Per- and polyfluoroalkyl substances in occupational settings: a review

Per- and polyfluoroalkyl substances (PFAS) are a large family of synthetic, persistent chemicals that are used extensively in various consumer products and industrial applications, yet there is currently no specific regulations in occupational settings. Here review the toxicity and risks associated with PFAS exposure in occupational settings, with focus on biomonitoring procedures and health effects. Biomonitoring procedures include the choice of the biological matrix, and targeted- and non-targeted approaches. Health effects comprise immunotoxicity, cardiovascular effects, carcinogenicity, hepatotoxicity, effects on the tyroid function and reproduction, and neurotoxicity. Liquid chromatography coupled with tandem mass spectrometry is widely used for biomonitoring, particularly for PFAS quantification in serum, however, such targeted approaches have so far focused only on a few congeners. Whereas some PFAS are linked to hepatotoxicity by altering liver enzymes and lipid metabolism, to immunotoxicity such as reduced vaccine antibody responses, and to carcinogenicity, for instance perfluorooctanoic acid is classified as carcinogenic to humans, toxicological data remains limited. In particular, reported results on cardiovascular, thyroid, reproductive, developmental and neurotoxic effects are less conclusive.