Skin rashes, difficulty breathing, blurry vision and hair loss.

Those are some of the issues thousands of Delta Air Lines flight attendants have reportedly dealt with since the company switched their uniforms nearly two years ago.

At first, many of the workers quietly coped — seeing doctors, visiting urgent care during their layovers and wearing a protective base layer between their skin and the uniforms. But as symptoms worsened, many say they couldn’t perform their jobs.

Eventually, the workers started talking to one another about their personal health problems and noticed striking similarities.

A year after the new uniform line launched, Delta workers filed the first class action lawsuit in a New York district court against the clothing manufacturer, Lands’ End of Dodgeville, Wis. Then, two weeks ago on New Year’s Eve, the second class action lawsuit was filed by 536 Delta workers, including dozens from Minnesota, who provided details about the adverse health conditions they’ve experienced since donning Delta’s new threads. The vast majority of the plaintiffs are flight attendants, but several gate agents, cargo workers and Sky Club employees also have joined the suit.

As of November, about 3,000 flight attendants have formally reported adverse health effects attributed to the uniforms, Delta said.

The issue is a hot one that intersects a unionization effort of Delta flight attendants and is drawing comparisons to nearly identical situations recently experienced at American and Alaska Airlines. It also highlights a relatively new field of medicine for lower-exposure hazards in the workplace that are increasingly difficult to pinpoint and trace as the global clothing supply chain expands farther from home.

Much fanfare

In May 2018, Atlanta-based Delta threw glitzy runway shows at several of its largest hubs, including Minneapolis-St. Paul International Airport, to promote the launch of its new uniforms. The garments, imagined by celebrity designer Zac Posen and manufactured by Lands’ End, were to be worn by about 64,000 of its employees, from flight attendants to ramp workers.

“The uniforms at issue here have been in use for nearly two years, have been extensively tested multiple times by independent laboratories and have been found both safe and fit for their purpose,” Lands’ End said in a statement. “Because this matter is in litigation, we regret that we cannot comment further.”

A few years before Delta introduced new uniforms, American and Alaska had rolled out new uniforms by manufacturer Twin Hill that thousands of flight attendants alleged caused a number of illnesses, from severe hives to respiratory problems. After lengthy battles with both companies, workers at both American and Alaska will soon be wearing new uniforms again that they hope don’t cause the same reactions.

Delta’s workers saw what happened at those airlines and assumed their rollout would go smoother, believing Delta was the best U.S. airline.

However one flight attendant — one of several who spoke last week on the condition of anonymity for fear of retaliation — said about a year ago she started developing severe hives during work trips. She later started experiencing heart palpitations and hair loss, which, she said, “looks like male patterned baldness.” That’s when the flight attendant, in her 30s, knew she had to get out of the uniforms.

At first, she said, the company made it extremely difficult to win approval to wear an alternative uniform.

“It was really convoluted and unfair in how they were applying these rules. At first they approved me for an alternative uniform, then they retracted that,” the flight attendant said. “Now that this has happened, the trust between the company and the flight attendants is completely destroyed.”

Some colleagues were approved with just a doctor’s note, while others were told they would need to have an independent medical review by one of Delta’s approved doctors. Some had to undergo a “patch test” where clothing materials are applied to the skin and if a reaction did not immediately occur, the workers were denied alternative uniforms. Others slogged through workers’ compensation claims, many of which were also denied.

On Nov. 12 Delta executives sent a memo to its flight attendants and airport customer service agents with results of a toxicology study commissioned by the airline. The memo concluded “the toxicology study confirms that the uniforms are not the cause of skin and respiratory health reactions” and maintained the need for those with symptoms to continue jumping through medical hoops.

On Nov. 25, the Association of Flight Attendants-CWA (AFA) — the union trying to organize Delta’s flight attendant labor group — announced it was commissioning its own toxicology study on the uniforms. The next day, Delta informed its employees wearing alternative uniforms that they were extending approvals to wear their alternatives, called “black and whites,” for another year.

Delta said it decided to simplify the process based on employee feedback. “We haven’t made any conclusions [on the root cause] and we are trying to get to the bottom of the situation,” said Delta spokeswoman Gina Laughlin. Since August, the number of flight attendants approved to wear the alternatives has increased from “a few hundred” to about 1,000, and the airline dropped its additional medical exam requirements in late November, Laughlin said.

Complex supply chain

Before Alaska flight attendants started reporting adverse health effects in 2011, the union had never seen anything like this before, said Sara Nelson, president of AFA International.

In the past few decades, the clothing supply chain has become far less centralized, she said.

In 1991, 56% of the clothing sold in the United States was made domestically, compared with just 3% in 2018, according to data from the American Apparel & Footwear Association.

The fact that a fabric or product is made overseas though, the AAFA said, does not make it unsafe.

Instead, says Judith Anderson, AFA’s industrial hygienist, this longer supply chain can just make it harder to control. She said fabrics might be sourced in one country and assembled in another before being shipped to the United States. Chemicals with specific purposes could be added anywhere along the way.

For workers who travel for a living, it makes sense that attributes like antimicrobial, stain- and wrinkle-resistance would be desired, Anderson said. The problem, she believes, is that chemical compounds added to the fabrics to elicit those attributes are interacting in a negative way, causing these health issues.

The challenge for individuals experiencing these lower-level exposures at work is identifying the chemical culprit.

Zeke McKinney, a Twin Cities-based doctor at HealthPartners specializing in occupational medicine, has seen around 50 Delta flight attendants with conditions possibly linked to the uniforms, ranging from rashes to vocal cord impairment to flu-like symptoms. Whereas medical toxicologists treat patients with immediate and life-threatening poisons, he focuses more on environmental toxicology, which studies people exposed to toxins over time.

McKinney read the full toxicology report from Seattle-based Intertox, the firm Delta hired to study the uniforms.

“I think it was a thorough study, but not perfect. To say you’ve tested for every possible thing is just not possible,” he said. “We make hundreds of thousands of chemicals every day and we have data on a very small percentage on it. The medical literature is not comprehensive. There are a lot of aspects of our immune systems we as doctors don’t yet fully understand.”

According to the class action suit, none of the more than 500 plaintiffs experienced any adverse health effects wearing the old uniforms.