Unfinished business: formaldehyde exposure from uniforms and the case for U.S. textile regulation.

Introduction: Formaldehyde is a known human allergen and irritant, yet health risks from exposure via treated textiles - especially occupational uniforms - remain underrecognized. This article combines a review of international literature and public data on formaldehyde sensitization rates and regulatory approaches with a study of airline employees exposed to formaldehyde-treated uniforms.

Content: A literature review was conducted to assess sensitization prevalence and regulatory frameworks across countries. Publicly available data suggest that countries with stricter formaldehyde limits in textiles tend to report lower population-level sensitization rates. To explore implications in the U.S., we assessed self-reported symptoms among 291 airline employees required to wear new uniforms containing 26-83 ppm of formaldehyde. Participants completed a health survey capturing symptoms before, during, and after uniform use. Results were compared to the 2020 National Health Interview Survey (NHIS), adjusting for age, gender, BMI, and smoking status.

Summary: Compared to the NHIS sample, uniformed airline employees reported significantly higher rates of asthma, anxiety, depression, and immune-related conditions. Time spent perspiring while wearing uniforms - a biologically relevant exposure proxy - was significantly associated with increased dermatologic symptom severity.

Outlook: Even moderate levels of formaldehyde in occupational textiles can trigger adverse health effects under real-world wear conditions involving heat, friction, and perspiration. In the absence of enforceable U.S. regulations for formaldehyde in textiles, employers serve as the first line of defense. They must assess garment safety, consider vulnerable subpopulations, and take precautionary steps - such as requiring OEKO-TEX certification - to protect worker health.