NIOSH Evaluates Uniform-Related Health Complaints by Airline Employees

NIOSH has released the report of a health hazard evaluation (HHE) conducted in response to multiple requests from employees of a commercial airline who were concerned about health effects associated with their new uniforms (PDF). Flight attendants and customer service representatives filed compensation claims and accommodation requests primarily due to skin and allergy symptoms, NIOSH found. Less commonly, employees reported ear, nose, throat, and sinus symptoms; headaches, dizziness, and balance problems; eye symptoms; burning sensations; and hair loss. NIOSH could not establish a link between widespread symptoms and the introduction of the new uniforms, which began in May 2021. Nonetheless, the HHE report notes that some employee symptoms may be related to the uniforms.

“Few studies about textiles and health effects, other than skin conditions, exist,” the report states. “Not all chemicals in textiles or their potential health effects are well characterized.”

The HHE report recommends that the airline increase the flexibility of its uniform policy. This may involve revising the process for approving uniform accommodation requests and allowing employees who report symptoms to wear alternative uniform pieces. While the report acknowledges that the airline’s policy states uniforms are essential to employees’ service mission, it notes that offering greater flexibility may reduce employees stress. This, in turn, may “increase employee, team, and organizational productivity while continuing to offer a cohesive, consistent, and professional look,” the report states.

NIOSH also recommends that the airline work to improve communication between management and employees, so that employees feel their concerns are being taken seriously and are aware of their employer’s steps to address them. The airline can encourage employees to report health concerns to supervisors, systematically and objectively review and act on data about potential work-related conditions, and encourage employees to seek evaluations from occupational healthcare providers, if necessary.

Throughout the past decade, employees of American Airlines, Delta Airlines, and Alaska Airlines have all filed lawsuits against manufacturers of allegedly toxic uniforms. A 2018 study by the Harvard T.H. Chan School of Public Health found that symptoms including chemical sensitivity, itchy and irritated skin, rashes and hives, itchy eyes, and sinus irritation became more frequent among Alaska Airlines flight attendants after new uniforms were introduced in 2011. Testing found that the uniforms contained tributyl phosphate, which causes eye, skin, and respiratory irritation, as well as heavy metals, biocides, and dispersion dyes suspected to be carcinogens.

“It’s unlikely that there’s one specific smoking gun type of a chemical that’s causing these issues, but it’s likely to be a unique combination,” said Irina Mordukhovich, one of the study’s coauthors.

NIOSH’s report on symptoms among airline employees can be downloaded as a PDF from the agency’s HHE report library.