Feb. 2013: “Investigation into chemicals in uniforms & lessons learned” - AFA-CWA PowerPoint presentation at AFA-CWA Safety, Health, and Security Roundtable meeting in Chicago, IL. (Photo selection and slides revised May 2013; photos included with permission.)

 

May 2013: “Your uniform, your health” - Informational bulletin published by AFA-Alaska Airlines MEC regarding uniform issues. (Originally published 6/2012; revised 5/2013.)

 

July 2013: “Information on chemical content of TwinHill uniforms” - Summary of chemicals identified in TwinHill uniform garments in circulation at Alaska Airlines, including tributyl phosphate, orange dye 37/76, diisodecyl maleate, 2-ethylhexyl fumarate, arsenic (see list above), chromium (see list above), lead (see list above), cobalt, and antimony.

 

Jan. 2018: Researchers at the Harvard School of Public Health published their study into the symptoms reported by Alaska Airlines flight attendants before, during, and after the new uniforms. They formally recognized “a relationship between health complaints and the introduction of new uniforms.”

Links to abstracts/articles of interest:

 

Metal content in textile and nano-textile products (2022)  https://pubmed.ncbi.nlm.nih.gov/35055766/

 

Symptoms related to new flight attendant uniforms (2018) https://pubmed.ncbi.nlm.nih.gov/29295715/

 

Substitution of PFAS chemistry in outdoor apparel, impact on repellency performance (2017) https://pubmed.ncbi.nlm.nih.gov/28460297/

 

Detection of azo dyes and aromatic amines in women undergarments (2016) https://pubmed.ncbi.nlm.nih.gov/27149414/

 

Toxicity appraisal of untreated dyeing industry wastewater based on chemical characterization and short term bioassays (2016) - https://pubmed.ncbi.nlm.nih.gov/26920697/

 

Patch testing to a textile dye mix by the international contact dermatitis research group (2015) - https://pubmed.ncbi.nlm.nih.gov/26172486/

 

Patch testing with a textile dye mix in two concentrations - a multicentre study by the Swedish contact dermatitis research group (2015) - https://pubmed.ncbi.nlm.nih.gov/25166030/

 

Case report: poisoning with lead, mercury, arsenic caused hair loss, rash, gastrointestinal, neuropathy, weakness (2013) - https://pubmed.ncbi.nlm.nih.gov/23582936/

 

Case report: metal sensitivity caused systemic dermatitis and hair loss (2013) - https://pubmed.ncbi.nlm.nih.gov/23590797/

 

Contact allergy from disperse dyes in textiles: a review (2013) - https://pubmed.ncbi.nlm.nih.gov/23289879/

 

Patch testing with contact allergens: the Mayo Clinic experience (2012) - https://pubmed.ncbi.nlm.nih.gov/23169208/

 

Immunoregulation of skin sensitization and regulatory T cells (2012) - https://pubmed.ncbi.nlm.nih.gov/22804346/

 

Assessment of the sensitizing potential of textile disperse dyes and some of their metabolites by the loose-fit coculture-based sensitization assay (2012) - https://pubmed.ncbi.nlm.nih.gov/22349058/

 

Allergic contact dermatitis probably caused by mercaptobenzothiazole in thermal undergarments (2012) - https://pubmed.ncbi.nlm.nih.gov/22486572/

 

Globalisation and allergy (2011) - https://pubmed.ncbi.nlm.nih.gov/21546337/

 

Allergic contact dermatitis from formaldehyde textile resins (2010) - https://pubmed.ncbi.nlm.nih.gov/20233544/

 

Halogenated flame retardants: Do the fire safety benefits justify the risks? (2010) - https://pubmed.ncbi.nlm.nih.gov/21268442/

 

Formaldehyde in textiles: GAO 10-875 (2010; not peer-reviewed) - https://www.gao.gov/assets/gao-10-875.pdf

 

Association between indoor exposure to semi‐volatile organic compounds and building‐related symptoms among the occupants of residential dwellings (2010) - https://pubmed.ncbi.nlm.nih.gov/20028434/

 

Allergic contact dermatitis to dimethyl fumarate in footwear (2010) - https://pubmed.ncbi.nlm.nih.gov/20136899/

 

An epidemic of furniture-related dermatitis: searching for a cause (2010) - https://pubmed.ncbi.nlm.nih.gov/19796182/

 

Contact allergy: Alternatives for the 2007 North American contact dermatitis group (NACDG) standard screening tray (2008) - https://pubmed.ncbi.nlm.nih.gov/18215657/

 

Contact allergy to textile dyes in southern Sweden (2006) - https://pubmed.ncbi.nlm.nih.gov/16787452/

 

Diagnosis and treatment of dermatitis due to formaldehyde resins in clothing (2004) - https://pubmed.ncbi.nlm.nih.gov/15842060/

 

Atypical and unusual clinical manifestations of contact dermatitis to clothing (textile contact dermatitis): case presentation and review of the literature (2003) -  https://pubmed.ncbi.nlm.nih.gov/12952748/

 

Disperse dyes in fabrics of patients patch-test-positive to disperse dyes (2003) - https://pubmed.ncbi.nlm.nih.gov/14738722/

 

Occupational contact dermatitis to textile dyes in airline personnel (2001) - https://pubmed.ncbi.nlm.nih.gov/11753894/

 

Acute hypoallergenicity (1998) - https://pubmed.ncbi.nlm.nih.gov/9840282/

 

Chronic generalized eczema caused by multiple dye sensitization (1996) –

https://pubmed.ncbi.nlm.nih.gov/8955485/

 

Contact dermatitis in the textile industry: a review of 72 patients (1996) -  https://pubmed.ncbi.nlm.nih.gov/8955486/

 

Textile dye dermatitis (1995) - https://pubmed.ncbi.nlm.nih.gov/7896955/ 

 

Allergic and irritative textile dermatitis (1994) - https://pubmed.ncbi.nlm.nih.gov/8115841/

 

Textile dye dermatitis (1992) -  https://pubmed.ncbi.nlm.nih.gov/1493688/

 

Contact dermatitis from fabrics (1986) - https://pubmed.ncbi.nlm.nih.gov/2943672/

 

Clothing dermatitis (1986) - https://pubmed.ncbi.nlm.nih.gov/3743044/

 

Toxic effects of metals from the environment on hair growth and structure (1979) - https://pubmed.ncbi.nlm.nih.gov/227944/

 

A case for diagnosis (alopecia areata; arsenical dermatitis?) (1945) - https://pubmed.ncbi.nlm.nih.gov/21065672/

 

Chemicals in fabrics as potential skin irritants (1941) - https://pubmed.ncbi.nlm.nih.gov/19992434/