Chloramine and Your Shower

[drewkitty]

Someone pointed me towards foxgrrl's LJ post about this chemical used to disinfect drinking water, through the addition of both chlorine and ammonia.

Executive Summary

• Chloramine, formed in the municipal water supply by the use of both chlorine and ammonia and used as a disinfectant, has not been extensively studied for its safety in humans. High doses (as with chlorine, iodine, ozone and other water supply disinfectants) are known to be toxic.
  
• Water quality agencies are concerned primarily with microbiological quality, i.e. does the water contain bacteria. They are right on the numbers, considering that a clean water supply is one of the underappreciated essentials for technological civilization. However, their interest in and ability to clean potable water of organics, volatiles, and toxic substances is very limited.
  
• Volatiles such as chloramine (and di- and tri-chloramines), chlorine, and other organic chemicals can be absorbed and more importantly, inhaled -- which crosses the blood barrier directly through the lungs. These routes of exposure have not been extensively studied and may have serious health effects at much lower doses than with ingestion (where the digestion process breaks down these chemicals.)
  
• As I am neither a chemist nor a water quality specialist, and especially not a doctor, I don't know if the chloramine - nitrate - hemoglobin binding route posited by foxgrrl is valid or not. However, the fact that she notices, as a trained observer, a substantial effect on her health is good enough for me to also take notice.
  
• I (drewkitty), on no particular authority whatsoever, strongly recommend that you ventilate your bathroom while taking a shower. Use strong positive pressure ventilation, i.e. a powered fan within 3" of the window, pointing out the window, with a cracked bathroom door. Do not exhaust into the house. Overhead fans do not have sufficient exchange. Limit shower temperature to a comfortable level and reduce shower times as much as feasible, i.e. <10 minutes or take a "Navy" shower of wet-stop-soap-rinse. Also consider taking a bath instead. (Droplet formation in showers causes more exposure of water to air and thus more offgassing.)
  
• This recommendation does not hurt anything, saves hot water energy, reduces mold formation in bathrooms . . . and if there is anything to this chloramine/inhaled water contaminants issue, would reduce exposure dramatically, anywhere from 30% to 70%.
  
• At the present state of the art, shower filters are of limited and controversial value. Save your money.
  
• If one were highly concerned, one might purchase a whole-house RO or multiple-filter carbon system (we are talking thousands here) . . . or if one purchases a shower filter of dubious quality, either a rigorous replacement schedule should be followed or a testing kit should be used, or both.
  

Readers of the Deviant Survival Guide are reminded that paranoia is unhealthy.




There are several routes of exposure of a chemical into the body:

• ingestion: eating or drinking
  
• injection: forcing under pressure through breaks in the skin
  
• absorption: through the skin or mucous membranes
  
• inhalation: through the lungs
  

Current water system practice neglects the absorption and inhalation routes. Ingestion is about 25% of your daily exposure to organic/volatile chemicals in water -- which you can dodge neatly by drinking filtered water as much as possible. Surprisingly, general inhalation (i.e. from your work HVAC system, doing the dishes at home, etc.) is another 25%. Shower inhalation and shower skin absorption together are about 15%. The other 35% is almost entirely your diet, of which dairy products are about a third, coming in at about 13% by themselves.

So if one were to avoid ingestion and dairy products, as in foxgrrl's case, just under half would be from the work HVAC system and a quarter from the shower exposure. Interesting. Especially as some high-tech workplaces clean out chloramine because it interferes with manufacturing processes. Others use water purification techniques with incidental removal effects.

To quote from the SF water people, "The Integrated Risk Information System (IRIS) provides a summary of the EPA’s risk assessment of monochloramine. The summary includes information on oral toxicity, chronic exposure and carcinogenicity of monochloramine, based on human and animal studies. The oral reference dose for monochloramine of 0.1 mg/kg/day is based principally on the National Toxicology Program studies in rats and mice that were published in 1992. (US DHHS 1992) The rat studies found "no clinical changes attributable to consumption of chloraminated water" and "no non-neoplastic lesions after the 2-year treatment with chloraminated water." The mouse studies had similar results. (EPA 1992) One study in humans found no acute effects on lipid and thyroid metabolism associated with ingestion of chloraminated water at 2 ppm concentration. (Wones 1993) There is insufficient evidence to classify monochloramine as a human carcinogen. (EPA 1992)"

This appears to be testing of skin absorption and ingestion. Rats don't take showers and inhale hot water vapor.

Q: Can chloramine affect the human body through ingestion, absorption through skin during bathing?

A: When people ingest monochloramine, the monochloramine is broken down quickly in the digestive system. The chloride is eliminated through the urine, and the ammonia is transformed to urea in the urea cycle. There have been no published studies on the absorption of chloramine through the skin, in either animals or humans (EPA 1994). However, there is no evidence that chloramines would enter through the skin.

DREWKITTY SAYS: THIS IS NOT AN ANSWER!

Water that contains chloramine is safe to drink. The digestive process neutralizes the chloramine before it reaches the blood stream. Even kidney dialysis patients can drink and bathe in chloraminated water (Kirmeyer et al., 2003).

Q: What is the damage to red and white blood cells by chloramine?

A: If monochloramine enters the blood stream directly, it combines with hemoglobin (red blood cells) so it can no longer carry oxygen. This problem occurs if monochloramine is not removed from water used in dialysis machines. This does not occur by drinking chloraminated water. Studies in rats have shown that ingesting water containing monochloramine does not affect white blood cell or red blood cell counts in any clinically significant manner. (Moore 1980, as described in UNEP 2000)

Q: Can one safely wash an open wound with chloraminated water?

A: Yes. It is safe to use chloraminated water in cleaning an open wound because virtually no water can enter the bloodstream that way (Kirmeyer et al., 2003). (Kirmeyer et al. (2003), Optimizing Chloramine Treatment, Second Edition, AWWA Research Foundation, Denver, CO.) drewkitty notes that this book is $$$ expensive, $140+

Q: Can chloramine and ammonia bioaccumulate in the body?

A: Chloramine does not bioaccumulate in the body. Monochloramine is broken down quickly in the digestive system and eliminated through the urine. The breakdown product ammonia is converted to urea in the urea cycle. All proteins that people ingest are broken down into ammonia and converted to urea in the same way. These products do not bioaccumulate.

7. Human Health and the Environment (retrieved from Google cache

Users of kidney dialysis equipment are the most critical group that can be impacted by chloramine use. Chloramines can cause methemoglobinemia and adversely affect the health of kidney dialysis patients if chloramines are not removed from the dialysate water. Chloramines can also be deadly to fish. The residuals can damage the gill tissues, enter the red blood cells, and cause an acute blood disorder. Chloramine residuals should be removed from the water prior to the water contacting any fish. As such, fish hobbyists should be notified, along with pet stores and aquarium supply establishments."

It appears that at least one citizen advocacy group is calling the SF Water District out on these claims:

http://chloramine.org/chloraminefacts.htm

Also from: http://orsted.nap.edu/openbook/0309103061/html/88.html

"Contaminants in drinking water can produce adverse effects in humans due to multiple routes of exposure. In addition to risk from ingestion, exposure can also occur from inhalation and dermal routes. For example, inhalation of droplets containing respiratory pathogens (such as Legionella or Mycobacterium) can result in illness. It is known that DBPs [trihalomethanes] present in drinking water may volatilize resulting in inhalation risk, and these compounds (and likely other organics) may also be transported through the skin (after bathing or showering) into the bloodstreem (Jo et al., 1990). Reaction of disinfectants in potable water with other materials in the household may also result in indoor air exposure of contaminants; for example Shepard et. al. (1996) reported on release of volatile organics in indoor washing machines."

Jo, W.K., C.P. Weisel and P.J. Lioy. 1990. Routes of chloroform exposure and body burden from showering with chlorinated tap water. Risk Analysis 10(4): 575-580.

Thickett KM, McCoach JS, Gerber JM, Sadhra S, Burge PS. Related Articles, Links
Free Full Text Occupational asthma caused by chloramines in indoor swimming-pool air.
Eur Respir J. 2002 May;19(5):827-32.
PMID: 12030720 [PubMed - indexed for MEDLINE]

Dijkman JH, Vooren PH, Kramps JA. Related Articles, Links
Abstract Occupational asthma due to inhalation of chloramine-T. I. Clinical observations and inhalation-provocation studies.
Int Arch Allergy Appl Immunol. 1981;64(4):422-7.
PMID: 6782023 [PubMed - indexed for MEDLINE]

http://www.epa.gov/waterscience/criteria/humanhealth/chloroform/draft-chloroform-doc.pdf


"Overall evaluation: Chloramine is not classifiable as to its carcinogenicity to humans (Group 3)." -- http://www.inchem.org/documents/iarc/vol84/84-02-chloramine.html

"The steam we inhale while showering can contain up to 50 times the level of chemicals than tap water due to the fact that chlorine and most other contaminants vaporize much faster and at a lower temperature than water. Inhalation is a much more harmful means of exposure since the chlorine gas (chloroform) we inhale goes directly into our blood stream. When we drink contaminated water the toxins are partially filtered out by our kidneys and digestive system. In fact, the chlorine exposure from one shower is equal to an entire day's amount of drinking the same water."
-- http://www.air-water-nutrition-healthsmart.com/open/point_of_use_shower_filters.html

*Note however that they are trying to sell filters, which arguably do not work against this type of issue*

Occupational asthma caused by chloramines in indoor swimming-pool air.

* Thickett KM, * McCoach JS, * Gerber JM, * Sadhra S, * Burge PS.

Dept of Respiratory Medicine, Heartlands Hospital, Birmingham, UK. kt01265702@blueyonder.co.uk

The first series of three workers who developed occupational asthma following exposure to airborne chloramines in indoor chlorinated swimming pools is reported. Health problems of swimmers in indoor pools have traditionally been attributed to the chlorine in the water. Chlorine reacts with bodily proteins to form chloramines; the most volatile and prevalent in the air above swimming pools is nitrogen trichloride. Two lifeguards and one swimming teacher with symptoms suggestive of occupational asthma kept 2-hourly measurements of peak expiratory flow at home and at work, analysed using the occupational asthma system (OASYS) plotter, and/or had specific bronchial challenge testing to nitrogen trichloride, or a workplace challenge. Air measurement in one of the pools showed the nitrogen trichloride levels to be 0.1-0.57 mg x m(-3), which was similar to other studies. Two workers had peak expiratory flow measurements showing occupational asthma (OASYS-2 scores 2.88 and 3.8), both had a positive specific challenge to nitrogen trichloride at 0.5 mg x m(-3) with negative challenges to chlorine released from sodium hypochlorite. The third worker had a positive workplace challenge. Swimming-pool asthma due to airborne nitrogen trichloride can occur in workers who do not enter the water because of this chloramine. The air above indoor swimming pools therefore needs to be assessed and managed as carefully as the water.


from http://chloramine.org/toxicshowersandbaths.htm

"Chemistry VOL 130 no. 12
Pages 177-192

Toxic showers and baths

In a new study, researcher Julian Andelman, of the University of Pittsburgh Graduate School of Public Health, the National Academy of Sciences has shown that volatile chemicals present in many municipal drinking water supplies are especially toxic to people when they are exposed to them when bathing or showering. ". . .the major health threat posed by these water pollutants is far more likely to be from their inhalation as air pollutants in the home, according to preliminary data from a study Andelman and his colleagues have just reported."

"In the past, he says, inhalation exposure to water pollutants has largely been ignored." His data indicates that hot showers can liberate between 50 to 80 percent of the dissolved chemicals into the air. Emissions from hot baths are half as high. "(One reason, explains Andelman, is that because water droplets dispersed by a shower head have a larger surface-to volume ratio than water streaming into a bath, more of the volatiles can vaporize out)."

It is interesting to note that chloramine actually exists in three forms: monochloramine, dichloramine, and trichloramine. The three forms constantly and rapidly shift from one form to another. "The different volatilities of the chloramines result in substantial differences in the rates of release from water: di- and tri-chloramine are released ~3 and 300 times faster than monochloramine, respectively." (See page 3 of Chemicals in Drinking Water: Chloramine (PDF, 178 KB), by Scottish Centre for Infection and Environmental Health.) These chemicals vaporize easily out of the water that is heated and aerosolized. All three forms are respiratory irritants, with trichloramine being the most toxic.

Andelman points out that.. . "Although showering can be an intense source of residential exposure to water pollutants, . . . it is far from the only important source. Andelman notes that only about 5 of the 50 to 70 gallons of water used daily by the average American goes for showers. Much of the rest is used by dishwashing and laundering. "

"Though actual doses will depend on many factors--especially the level of water contamination--the study does offer clues for limiting exposure. Cold showers can reduce the vaporization of dissolved volatile chemicals by 50 percent, Andelman says. And short showers help, since each doubling in shower time quadruples the dose from accumulating gases. Finally, to limit the spread of released gases into the rest of the home, he suggests closing the bathroom door while bathing and exhausting the room air outdoors."

as cited from Science News, Vol. 130 no. 12, pgs. 177-192"

Drewkitty implications:

• lower water temperature as much as is comfortable
  
• take Navy showers -- wet yourself, shut off water, soap up, then rinse as needed -- otherwise act to minimize exposure time
  
• natural ventilation is not enough, do forced-air ventilation of your bathroom with exhaust to the outside air
  
• consider substituting bathing, again with forced-air ventilation
  

http://www.epa.gov/waterscience/criteria/humanhealth/chloroform/draft-chloroform-doc.pdf

Has an interesting analysis of how much exposure to a hazard in water one might get based on source (pp. 48) total 1.62 ug/kg/day:

Treated Water: (1.15 ug/kg/day)
  Ingestion           0.46 ug/kg-day
  General Inhalation  0.43 ug/kg-day
  Shower Inhalation   0.14 ug/kg-day
  Shower Dermal       0.12 ug/kg-day

Outdoor Inhalation: 0.02 ug/kg-day

Diet: (<0.07 ug/kg-day EXCEPT)
  Grain 0.12 ug/kg-day
  Dairy 0.21 ug/kg-day

Some of the implications are:

1) your building's HVAC system and home A/C system (if any) may be contributing up to one-quarter of any toxic water exposure

2) the water you drink is about the same risk as your interior air inhalation exposure -- again, another quarter

3) your shower exposure is about one-sixth of your total exposure

4) . . . and the rest is diet, but especially dairy products (!) and to a lesser extent, grains with water-bearing content


More Scholarly Articles:

http://links.jstor.org/sici?sici=0091-6765(199601)104%3A1%3C48%3AIIADET%3E2.0.CO%3B2-H

Ingestion, Inhalation, and Dermal Exposures to Chloroform and Trichloroethene from Tap Water
Clifford P. Weisel, Wan-Kuen Jo
Environmental Health Perspectives, Vol. 104, No. 1 (Jan., 1996), pp. 48-51

"Abstract

Individuals are exposed to volatile compounds present in tap water by ingestion, inhalation, and dermal absorption. Traditional risk assessments for water often only consider ingestion exposure to toxic chemicals, even though showering has been shown to increase the body burden of certain chemicals due to inhalation exposure and dermal absorption. We collected and analyzed time-series samples of expired alveolar breath to evaluate changes in concentrations of volatile organic compounds being expired, which reflects the rate of change in the bloodstream due to expiration, metabolism, and absorption into tissues. Analysis of chloroform and trichloethene in expired breath, compounds regulated in water, was also used to determine uptake from tap water by each route (inhalation, ingestion, or absorption). Each route of exposure contributed to the total exposure of these compounds from daily water use. Further, the ingestion dose was completely metabolized before entering the bloodstream, whereas the dose from the other routes was dispersed throughout the body. Thus, differences in potential biologically effective doses depend on route, target organ, and whether the contaminant or metabolite is the biologically active agent."

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1539-6924.1990.tb00541.x

"Routes of Chloroform Exposure and Body Burden from Showering with Chlorinated Tap Water

* Wan K. Jo11Joint Graduate Teaching Program in Human Exposure, Department of Environmental Science, Rutgers University and the UMDNJ-Robert Wood Johnson Medical School and The Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey 08854.22InJae University, Department of Environmental Science, A-Bang Dong, KimHae, Seoul, Korea.,
* Clifford P. Weisel11Joint Graduate Teaching Program in Human Exposure, Department of Environmental Science, Rutgers University and the UMDNJ-Robert Wood Johnson Medical School and The Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey 08854.
* Paul J. Lioy11Joint Graduate Teaching Program in Human Exposure, Department of Environmental Science, Rutgers University and the UMDNJ-Robert Wood Johnson Medical School and The Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey 08854.33To whom correspondence should be addressed.

*
1Joint Graduate Teaching Program in Human Exposure, Department of Environmental Science, Rutgers University and the UMDNJ-Robert Wood Johnson Medical School and The Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey 08854.2InJae University, Department of Environmental Science, A-Bang Dong, KimHae, Seoul, Korea.

3To whom correspondence should be addressed.
Abstract

While there is an awareness of the need to quantify inhalation exposure from showers, the potential for dermal exposure to organic contaminants in showers has not been appreciated or explored. To establish routes of environmental exposure from showers, comparisons of the concentration of chloroform in exhaled breath after a normal shower with municipal tap water were made with those after an inhalation-only exposure. The postexposure chloroform breath concentrations ranged from 6.0–21 μg/m3 for normal showers and 2.4 to 10 μg/m3 for inhalation-only exposure, while the pre-exposure concentrations were all less than the minimum detection limit of 0.86 μg/m3. According to an F-test, the difference between the normal shower and the inhalation-only exposures was considered significant at a probability of p = 0.0001. Based on the difference, the mean internal dose due to dermal exposure was found to be approximately equal to that due to the inhalation exposure. The effect of the showering activities on the concentration of chloroform shower air was examined by comparing air concentrations during a normal shower with the air concentrations obtained when the shower was unoccupied. The F-test showed that there is no significant difference between the two sets of data."



http://www.blackwell-synergy.com/doi/abs/10.1111/j.1539-6924.1994.tb00032.x

"Exposure to Chlorination By-Products from Hot Water Uses

* Clifford P. Weisel11Environmental and Occupational Health Sciences Institute, 681 Frelinghuysen Road, Piscataway, New Jersey 08855-1179.
* Wei Jie Chen22Rutgers, The State University of New Jersey, Department of Environmental Science, Cook College, College Farm Road and Poultry Lane, New Brunswick, New Jersey 08903.

*
1Environmental and Occupational Health Sciences Institute, 681 Frelinghuysen Road, Piscataway, New Jersey 08855-1179.2Rutgers, The State University of New Jersey, Department of Environmental Science, Cook College, College Farm Road and Poultry Lane, New Brunswick, New Jersey 08903.

Abstract

Exposures to chlorination by-products (CBP) within public water supplies are multiroute in water. Cold water is primarily used for ingestion while a mixture of cold water and hot water is used for showering, bathing others, dish washing, etc. These latter two activities result in inhalation and dermal exposure. Heating water was observed to change the concentration of various CBP. An increase in the trihalomethanes (THM) concentrations and a decrease in the haloacetonitriles and halopropanones concentration, though an initial rise in the concentration of dichloropropanone, were observed. The extent of the increase in the THM is dependent on the chlorine residual present. Therefore, estimates of total exposure to CBP from public water supplies need to consider any changes in their concentration with different water uses. The overall THM exposures calculated using the THM concentration in heated water were 50% higher than those calculated using the THM concentration present in cold water. The estimated lifetime cancer risk associated with exposure to THM in water during the shower is therefore underestimated by 50% if the concentration of THM in cold water is used in the risk assessment."






Additional References:

http://www.thefilterguys.biz/chloramine_filters.htm (fish and aquarium discussion)

http://www.awwarf.org/research/TopicsAndProjects/execSum/2760.aspx

http://www.awwarf.org/research/TopicsAndProjects/execSum/PDFSubscriberReports/90993/AwwaRF90993.msi

http://www.scvwd.dst.ca.us/Water/Water_Quality/How_we_clean_your_water/Chloramine/index.shtm

http://www.scvwd.dst.ca.us/media/pdf/chloramine/chloramines_SFPUC_letter.pdf

http://www.sjwater.com/quality/supply.jsp

http://sfwater.org/detail.cfm/MC_ID/13/MSC_ID/166/MTO_ID/399/C_ID/2213

http://www.valleywater.org/media/pdf/Chloramine%20fact%20sheet04.pdf

http://www.who.int/water_sanitation_health/bathing/srwe2chap5.pdf

Comments

[rue-gingertabby.livejournal.com]

I, myself have seen the effects of this stuff......not pretty.

[trema-slo.livejournal.com]

As a friend of foxgrrl I read her post yesterday with great interest. Now I want to thank you for all of the research and tips you've come up with. Our chemical world can kick our butts anytime, lest we take precaution.
Great "article" drewkitty.

[lironess.livejournal.com]

Wow, and here I was closing the window to conserve heat!

EM me when you get a chance plez! I would like to properly thank you and talk a bit...but I don't have your address...

[lironess.livejournal.com]

Well, I know this is an old post but it is an ongoing issue.

I have a weird brain, it just chugs along thinking chains of random thoughts and once in a while it puts 2 and 2 together and bonks me on the head and says hey, listen up! After I read this I opened the window but could not fit my box fan in the frame and as you know there is nothing to set it on, so I left the window open and hoped for the best....then one day my brain said, hey you remember this, when they started putting ammonia in the water and you had to get ammonia chips in your fish filter charcoal....WOW OMG 2+2=5!!!! he is talking about mixing chlorine and ammonia as a gas, like the Cyclon B (or whatever it was called) and I freeked a bit.

I almost bought a tiny battery powered fan at the 99C store then I remembered that I have a small desk fan that plugs in, and is now installed in my window so that it comes on when you turn on the light....and with all of my cats I don't take candlelite baths although I like them....so, fan is offically installed and working...Yay!

This also goes to show me how muddled the ambien was making my thinking....glad I don't take it except once in a while now.....

Got your call, left you a message, but you may get this first....if so...phone tag! Your it!