Your uniform, your health

In September 2016, AFA members at Envoy, Piedmont, and PSA were provided with new uniforms manufactured by TwinHill. These uniforms are the same as those provided to Flight Attendants at mainline American Airlines (AA). Since then, a growing number of our members are reporting symptoms associated with wearing the new uniforms. The reported symptoms include rash/irritated skin, eye irritation, breathing problems, and headaches. They mirror the types of symptoms reported by our sisters and brothers who are wearing these uniforms at AA.

IMPORTANT UNIFORMS UPDATE

March 2017: The The results are in for chemical testing on 14 Flight Attendant uniform garments sent to a specialist fabrics lab. More details further down on this page or you can print those details HERE.

Key findings are:

• The lining fabric in both skirts (wrap skirt, polyester alternative skirt) failed a recognized fabric standard because of excess amounts of two wood preservative/fungicide chemicals.
• Five more garments (apron, dress, pants, women’s all-weather coat, vest) contained measurable amounts of various toxic chemicals, listed below. The amounts were within “allowed amounts,” but the “allowed amounts” are not necessarily protective for the reasons stated in Section 4, below.

On the basis of the chemical testing results and the documented symptoms, AFA sent a letter on March 21 to American management demanding a total recall of the uniforms at Envoy, Piedmont, PSA, and mainline American. We formally recommend that ALL of our members opt out of wearing these new uniforms.

 The purpose of this page is to:

1. Encourage you to report your uniform reactions to AFA;
2. Make sure that you know your options to get out of the uniform,
3. Provide you with information on the chemical contents of these these clothes (where known);
4. Provide you with information to help you interpret the chemical contents of these uniforms;
5. Keep you updated on how AFA is advocating for you;
6. Provide you with contact information for your AFA representatives.

IF YOU HAVE REACTED TO THE UNIFORM(S), REPORT TO AFA

Calling all members! Please report to AFA using this reporting form so that we can best understand what is happening on the line and advocate on your behalf. Your responses will be kept confidential within AFA and will not be shared with the company. Make sure you also report to your airline, and keep a copy of all reports and correspondence for your records.

OPTIONS TO GET OUT OF THE UNIFORM:

AFA recommends that all members opt out of wearing these uniforms by following the airline procedures listed below:

Envoy

• Envoy flight attendants are required to wear either TwinHill, Aramark, “old blues” (if in good condition), or “buy your own” (details below). 
• AFA recommends that members wear “old blues” or “buy your own,” given the hundreds of uniform reaction reports we have received. To choose these options, you must notify your base manager.
• As of this writing (July 2019), availability for Aramark garments is limited. 
• Flight attendants who want to purchase uniform-like garments can do so without management approval, although you must notify your base manager. You can only be reimbursed for up to a fixed dollar amount for two suiting garment bottoms (skirt/pants) and two shirts. Suggestions on where to find alternative uniform-like garments are posted online. Once you purchase those pieces, you can submit receipts for reimbursement up to fixed amount. Notify your base manager of your decision and request the expense reimbursement form from the company. 
• New hires are required to purchase TwinHill garments at training, although any unworn and unaltered garments that are still in the original packaging can be returned.  After the requisite initial TwinHill order, AFA recommends that new hires purchase (and submit paperwork to be reimbursed up to a fixed amount for) two grey suiting bottoms and two white shirts. Notify your training manager if you want to choose this option and request the expense reimbursement form from the company.
• Lab testing has found high levels of formaldehyde in fabric samples from Aramark shirts (Eagle/Van Heusen), TwinHill shirts (white and blue/white checkered), and TwinHill suiting pants. Formaldehyde is an irritant, allergen, and carcinogen. Based on these test results, we recommend that, at a minimum, members purchase their own lookalike alternatives for these garments. As above, remember to submit the paperwork to be reimbursed for the allowed amounts and inform your base manager of your choice. 
• AFA members who have questions can contact AFA-Envoy MEC Safety, Health, & Security Chair, Jan Wyatt. Remember to email Jan from your personal email address, not your company email.

Piedmont

• Members do not need a doctor’s note to opt out of wearing TwinHill uniform
• There is only limited availability for the polyester alternative suiting option made by Aramark.
• Members have the option to purchase two pairs of grey suiting bottoms (skirt or pants) plus two white shirts, and can be reimbursed for some of the cost. Suggestions on where to find suitable garments is posted online.
• New hires are required to purchase TwinHill garments at training, although any unworn and unaltered garments that are still in the original packaging can be returned. Beyond this requisite initial purchase, AFA recommends that new hires wear the grey suiting bottoms and white shirts that you were required to purchase and wear during training. 
• Members with uniform issues/concerns are instructed to call INFLIGHT (and then later call the TwinHill/AA Call Center ((1-800-327-0117; select 2,5,6,1, pause, 2) to get a shipping label to return garments)
• Lab testing has found high levels of formaldehyde in fabric samples from Aramark shirts (Eagle/Van Heusen), TwinHill shirts (white and blue/white checkered), and TwinHill suiting pants. Formaldehyde is an irritant, allergen, and carcinogen. Based on these test results, we recommend that, at a minimum, members purchase their own lookalike alternatives for these garments. Remember to submit the paperwork to be reimbursed for the allowed amounts and inform your base manager of your choice.
• Email AFA at [email protected] for help or questions. Remember to contact us using your personal email, not your company email. 

PSA Airlines

• Members do not need a doctor's note to opt out of wearing TwinHill or Aramark uniforms.
• There is only limited availability for the polyester alternative suiting option made by Aramark.
• Members with uniform reactions/concerns can either wear their "old blues," or purchase up to a full uniform complement of "uniform-like" grey garments and be reimbursed up to a fixed amount. Given the hundreds of uniform reaction reports AFA has received, we recommend these options.
• PSA management has posted instructions for Flight Attendants who wish to opt out of the uniform.
• AFA-PSA has gathered information on where you can find look alike uniform pieces online, including grey suiting garments and blue/white shirts for women and men. 
• Management has given permission to wear any approved scarf issued by US Airways or AA, including the navy blue scarf that you should have received in training. Alternatively, with company approval, you can purchase and be reimbursed for a look-alike scarf available online (per company directions).
• Lab testing has found high levels of formaldehyde in fabric samples from Aramark shirts (Eagle/Van Heusen), TwinHill shirts (white and blue/white checkered), and TwinHill suiting pants. Formaldehyde is an irritant, allergen, and carcinogen. Based on these test results, we recommend that, at a minimum, members purchase their own lookalike alternatives for these garments. Remember to submit the paperwork to be reimbursed for the allowed amounts and inform your base manager of your choice.
• Email AFA at [email protected] for help if the company response does not address your needs. Remember to contact us using your personal email, not your company email.

CHEMICALS MEASURED IN UNIFORM FABRICS

• This section summarizes the chemicals found in these garments. The next section helps you makes sense of this section…
• It is important to recognize that the chemical test data posted on this page for these uniforms will not capture all of the chemicals contained in these clothes because the market is so diverse and fluid. A single garment may be comprised of multiple fabrics sourced to different factories all over the world, each with its own standards and production practices. The origin of each of the fabrics that comprise these garments is unknown but, collectively, a sample of 14 of these TwinHill garments were assembled in five countries (Bangladesh, China, Indonesia, Sri Lanka, and Vietnam). See Table 1.

Table 1: Uniform garments: description of component fabrics, and country of origin

• What follows is a short summary of available chemical testing data for the uniforms distributed to these work groups. Comprehensive chemical testing has not been conducted on a representative sample of garments and it is not clear if the test results posted on this page represent the garments in circulation now. Still, this is the available information and we consider it important to summarizes it and share it with our members. The data is presented by date: April 2016, Oct. 2016, Feb. 2017, and March 2017.
  
  The types of chemicals of concern (listed below in more detail) include:
  
  o Irritants – chemicals that cause irritation to the skin, eyes, or respiratory tract that is local to the part of the body that is exposed to the chemical in question;
  o Sensitizers – chemicals that cause an immune-mediated response which is generally more serious than the “local” type of irritant reaction and may be systemic, rather than localized;
  o Endocrine disruptors – chemicals that are structurally similar to human hormones, such that they can disrupt hormonal cycles; and
  o Carcinogens – chemicals that either can (confirmed ) or may (probable/possible) cause uncontained cell growth/tumor formation.
• In April 2016, testing in 31 Flight Attendant and Pilot uniform garments identified the compounds listed here:
  
  
  • Irritants
    • 2-Bromo-4,6-dinitro-benzeneamine: women’s parka with fur
    • 2-Butoxy ethanol: women’s crew scarf
    • 2-(phenylmethylene)-octanol: women’s pilot pants and blouse
    • 9,10-Anthracenedione: men’s “car coat”
    • 9, 10-Dimethylanthracene: black men’s tie
    • 9-0ctadecenoic acid: men’s/women’s pilot blazers
    • Benzaldehyde: women’s pilot blazer
    • Bis-(2-hydroxyethyl)lauramide: men’s crew blazer
    • Butylated hydroxytoluene: men’s coat, women’s parka with fur
    • Caprolactam: women’s crew blazer, men’s copilot jacket, women’s crew jacket
    • Docosane: women’s pilot blouse and neckwear, men’s car coat, shirt (undefined)
    • Isopropyl palmitate (1-methylethyl ester hexadecanoic acid): women’s jacket
    • Methyl palmitate (methyl ester hexadecanoic acid): women‘s blue-checkered blouse, dress, women’s jacket, men’s blue tie
    • N-ethyl-4-methyl benzenesulfonamide: women’s pilot blouse
    • Octadecane: women’s pilot neckwear, men’s/women’s pilot blazers, men’s long-sleeved white shirt, men’s long-sleeved pilot shirt, women’s short-sleeved blue blouse
    • Oleic acid: pants (undefined)
    • Tridecanol: women’s pilot blouse
    • Undecanol: women’s pilot blouse
  • Sensitizers
    • Benzyl benzoate: men’s pilot tie, long-sleeved men’s “rip stop” shirt
    • Disperse orange dye 30: men’s pilot tie
    • 2-(phenylmethylene)-octanol: women’s pilot pants and blouse
    • Benzaldehyde: women’s pilot blazer
    • 9,10-Anthracenedione: men’s “car coat”
    • 9, 10-Dimethylanthracene: men’s black tie

AFA is aware that the chemical testing lab in question dismissed these test data, claiming that the levels of each compound was “too low to worry about” (essentially) and may even be sourced to personal care products (rather than the uniforms), in some cases. However, there are no allowed/recommended limits for most of these chemicals in clothes. And even if there were health-based limits published for every one of these compounds, the health effects of physical contact with a complex mixture of chemicals is undefined. There are very few health-based standards for individual chemicals in fabrics, and the chemical of clothes sold in the US is practically unregulated.

• In Oct. 2016, chemical testing of a small sample of Flight Attendant uniform garments found:
  • Pentachlorophenol, tetrachlorophenols and trichlorophenols; and
  • Formaldehyde
• In Feb. 2017, a report on some chemical testing (SVOCs, VOCs, and five metals) of 68 Flight Attendant and Pilot uniform garments, identified the presence of 15 sensitizer compounds:
  • Antimony;
  • Arsenic salts;
  • Benzophenone (CAS number 119-61-9);
  • Benzyl benzoate (CAS number 120-51-4) – also potentially irritating;
  • 4-Biphenyl ester benzoic acid (CAS number 2170-13-0);
  • C.I. Disperse Red 60 (CAS number 17418-58-5) – also potentially irritating;
  • C.I. Disperse Orange 30 (CAS number 12223-23-3/5261-314)
  • Cobalt and cobalt compounds;
  • 9,10-Dimethylanthracene (CAS number 781-43-1);
  • 4,4’-Diphenylmethane diisocyanate (CAS number 101-68-8) – also potentially irritating;
  • Ethylbenzaldehyde (CAS number 4748-78-1);
  • Formaldehyde (CAS number 50-00-0) – also potentially irritating;
  • Mercaptobenzothiazole (CAS number 149-30-4);
  • 2-(Methylthio)-benzothiazole (CAS number 615-22-5) – also potentially irritating; and
  • Soluble chromium.

Some of these compounds (e.g., antimony, benzyl benzoate, disperse orange 30, formaldehyde, and chromium) are specifically listed in a 2013 European Commission report titled: Study on the Link Between Allergic Reactions and Chemicals in Textile Products. Others are referenced in that document by class of chemicals (e.g., diisocyanates). The presence of up to four allergenic metals (antimony, arsenic, cobalt, and chromium) in some of these fabrics suggests that a blood test for heavy metals may be an appropriate test for affected individuals.

• In March 2017, a report on some chemical testing of the 14 uniform garments listed in Table 1 was received by AFA. The key findings are listed below in Table 2.

Table 2: Summary of chemical testing of 14 TwinHill uniform garments
(Bold font indicates amount of chemical that exceeded limits in Oeko-Tex 100 Standard)

NP = nonylphenol (NP); listed if ≥ 5 mg/kg (below Oeko-Tex 100 standard limit)
NP(EO) = nonylphenolethoxylates; listed if ≥ 15 mg/kg (below Oeko-Tex 100 standard limit)
OP(EO) = octylphenolethoxylates; listed if ≥ 15 mg/kg (below Oeko-Tex 100 standard limit)

Table 3, below, provides a summary of which of the chemical compounds that were found in the uniform fabrics are sensitizers, irritants, endocrine disruptors, and carcinogens. Table 4 lists how these chemicals are used in textile production and shipping. All of these details can also be downloaded and printed in this AFA bulletin.

Table 3: Chemicals found in 1+ fabrics with indication of whether sensitizer, irritant, endocrine disruptor, or carcinogen

NP = nonylphenol (NP); NP(EO) = nonylphenolethoxylates; OP(EO) = octylphenolethoxylates:

Table 4: Description of how these chemicals can be used in textile production

• In addition to the specific chemicals measured in the current uniform garments, there are additional chemicals that can be used in garment production/shipping and can cause ill health. The chemicals that are cited most often include:
  • Dimethyl fumarate: anti-fungal agent which may be added to packaging material to prevent mold growth during overseas shipment, but also a skin/eye/respiratory irritant and a potent sensitizer; 
  • Heptadecafluorodecyl acrylate: can be used as a coating agent in polyester dyeing processes but also an irritant to the skin, eyes, and respiratory tract;
  • Perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA): may be used as stain repellants, but are also endocrine disruptors, and PFOA may have a negative impact on thyroid and liver function;
  • Perchloroethylene: a dry-cleaning chemical, but also an irritant, central nervous system depressant, and probable carcinogen;
  • Phthalates: may be found in synthetic fabrics (including those made from recycled plastics) and plastic buttons, both to make them more flexible and to decrease the melting temperature of plastics during production, but are also endocrine disruptors; and
  • Tributyl phosphate: can be used as a wetting agent in textile production, but is also an irritant and potential endocrine disruptor;

INSIGHTS INTO HOW TO INTEPRET THE MARCH 2017 TESTING DATA ON 14 GARMENTS

Which garments were tested?
In Feb. 2017, AFA sent 14 TwinHill uniform garments to a specialty fabrics lab to have them tested for the presence of chemical compounds that have previously been associated with reports of clothing-related outbreaks of symptoms. The 14 tested garments came from some of the batches of uniforms being worn by our members at PSA, Piedmont, and Envoy since September 2016. They are the same types of garments being worn by the mainline AA flight attendants.

In all, about 28,000 flight attendants are wearing these garments which have been (and are being) assembled in batches at factories located in at least five countries (Bangladesh, China, Indonesia, Sri Lanka, and Vietnam) with fabrics sourced to unknown locations and where production line practices may vary over time, between factories, and between batches of the same garments. So, the chemical contents in the apron, for example, may vary over time or even between batches from the same factory.

How did AFA decide which chemicals to ask the lab to look for in those garments?
The chemical tests performed on these fabrics represent our "best guess" as to what chemicals could be in the uniforms and could be causing the reported skin, eye, and respiratory symptoms. We focused on chemicals that can be measured in fabrics and for which there is at least one published fabric standard, so that we could have some context for understanding the test results.

Testing on these uniform garments prior to March 2017 confirms that additional chemical compounds have been found in these fabrics. Those data matter because they highlight the "chemical soup" nature of these fabrics. However, it is hard to interpret the health impact of exposure to long lists of chemicals where there are no standards for comparison, so we limited our testing to specific compounds.

If the amount of a chemical in a garment is below a published limit, is it safe?
Published limits for chemicals in fabrics are helpful because they provide some context for what a given amount of a chemical in a fabric means. However, they do not necessarily represent an assurance of safety. One of the million dollar questions is that, if a chemical (like nickel) is measured in a fabric, but is below the maximum allowed amount for nickel in fabrics, does it matter? The short answer is that it's complicated, but it certainly could matter, and especially for sensitizers. It is helpful to understand that fabric limits are set one chemical at a time which does not address the impact of contact with a complex mixture of chemicals in a fabric. Obviously, contact with fabric that contains one irritant at "low levels" is not the same as contact with a fabric that contains 20 irritants, each at "low levels."

And aside from the complication of having contact with a mixture of chemicals, some chemical limits for fabrics are based on the sensitivity of the laboratory equipment that will be used to measure that chemical in fabric. Of course, you can't set a chemical limit below what your equipment can measure, but the basis for a particular published limit must be clearly defined, and some limits may need to be revised downward when technology improves.

Even when the published limit for a given chemical in clothes is grounded in protecting the wearer from developing symptoms, chances are good that the basis is preventing irritant symptoms, because it's generally accepted that there is some "no effect" concentration for most people who have contact with a single chemical on intact skin. However, it is more complex to define a "no effect" level for sensitizers because (as the name suggests) some people will develop a sensitization response when exposed to one or more sensitizer chemicals. Sensitization involves an immune-mediated response (called the "sensitization phase") which is "clinically quiet" (meaning no symptoms). When a sensitized person is reexposed, they exhibit symptoms, and the amount of the chemical that triggers their symptoms can be less than both the dose that caused their immune system to get involved and the dose required to cause irritant effects in non-sensitized people. So there is a lot of variability between people in terms of "what's safe." Continued exposure to chemical allergens can result in worsening of symptoms and a poorer prognosis. For these reasons, if a person sensitized to a given chemical, then a "no effects" limit for irritant effects is unlikely to be protective.

Other factors that influence how much of an exposure is needed to cause symptoms include whether the skin is intact or broken/irritated, the duration of the exposure (cumulative dose), and whether or not the person is exposed to a mixture of compounds that may interact with each other.

The sweaters and blouses/shirts are not included in Table 2. Does that mean they tested clean?
We invited AFA members who reported uniform reactions to identify which garments they associated with symptoms. The top five answers were the pants (67% of respondents), one of the shirts (63%), buttoned cardigan (56%), blazers (52%), and dress (46%). So, shirts were #2 and a sweater was #3. Thus there are still unanswered questions about the chemical contents of these clothes.

What if I have symptoms when I wear my uniform?
If you have symptoms associated with wearing one or more of these garments, stop wearing them! Same applies if you are pregnant, nursing, or planning to be pregnant…

Also, report to your company and report to AFA.

Keep a record of symptom onset/improvement and see a doctor, as necessary. If you see a doctor, provide a copy of the AFA "Chemicals in Clothes" bulletin and the AFA "Chemical Testing of Flight Attendant Uniforms" bulletin. Talk to them about what testing may be helpful; for example, skin patch/prick testing may help to identify the causal factor(s) for skin reactions. If you talk to your doctor about blood or urine testing for compounds like the metals listed above or pentachlorophenol, for example, make sure your doctor understands how long it has been since you wore your uniforms so that the results are interpreted properly.

Ultimately, fabrics contain complex mixture of chemical compounds, many of which are undefined. Thus, finding the causal factor(s) will be challenging and may be impossible. The most effective way to protect your health is to wear an alternative uniform if the uniform you are wearing is correlated with symptom onset.

What if I don't appear to be reacting to my new uniforms?
The information on this webpage is largely intended for our members who are experiencing uniform reactions, or who are either pregnant, planning to be pregnant, or nursing. But if you do not fall into one of those groups, AFA recommends that you opt out of the uniforms anyway. First, the chemicals in the fabrics include known/suspected carcinogens and endocrine disruptors, so any relationship of related symptoms to the uniforms may not be obvious. Second, some affected flight attendants (likely due to sensitization reactions) experience reactions when working in close proximity with colleagues who are still wearing the uniforms.

If you do not opt out, then be sure to at least wash and dry your uniforms and relevant undergarments in a separate load from the rest of your and your family's laundry. Also, donate your "old blues" to AFA so that someone else who needs them can wear them.

HOW IS AFA ADVOCATING FOR YOU?

• Your AFA Master Executive Council (MEC) representatives at the three affected carriers (Envoy, Piedmont, and PSA) are working in partnership with staff at the AFA International Safety, Health, & Security Department, Legal Department, and Communications Department.
• AFA developed an online uniform reaction reporting form and is actively gathering reports and photos of adverse reactions from our members. (If you have reacted to the uniforms, please report to AFA, in confidence, if you have not already done so.)
• AFA collected a sample of each garment, shipped them to a specialist lab for chemical testing, reported the results.
• AFA has (and will continue to) notify all our members of their options to wear something else to work, as described on this website. This includes, but is not limited to, members who have reacted to the uniforms, or who are concerned about wearing them, either because of pre-existing medical conditions, being pregnant, nursing, or planning to become pregnant.
• AFA has actively worked to clarify uniform options for our members and to push for parity across airlines. It is neither fair nor appropriate for management to treat Flight Attendants at the wholly-owned regional carriers differently than those employed by the mainline American Airlines.
• AFA is squarely on the record with management at PSA, Piedmont, and Envoy that our affected members need practical, accessible, clear, consistently-applied options for wearing alternative uniform. And for Flight Attendants whose only option is to purchase uniform-like garments, we need the option for them to buy (and be reimbursed for) the cost of a full uniform complement. AFA-PSA has built an "Open Closet" of donated and laundered "old blues," and is hosting crew sits to distribute those garments to Flight Attendants who need them.
• AFA has carefully researched Flight Attendant uniform options and has identified a safe vendor that uses reliably-sourced fabrics that meet recommended health and environmental standards. We have provided this information to all three carriers and asked that they pursue a new contract with either this or an equivalent uniforms vendor for the good of the Flight Attendant work group.
• AFA has developed guidance on selecting a new vendor and the suitable garments to protect safety, health and security.
• For more information about chemicals in clothes in general, visit AFA's uniforms page. Bottom line: your uniform should not make you sick.

More questions?

• Email AFA at [email protected]. Remember to contact us using your personal email, not your company email.

And for more information about chemicals in clothes in general, visit AFA's uniforms page. Bottom line: your uniform should not make you sick.

On June 21, 2017, American Airlines and its three wholly-owned carriers formally announced that they would not renew its contract with TwinHill. This is a relief to all of our member Flight Attendants at Envoy Air, PSA Airlines, and Piedmont Airlines, as well as our brother and sister pilots and CSAs at our airlines, and all of the airline workers at American Airlines. Collectively, so many of us have been affected by wearing or working around these garments and, until now, have been living with the prospect of these four airlines having a long-term relationship with TwinHill. Finally, we have been formally notified that change is coming. It is encouraging that AA – on behalf of the parent airline and its three regional carriers - has explicitly invited the airline worker unions to be part of the new vendor selection process. AFA has already responded to that invitation by formally reaching out to AA and offering our expertise and ideas to assist in that process. Since 2011, AFA has been researching the options for uniform materials and styles that influence safety, health and security. We look forward to being part of the process to select new uniforms that protect health and safety, and project a single, streamlined, professional image, for the good of all.