Poisoning due to pyrethroids

Toxicological Reviews

Volumn 24, Issue 2, 2005, Pages 93-106

  Bradberry, Sally M ^a   Cage, Sarah A ^a   Proudfoot, Alex T ^a   Allister Vale, J ^a  

^a CITY HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ALLETHRIN; ALPHA TOCOPHEROL; ATROPINE; CIPERMETHRIN; DIAZEPAM; FENVALERATE; FLUCYTHRINATE; IVERMECTIN; PENTOBARBITAL; PERMETHRIN; PROPRANOLOL; PYRETHROID; SODIUM CHANNEL;

ABDOMINAL PAIN; ABSORPTION; ACTION POTENTIAL; BODY SIZE; CHOREOATHETOSIS; CLINICAL FEATURE; CONVULSION; DIZZINESS; DYSPHAGIA; FASCICULATION; FATIGUE; HEADACHE; HUMAN; HYPERSALIVATION; INSECTICIDAL ACTIVITY; INTOXICATION; LUNG EDEMA; MOUTH ULCER; NAUSEA; NONHUMAN; OCCUPATIONAL EXPOSURE; PARESTHESIA; REVIEW; SENSORY NERVE CELL; SORE THROAT; STEREOCHEMISTRY; TREMOR; TROPICS; VOMITING;

ADULT; ANIMALS; CHILD; CHILD, PRESCHOOL; FEMALE; HUMANS; INSECTICIDES; MALE; MIDDLE AGED; NEUROTOXICITY SYNDROMES; POISONING; PYRETHRINS; RATS;

HEXAPODA; MAMMALIA;

EID: 26844463912     PISSN: 11762551     EISSN: 11762551     Source Type: Journal    
DOI: 10.2165/00139709-200524020-00003     Document Type: Review

References (127)

1. Aldridge WN, Clothier B, Forshaw P, et al. The effect of DDT and the pyrethroid cismethrin and decamethrin on the acetyl choline and cyclic nucleotide content of rat brain. Biochem Pharmacol 1978; 27: 1703-6
2. Kumar S, Thomas A, Sahgal A, et al. Variations in the insecticide-resistance spectrum of Anopheles stephensi after selection with deltamethrin or a deltamethrin-piperonyl-butoxide combination. Ann Trop Med Parasitol 2004;98: 861-71
3. Barlow SM, Sullivan FM, Lines J. Risk assessment of the use of deltamethrin on bednets for the prevention of malaria. Food Chem Toxicol 2001; 39: 407-22
4. He F, Wang S, Liu L, et al. Clinical manifestations and diagnosis of acute pyrethroid poisoning. Arch Toxicol 1989; 63: 54-8
5. Peter JV, John G, Cherian AM. Pyrethroid poisoning. J Assoc Physicians India 1996; 44: 343-4
6. Litovitz TL, Klein-Schwartz W, Rodgers GC, et al. 2001 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2002; 20: 391-452
7. Watson WA, Litovitz TL, Rodgers GC, et al. 2002 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2003; 21: 353-421
8. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2004; 22: 335-404
9. Ray DE. Toxicology of pyrethrins and synthetic pyrethroids. In: Marrs TC, Ballantyne B, editors. Pesticide toxicology and international regulation. Chichester: John Wiley & Sons, 2004: 129-58
10. Narahashi T, Carter DB, Frey J, et al. Sodium channels and GABAA receptor-channel complex as targets of environmental toxicants. Toxicol Lett 1995; 82-83: 239-45
11. Narahashi T. Neuronal ion channels as the target sites of insecticides. Pharmacol Toxicol 1996; 78: 1-14
12. Song J-H, Narahashi T. Modulation of sodium channels of rat cerebellar Purkinje neurons by the pyrethroid tetramethrin. J Pharmacol Exp Ther 1996; 277: 445-53
13. Bradbury SP, Coats JR. Comparative toxicology of the pyrethroid insecticides. Rev Environ Contam Toxicol 1989; 108: 133-77
14. Hodgson E, Levi PE. Interactions of piperonyl butoxide with cytochrome P450. In: Glynne Jones D, editor. Piperonyl butoxide. London: Academic Press, 1999: 41-53
15. Hutson DH. The metabolic fate of synthetic pyrethroid insecticides in mammals. In: Bridges JW, Chasseaud LF, editors. Progress in drug metabolism. New York: John Wiley & Sons, 1979: 215-52
16. Abou-Donia MB, Wilmarth KR, Jensen KF, et al. Neurotoxicity resulting from coexposure to pyridostigmine bromide, DEET, and permethrin: implications of Gulf War chemical exposures. J Toxicol Environ Health 1996; 48: 35-56
17. He F, Zhang Z, Chen S, et al. Effects of combined exposure to pyrethroids and methamidophos on sprayers. Arch Complex Environ Stud 1990; 2: 31-6
18. Narahashi T. The role of ion channels in insecticide action. In: Narahashi T, Chambers JE, editors. Insecticide action: from molecule to organism. New York: Plenum Press, 1989: 55-84
19. Eells JT, Bandettini PA, Holman PA, et al. Pyrethroid insecticide-induced altera-tions in mammalian synaptic membrane potential. J Pharmacol Exp Ther 1992; 262: 1173-81
20. Vijverberg HPM, van den Bercken J. Action of pyrethroid insecticides on the vertebrate nervous system. Neuropathol Appl Neurobiol 1982; 8: 421-40
21. Soderlund DM, Bloomquist JR. Neurotoxic actions of pyrethroid insecticides. Annu Rev Entomol 1989; 34: 77-96
22. Miyamoto J, Kaneko H, Tsuji R, et al. Pyrethroids, nerve poisons: how their risks to human health should be assessed. Toxicol Lett 1995; 82-83: 933-40
23. Clark JM, Brooks MW. Neurotoxicology of pyrethroids: single or multiple mechanisms of action? Environ Toxicol Chem 1989; 8: 361-72
24. Song J-H, Nagata K, Tatebayashi H, et al. Interactions of tetramethrin, fenvalerate and DDT at the sodium channel in rat dorsal root ganglion neurons. Brain Res 1996; 708: 29-37
25. Forshaw PJ, Ray DE. A novel action of deltamethrin on membrane resistance in mammalian skeletal muscle and non-myelinated nerve fibres. Neuropharmacol-ogy 1990; 29: 71-81
26. Forshaw PJ, Ray DE. A voltage-dependent chloride channel in NIE115 neuroblastoma-cells is activated by protein-kinase-c and also by the pyrethroid deltamethrin [abstract]. J Physiol 1993; 467: 252
27. Ray DE, Sutharsan S, Forshaw PJ. Actions of pyrethroid insecticides on voltage-gated chloride channels in neuroblastoma cells. Neurotoxicology 1997; 18: 755-60
28. Forshaw PJ, Lister T, Ray DE. The role of voltage-gated chloride channels in type II pyrethroid insecticide poisoning. Toxicol Appl Pharmacol 2000; 163: 1-8
29. Bloomquist JR, Adams PM, Soderlund DM. Inhibition of gamma-aminobutyric acid-stimulated chloride flux in mouse brain vesicles by polychlorocycloalkane and pyrethroid insecticides. Neurotoxicology 1986; 7: 11-20
30. Bradbury JE, Forshaw PJ, Gray AJ, et al. The action of mephenesin and other agents on the effects produced by two neurotoxic pyrethroids in the intact and spinal rat. Neuropharmacology 1983; 22: 907-14
31. Joy RM, Albertson TE. Interactions of GABAA antagonists with deltamethrin, diazepam, pentobarbital, and SKF100330A in the rat dentate gyrus. Toxicol Appl Pharmacol 1991; 109: 251-62
32. Cremer JE, Cunningham VJ, Ray DE, et al. Regional changes in brain glucose utilization in rats given a pyrethroid insecticide. Brain Res 1980; 194: 278-82
33. Gammon DW, Lawrence LJ, Casida JE. Pyrethroid toxicology: protective effects of diazepam and phenobarbital in the mouse and the cockroach. Toxicol Appl Pharmacol 1982; 66: 290-6
34. Devaud LL, Szot P, Murray TF. PK 11195 antagonism of pyrethroid-induced proconvulsant activity. Eur J Pharmacol 1986; 121: 269-73
35. Cremer JE, Seville MP. Comparative effect of two pyrethroids, deltamethrin and cismethrin on plasma catecholamines and on blood glucose and lactate. Toxicol Appl Pharmacol 1982; 66: 124-33
36. Cremer JE, Ray DE, Sarna GS, et al. A study of the kinetic behaviour of glucose based on simultaneous estimates of influx and phosphorylation in brain regions of rats in different physiological states. Brain Res 1981; 221: 331-42
37. Husain R, Husain RA, Adhami VM, et al. Behavioral, neurochemical, and neuromorphological effects of deltamethrin in adult rats. J Toxicol Environ Health 1996; 48: 515-26
38. Ray DE, Forshaw PJ. Pyrethroid insecticides: poisoning syndromes, synergies, and therapy. J Toxicol Clin Toxicol 2000; 38: 95-101
39. Ray DE. The contrasting actions of two pyrethroids (deltamethrin and cismethrin) in the rat. Neurobehav Toxicol Teratol 1982; 4: 801-4
40. Brodie ME, Aldridge WN. Elevated cerebellar cyclic gpm levels during the deltamethrin-induced motor syndrome. Neurobehav Toxicol Teratol 1982; 4: 109-13
41. Dorman DC, Beasley VR. Neurotoxicology of pyrethrin and the pyrethroid insecticides. Vet Hum Toxicol 1991; 33: 238-43
42. Nassif M, Brooke JP, Hutchinson DBA, et al. Studies with permethrin against bodylice in Egypt. Pestic Sci 1980; 11: 679-84
43. Eadsforth CV, Bragt PC, van Sittert NJ. Human dose-excretion studies with pyrethroid insecticides cypermethrin and alphacypermethrin: relevance for biological monitoring. Xenobiotica 1988; 18: 603-14
44. Woollen BH, Marsh JR, Chester G. Metabolite profiles of a pyrethroid insecticide following oral and dermal absorption in man. In: Proceedings of a Conference on Percutaneous Penetration; 1991 Apr 10-12, 20-5
45. Woollen BH, Marsh JR, Laird WJD, et al. The metabolism of cypermethrin in man: differences in urinary metabolite profiles following oral and dermal administration. Xenobiotica 1992; 22: 983-91
46. Chester G, Sabapathy NN, Woollen BH. Exposure and health assessment during application of lambda-cyhalothrin for malaria vector control in Pakistan. Bull World Health Organ 1992; 70: 615-9
47. Bast GE, Taeschner D, Kampffmeyer HG. Permethrin absorption not detected in single-pass perfused rabbit ear, and absorption with oxidation of 3-phenoxybenzyl alcohol. Arch Toxicol 1997; 71: 179-86
48. Gotoh Y, Kawakami M, Matsumoto N, et al. Permethrin emulsion ingestion: clinical manifestations and clearance of isomers. J Toxicol Clin Toxicol 1998; 36: 57-61
49. Selim S, Preiss FJ, Gabriel KL, et al. Absorption and mass balance of piperonyl butoxide following an 8-h dermal exposure in human volunteers. Toxicol Lett 1999; 107: 207-17
50. Wester RC, Bucks DAW, Maibach HI. Human in vivo percutaneous absorption of pyrethrin and piperonyl butoxide. Food Chem Toxicol 1994; 32: 51-3
51. Kamienski FX, Casida JE. Importance of demethylenation in the metabolism in vivo and in vitro of methylenedioxyphenyl synergists and related compounds in mammals. Biochem Pharmacol 1970; 19: 91-112
52. Ray DE. Pesticides derived from plants and other organisms. 13.2 Pyrethrum and related compounds. In: Hayes Jr WJ, Laws Jr ER, editors. Handbook of pesticide toxicology. San Diego (CA): Academic Press, 1991: 585-636
53. Kaneko H, Miyamoto J. Pyrethroid chemistry and metabolism. In: Krieger RI, editor. Handbook of pesticide toxicology. 2nd ed. San Diego (CA): Academic Press, 2001: 1263-88
54. Leahey JP. Metabolism and environmental degradation. In: Leahey JP, editor. The pyrethroid insecticides. London: Taylor & Francis, 1985: 263-342
55. Soderlund DM, Casida JE. Effects of pyrethroid structure on rates of hydrolysis and oxidation by mouse liver microsomal enzymes. Pestic Biochem Physiol 1977; 7: 391-401
56. Kinsler S, Levi PE, Hodgson E. Relative contributions of the cytochrome P450 and flavin-containing monooxygenases to the microsomal oxidation of phorate following treatment of mice with phenobarbital, hydrocortisone, acetone, and piperonyl butoxide. Pestic Biochem Physiol 1990; 37: 174-81
57. Dalvi RR, Dalvi PS. Differences in the effects of piperine and piperonyl butoxide on hepatic drug-metabolizing enzyme system in rats. Drug Chem Toxicol 1991; 14: 219-29
58. Conney AH, Chang R, Levin WM, et al. Effects of piperonyl butoxide on drug metabolism in rodents and man. Arch Environ Health 1972; 24: 97-107
59. Krieger RI, editor. Handbook of pesticide toxicology. Vol. 2, agents. 2nd ed. San Diego (CA): Academic Press, 2001
60. Zhang Z, Sun J, Chen S, et al. Levels of exposure and biological monitoring of pyrethroids in spraymen. Br J Ind Med 1991; 48: 82-6
61. van der Rhee HJ, Farquhar JA, Vermeulen NPE. Efficacy and transdermal absorption of permethrin in scabies patients. Acta Derm Venereol 1989; 69: 170-82
62. Eadsforth CV, Baldwin MK. Human dose-excretion studies with the pyrethroid insecticide, cypermethrin. Xenobiotica 1983; 13: 67-72
63. He F, Sun J, Han K, et al. Effects of pyrethroid insecticides on subjects engaged in packaging pyrethroids. Br J Ind Med 1988; 45: 548-51
64. He F, Deng H, Ji X, et al. Changes of nerve excitability and urinary deltamethrin in sprayers. Int Arch Occup Environ Health 1991; 62: 587-90
65. International Programme on Chemical Safety. Environmental health criteria 82. Cypermethrin. Geneva: World Health Organization, 1989
66. Asakawa F, Jitsunari F, Miki K, et al. Agricultural worker exposure to and absorption of permethrin applied to cabbage. Bull Environ Contam Toxicol 1996; 56: 42-9
67. Leng G, Kühn KH, Idel H. Biological monitoring of pyrethroid metabolites in urine of pest control operators. Toxicol Lett 1996; 88: 215-20
68. Anadón A, Martinez-Larrañaga MR, Fernandez-Cruz ML, et al. Toxicokinetics of deltamethrin and its 4′-HO-metabolite in the rat. Toxicol Appl Pharmacol 1996; 141: 8-16
69. Gray AJ, Connors TA, Hoellinger H, et al. The relationship between the pharmacokinetics of intravenous cismethrin and bioresmethrin and their mammalian toxicity. Pestic Biochem Physiol 1980; 13: 281-93
70. FAO/WHO. Pesticide residues in food: evaluations 1999. Part II: toxicological. Geneva: WHO/PCS, 2000
71. FAO/WHO. Pesticide residues in food: evaluations 2000. Part II: toxicological. Geneva: WHO/PCS, 2001
72. Adamis Z, Antal A, Füzesi I, et al. Occupational exposure to organophosphorus insecticides and synthetic pyrethroid. Int Arch Occup Environ Health 1985; 56: 299-305
73. Chen S, Zhang Z, He F, et al. An epidemiological study on occupational acute pyrethroid poisoning in cotton farmers. Br J Ind Med 1991; 48: 77-81
74. Llewellyn DM, Brazier A, Brown R, et al. Occupational exposure to permethrin during its use as a public hygiene insecticide. Ann Occup Hyg 1996; 40: 499-509
75. Chester G, Hatfield LD, Hart TB, et al. Worker exposure to, and absorption of cypermethrin during aerial application of an 'ultra low volume' formulation to cotton. Arch Environ Contam Toxicol 1987; 16: 69-78
76. Altenkirch H, Hopmann D, Brockmeier B, et al. Neurological investigations in 23 cases of pyrethroid intoxication reported to the German Federal Health Office. Neurotoxicology 1996; 17: 645-51
77. Wilkes MF. Pyrethroid-induced paresthesia: a central or local toxic effect? J Toxicol Clin Toxicol 2000; 38: 103-5
78. Aldridge WN. An assessment of the toxicological properties of pyrethroids and their neurotoxicity. Crit Rev Toxicol 1990; 21: 89-104
79. Tucker SB, Flannigan SA, Smolensky MH. Comparison of therapeutic agents for synthetic pyrethroid exposure. Contact Dermatitis 1983; 9: 316
80. Knox JM, Tucker SB. A new cutaneous sensation caused by synthetic pyrethroids [abstract]. Clin Res 1982; 30: 915a
81. Knox JM, Tucker SB, Flannigan SA. Paresthesia from cutaneous exposure to a synthetic pyrethroid insecticide. Arch Dermatol 1984; 120: 744-6
82. Flannigan SA, Tucker SB. Variation in cutaneous sensation between synthetic pyrethroid insecticides. Contact Dermatitis 1985; 13: 140-7
83. Wang S, Zheng Q, Yu L, et al. Health survey among farmers exposed to deltamethrin in the cotton fields. Ecotoxicol Environ Saf 1988; 15: 1-6
84. Coleman CI, Gillespie EL, White CM. Probable topical permethrin-induced neck dystonia. Pharmacotherapy 2005; 25: 448-50
85. Kolmodin-Hedman B, Swensson Å, Åkerblom M. Occupational exposure to some synthetic pyrethroids (permethrin and fenvalerate). Arch Toxicol 1982; 50: 27-33
86. Brandenburg K, Deinard AS, DiNapoli J, et al. 1% permethrin cream rinse vs 1% lindane shampoo in treating pediculosis capitis. Am J Dis Child 1986; 140: 894-6
87. Kalter DC, Sperber J, Rosen T, et al. Treatment of pediculosis pubis: clinical comparison of efficacy and tolerance of 1% lindane shampoo vs 1% permethrin creme rinse. Arch Dermatol 1987; 123: 1315-9
88. International Programme on Chemical Safety. Environmental health criteria 94. Permethrin. Geneva: World Health Organization, 1990
89. Kolmodin-Hedman B, Åkerblom M, Flato S, et al. Symptoms in forestry workers handling conifer plants treated with permethrin. Bull Environ Contam Toxicol 1995; 55: 487-93
90. DiNapoli JB, Austin RD, Englender SJ, et al. Eradication of head lice with a single treatment. Am J Public Health 1988; 78: 978-80
91. Lisi P. Sensitization risk of pyrethroid insecticides. Contact Dermatitis 1992; 26: 349-50
92. Müller-Mohnssen H. Chronic sequelae and irreversible injuries following acute pyrethroid intoxication. Toxicol Lett 1999; 107: 161-76
93. Wagner SL. Allergy from pyrethrin or pyrethroid insecticides. J Agromed 1994; 1: 39-45
94. Choudhary S. Burns due to anti-lice lotion. Burns 1999; 25: 184-5
95. Burns JD, Muller LT, Jenkins PF, et al. Unilateral mydriasis associated with exposure to flea spray. Arch Ophthalmol 2002; 120: 665
96. Miyamoto J. Degradation, metabolism and toxicity of synthetic pyrethroids. Environ Health Perspect 1976; 14: 15-28
97. Moretto A. Indoor spraying with the pyrethroid insecticide lambda-cyhalothrin: effects on spraymen and inhabitants of sprayed houses. Bull World Health Organ 1991; 69: 591-4
98. Lessenger JE. Five office workers inadvertently exposed to cypermethrin. J Toxicol Environ Health 1992; 35: 261-7
99. Fuortes L. Urticaria due to airborne permethrin exposure. Vet Hum Toxicol 1999; 41: 92-3
100. Newton JG, Breslin ABX. Asthmatic reactions to a commonly used aerosol insect killer. Med J Aust 1983; 1: 378-80
101. Vandenplas O, Delwiche JP, Auverdin J, et al. Asthma to tetramethrin. Allergy 2000; 55: 417-8
102. Karpati AM, Perrin MC, Matte T, et al. Pesticide spraying for West Nile virus control and emergency department asthma visits in New York City, 2000. Environ Health Perspect 2004; 112: 1183-7
103. Bradley K, Cox R. Acute upper-airway obstruction in a two-year-old child who ingested an herbicide preparation. J Miss State Med Assoc 2004; 45: 98-101
104. Yang P-Y, Lin J-L, Hall AH, et al. Acute ingestion poisoning with insecticide formulations containing the pyrethroid permethrin, xylene, and surfactant: a review of 48 cases. J Toxicol Clin Toxicol 2002; 40: 107-13
105. Grant SMB. An unusual case of burning mouth sensation. Br Dent J 1993; 175: 378-80
106. Hou D. Pesticide 'Decis' induced massive hemorrhage of gastric intestinal tract [abstract]. Chin J Dig Dis 1986; 2: 116
107. Poisindex. Pyrethroids. In: POISINDEX® managements. Greenwood Village (CO): Micromedex, 2005
108. Terzi C, Bacakoglu A, Ünek T, et al. Chemical necrotizing fasciitis due to household insecticide injection: is immediate radical surgical debridement necessary? Hum Exp Toxicol 2002; 21: 687-90
109. LoVecchio F, Knight J. Injection of pyrethroids without significant sequelae. Am J Emerg Med 2005; 23: 406
110. Garg P, Garg P. Mosquito coil (allethrin) poisoning in two brothers. Indian Pediatr 2004; 41: 1177-8
111. Berthier F, Orrillard M, Blanchard M, et al. Intoxication par un insecticide: la deltamethrine. JEUR 1995; 8: 25-8
112. Poulos L, Athanaselis S, Coutselinis A. Acute intoxication with cypermethrin (NRDC 149). J Toxicol Clin Toxicol 1982; 19: 519-20
113. O'Malley M. Clinical evaluation of pesticide exposure and poisonings. Lancet 1997; 349: 1161-6
114. Box SA, Lee MR. A systemic reaction following exposure to a pyrethroid insecticide. Hum Exp Toxicol 1996; 15: 389-90
115. Pall HS, Williams AC, Waring R, et al. Motorneurone disease as manifestation of pesticide toxicity. Lancet 1987; II: 685
116. He F. Health surveillance of pesticide workers: a manual for occupational health professionals. Toxicology 1994; 91: 43-9
117. Vijverberg HPM, van den Bercken J. Neurotoxicological effects and the mode of action of pyrethroid insecticides. Crit Rev Toxicol 1990; 21: 105-26
118. Tucker SB, Flannigan SA, Ross CE. Inhibition of cutaneous paresthesia resulting from synthetic pyrethroid exposure. Int J Dermatol 1984; 23: 686-9
119. Flannigan SA, Tucker SB, Key MM, et al. Synthetic pyrethroid insecticides: a dermatological evaluation. Br J Ind Med 1985; 42: 363-72
120. Advisory Committee on Pesticides. Evaluation number 55: esfenvalerate. London: Ministry of Agriculture Fisheries and Food, 1992
121. Song J-H, Narahashi T. Selective block of tetramethrin-modified sodium channels by (+/-)-alpha-tocopherol (vitamin E). J Pharmacol Exp Ther 1995; 275: 1402-11
122. Flannigan SA, Tucker SB. Topical indomethacin for synthetic pyrethroid exposure. Contact Dermatitis 1984; 11: 55-6
123. Salawu OA, Iyaniwura TT, Adaudi AO. Effects of anticonvulsants on acute cypermethrin poisoning in mice and rats. Vet Hum Toxicol 2000; 42: 303-5
124. Hiromori T, Nakanashi T, Kawaguchi S, et al. Therapeutic effects of metho-carbamol on acute intoxication by pyrethroids in rats. J Pestic Sci 1986; 11: 9-14
125. Leclercq M, Cotonat J, Foulhoux P. Recherche d'un antagonisme á l'intoxication par la deltamèthrine. J Toxicol Clin Exp 1986; 6: 85-93
126. Matsumoto K, Eldefrawi ME, Eldefrawi AT. Action of polychlorocycloalkane insecticides on binding of (35S)t-butylbicyclophosphorothionate to Torpedo electric organ membranes and stereospecificity of the binding site. Toxicol Appl Pharmacol 1988; 95: 220-9
127. Forshaw PJ, Ray DE. Development of therapy for type II pyrethroid insecticide poisoning [abstract]. Hum Exp Toxicol 1997; 16: 382