5.2    Type and Severity of the Symptoms

The symptoms that were found in persons surveyed were mostly pertaining to skin , eyes and the Upper respiratory tract.

Skin :

Skin was the most common site of allergy. The type of symptoms reported were itching (pruritis), redness of skin (erythema), eruptions on body (papilo-vesicular eruptions) and swelling (oedema). After 4-5 hours of exposure most people complained of itching on face and hand (exposed parts) not relating it to any specific cause (some said they felt it must have been mosquito bite) they continued with their work. Soon the severity of itching increased and by the time they had finished picking at the end of the day they had redness in hands and face and swelling of face. After 1-2 days  of continued exposure they had small white eruptions mostly on the face and then after varying periods (4-5 days to upto 5-6 months) the symptoms started subsiding and they had black discolouration of skin. The people affected with these allergies did not have previous history of allergies even though they were involved in cotton picking earlier.

 

Table 3 - Symptoms pertaining to Skin (Multiple Response)

No	Type of Symptoms	No of Respondents	%
1	Itching on skin	23	100%
2	Redness of skin(mostly face and forearms/hands)	19	82.6%
3	Eruptions on body	20	86.9%
4	Swelling of face	13	56.5%
5	Other symptoms	02	08.6%

Source: Primary Survey, Year: 2005, n = 23

All the 23 persons surveyed had itching of varying severity. In some cases the itching was so severe that they were forced to discontinue working in the fields. In other cases because of itching there was fall in their output i.e. they were able to pick less number of bags. The next most common symptom after itching was white papulo-vescicular eruptions[1]  affecting 20 (on mostly face) and then 19 persons had redness of skin and 13 suffered from swelling of face. Other symptoms were serious discharge from the eruptions and nausea.

 Sooka Bai, w/o Rupa 50 years, Village Kothra Agricultural labourer

She went to pick cotton on the farm of Shoba Ram Tirkat, Kothra who had sown BT 162 in 6 Bigha land. She said that Kapas season is good because in this season she gets around Rs20-25/Bag and able to pick 5-6 bags daily (average income- Rs 100-150). She said, ” Pahle din lagbhag dopahar ke samay hathon aur chehre par khujli shuru hui par main kaam karti rahi. Shaam tak to itna hua ki khoob munda suj gaya. Khoob jalan hui,munda lal ho gaya,aankhe bhi lal ho gai aur pani ane laga, ankhon main khujli hui aur sujan aa gai. Naak se pani aya aur chikey aai. Chere se safed pani nikla phir kala cahta par gaya. 8-12 din kaa nahin kiya phir jana para kyon ki gharan baithe to kawan kya. Pachis rupaye ki tube laga kar thik hua apne gaon ke Dr Vinod se ilaj liya, Pantis sal se bin rahe hoon kabhi nahin hua pehli bar hooaa. Meri gaon ki Anu Bai Manglia aur Kali Bai Manohar ko bhi aisa hua.  

 

Table 4- Parts of Skin Affected (Multiple Response)

 

No	Parts of Skin Affected	No of Respondents	%
1	Face	17	73.9%
2	Hands	15	65.2%
3	Feet	11	47.8%
4	Back	07	30.4%
5	Neck	06	26.1%
6	Abdomen	04	17.4%

Source: Primary Survey, Year: 2005, n = 23

 

The parts mostly affected were exposed parts mainly face, hands and feet. In some persons where the symptoms were more severe the back abdomen neck (covered portions) were affected. Most persons had multiple areas of their bodies affected.

 

5.3       Eyes and Respiratory Tract:

Those who had more severe symptoms of the skin had associated allergies of eyes and respiratory tract.

 

Table 5- Symptoms pertaining to Eyes

No	Types of Symptoms	No of Respondents	%
1	Itching in eyes	02	8.6%
2	Redness of Eyes	01	4.3%
3	Swelling of Eyelids	02	8.6%
4	Watering of Eyes	01	4.3%
5	All above	05	21.7%
	Total with symptoms	11	47.8%
6	No symptoms relating to eyes	12	52.2%
	Total	23	100%

Source: Primary Survey, Year: 2005, n = 23

 

Out of 23 persons 11 had eye symptoms of varying severity. 2 persons had itching in eyes, 2 had swelling of eyelids, 1 had redness of eyes and 1 had watering of eyes. And 5 of the respondents had all the above symptoms.

 

Table 6- Symptoms pertaining to Upper  Respiratory System (URS)

 

No	Types of Symptoms	No of Respondents	%
1	Watering from nose	1	4.3%
2	Excessive sneezing	2	8.6%
3	Both	6	26.1%
	Total with symptoms	9	39.1%
4	No URS symptoms	14	60.8%
	Total	23	100%

Source: Primary Survey, Year: 2005, n = 23

 

Out of 23 persons 9 had allergic symptoms relating to upper respiratory tract which were excessive sneezing (2 persons) and watering from nose (1 person). 6 persons had both these symptoms.

 

Table 7- Severity of illness

 

No	Severity of illness	No of Respondents	%
1	Mild	03	13%
2	Moderate	10	43.5%
3	Severe	10	43.5%
	Total	23	100%

Source: Primary Survey, Year: 2005, n = 23

 

Out of 23 persons 20 persons were having severe to moderate degree of symptoms. One women from Khaparkhera narrated that she had to be removed from the fields and taken to Barwani District Hospital where she was admitted for 9 days.

 

 

Discussion: Tables 1-5 describe in detail the spectrum of symptoms which have been occurring to people exposed to an allergen during the cotton harvesting season. Tables 1 & 2 describe the  symptoms in the skin while Tables 3 & 4 describe symptoms in eyes and Upper Respiratory Tract. The depositions of the agri-workers and farmers also describe in detail the start, progress and regression of symptoms. If we try to  form an overall picture then we see that the allergic reaction typically presents with mild to severe itching of face, neck, hand and feet along with redness and swelling mostly of face, followed by papilo-vesicular eruptions, in severe cases the eyes also become red, swollen (swelling of eyelids) and there is excessive lacrimation (tear formation), there is excessive watering from nose and sneezing. The symptoms mostly occur in exposed parts but in few cases depending on the predisposition of the individual and exposure to allergen the covered portions like back, abdomen, legs are affected. The symptoms get aggravated on continued exposure and resolve in leaving black discolouration of skin.

 

5.4    The relationship between exposure and symptoms

 

i)          The second section from Table 6 to 9 analyse the relationship between exposure and symptoms.

There was a direct relation of exposure with the symptoms. But in addition the affected parts, place of exposure, agricultural operations being done before symptoms occurred and state of crop all showed a relationship between exposure and symptoms.

 

Relationship of Exposure and Symptoms

 

Table 8- Effect on exposed or covered parts

 

No	Parts Affected	No of Respondents	%
1	Exposed parts	14	60.9%
2	Covered parts	01	4.3%
3	Both	08	34.8%
	Total	23	100%

Source: Primary Survey, Year: 2005, n = 23

 

Out of 23 persons 14 had allergic symptoms on exposed parts of body (face, hand and feet,face,neck, eyes and respiratory tract), 8 persons had effect on both covered and exposed parts and only one had on covered portion alone.

Table 9- Place of exposure

 

No	Place of exposure	No of Respondents	%
1	Cotton Field	18	78.3%
2	Home	04	17.4%
3	Both	01	4.3%
	Total	23	100%

Source: Primary Survey, Year: 2005, n = 23

 

Out of 23 persons who experiences symptoms 18 had exposure from the field while 4 had exposure because of storage of cotton at home and only one person had been exposed both at home and at the fields.

 

Dooda Lal s/o Sita Ram Jat, Bagud 37 M

In our home cotton stored had to be transported to Mandi for sale for which six labourers were employed to tie the cotton into bundles and load on tractor. All the workers suffered from itching on hands and feet. The skin became red and there were rashes and there was lot of itching. It did not effect the face. We gave them Tab Avil the symptoms were relieved. After three days we had to take a bag of cotton to Barwani Mandi but we did not take it on the motocycle because of fear of allergy but in the busbecause of contact. We had grown bollgard 184. I am looking after the farms independently since 1990 and always grown Shankar-8, JK H-1, H-4, and in 70-75 we used to grow Maljhiri Kapas when we did not get water from Narmadaji. The water first came in 1984 and we shifted to Shankar-8 etc. But we never faced itching in any of these varieties.

 

 

 

Table 10- Agricultural Operation leading to the symptoms

No	Agricultural Operation	No. Respondents	%
1	Cotton Picking	17	73.9%
2	Carrying out other operations inside cotton fields	02	8.6%
3	Storing inside house	02	8.6%
4	Multiple Operations (spraying, picking and weighing)	02	8.6%
	Total	23	100%

Source: Primary Survey, Year: 2005, n = 23

17 affected persons were directly involved in operation of picking cotton. 2 persons had symptoms while doing other work inside cotton field(one cutting grass for cattle below the cotton plant other while plucking vegetables inside the cotton field. 2 persons got the symptoms while the cotton was stored inside their house while sleeping on the cotton heap or resting his back on the heap. Two persons had symptoms after involved in multiple agricultural operation. As has been mentioned in earlier section the cotton is picked manually by means of both the hand and put into a bag slung across the shoulder. The labourer has to move inside the fields picking from each plant then the other. This operation is mostly carried out by women and involves intimate contact with the cotton plant on all parts of body especially the exposed parts.

 

 

 

 

Table 11- Stage of the crop

No	State of the crop	No of Respondents	%
1	Before the flowering stage	0	0%
2	Flowering stage	0	0%
3	Before eruption (Pods)	0	0%
4	Eruption of cotton	18	78.3%
5	After plucking  of cotton	05	21.7%
	Total	23	100%

Source: Primary Survey, Year: 2005, n = 23

 

 

Discussion Tables 6 to 9 are indicative of an association of the symptoms with exposure to BT plant. Table 6 indicates that 60.9 % of the respondents are having symptoms only on the exposed parts and only 4.3% had on unexposed part, indicates that physical contact with an allergen is responsible for the allergy. Subsequent questions indicated in tables 7-9 have been asked to identify the allergen and its association with symptoms. Results of Table 7 show that 78% of the people were exposed to the allergen in the field during the cotton season. The others also had a definite exposure to cotton (in stored form inside the houses) even if their symptoms appeared at home. Table 8 indicates that for 73.8% of people the immediate event that preceded their symptom was the cotton picking operation. This is a very important link which is  strongly indicative of an association of symptoms and cotton picking operation.  Even for the others they were handling cotton fibre or in direct contact with cotton immediately prior their symptoms.

All the Data collected is not summarized in the Tables but there are certain conclusions which can also be drawn from  case histories. People have reported that when they continued to work in the field the severity of symptoms have increased and they got relief after they stopped work i.e. they no longer remained exposed. This indicates a dose response relationship and symptoms did not get worsened after the exposure was removed (reversibility of symptoms). The agri-worers and farmers have stated that they have been involved in cotton related operations for many years but it was only from the last 2 years when Bt cotton was introduced 2 years ago that they started have alleries. This is a very important statement which indicates a strong relation between the symptoms and its causative factor. Table 9 indicates a set of questions which were included in the questionnaire to determine the stage of the cotton plant which is causing allergy. To some extent it also indicates the part of plant which is having the allergen. From the negative responses of this table we can have an idea that neither the leaves, stem, flower or pod of Bt. Plant causes allergy but the cotton fibre is causing the allergy. More of this is discussed in section of Agri Sceintist and plausibility.

5.5    Ginning factory  labourers and owner.

The Investigation team also visited the ginning factory and collect information from the owner of the factory. According to them last year there were several complaints of allergy among the labourers. The owner of M/s. Vishal Udyog, Anjad (Barwani) told that most of the farmers and labourers were having skin related problem due to Bt. cotton and that’s why labourers were not ready to unload the cotton-loaded truck from Maharastra.

According to Mr. Sunil Patidar, owner of ginning factory symptoms like itching, redness of eyes, watering of eyes and cough were found in labourers who work in his factory, most of the labourers were having this problem last year it was more, this year also cases were found. Most of the labourers were complaining him about this health related problem.

“ Pichele saal to khujli ki itni taklif thi ki hum yaha office mein avil ki goliya  rakhni parthi thi, mazdoor taklif hone par goli khakar kam par lag jate thhe’’, according to Sh Babulal Vyas  of M/s. Rajesh Ginning Factory, Anjad (Barwani).

Discussion with labourers:- The team has done a detailed discussion with the labourers working in different ginning factory. It came out from the discussion that itching in whole body was very common among labourers who carry Bt cotton. They told that they take Tab. Avil every day and then only they were able to work. It came to the notice that the problem increase in hotter days. We met 2 women labour (one works in ginning factory and other pluck cotton from the field) both had same type of problem. They told that itching start from exposed part of body-hand and leg and then spread over to face.

We had done detailed interview with 6 labourer from different ginning factory and found that all were having itching problem and 2 of them were having eruptions on body. Skin problem were found in exposed part of the body. The affected parts in body were hands, legs and face. They were working as labourer in the factory from 2-7 years, but they suffered first time with this type of health related problem due to this cotton.

It is quite clear that not only farmers but also the labourers who were engage in transportation of cotton had health related problems.

5.6    Doctor practicing in the area.

            Dr Ramesh Jar of Saigaon, Ayurvedic Doctor, has been doing practice in Aawli, Tal Thikri, Dist Barwani. He sits from 6-7 PM. He said this year i.e. in  2005 he has already received   around 150 cases allergy from two villages of Aawli and saigaon. In 2004 he had got around 100 cases of allergy. The symptoms begin with itching in all parts of body, followed by red patches (Dadre), redness of eyes, swelling of face and hands. It happens mostly while picking Kapas. Also some people who load and tractor with rui were getting these symptoms.

He is giving Dexona injection and Levocetrigen for skin and anti allergic drops for eyes.

Case Study-

 Chanda Bai a women from Aawli, cotton is the main earning  source in her family and out of 7 members in her family 2 go for agriculture related works. She earns Rs 50-60/ daily and work around 10-12 hour per day for 2 months  and for the rest of the year depending upon the work she earn around Rs 25/ per day.  Her husband is alcholic. She   had suffered from health Problem due to Bt cotton in 2004 and 2005.She remembered that when first time she went to Dr Babu, Anjad he told that -" Bolgard kapas action kar gaya ".

Matha Aakh Sab Sujan ho gaya, dadore ho gaye lal rang ke.Kapas hum to kapra bandh kar binte hai, par sir par bhi ho jata hai,haath pair par ho jata hai, abhi bhi hota hai. Chunte hai to pata lagta hai- rui se nahi to pata se ho jata hai. jaha bhi lagta hai wahi par ho jata hai.

First symtom- Sep 2004.

 

Details of treatment

 

Sr no	Where	No of Days	Expense
1.	Dr Babu, Anjad, Pvt	3-4	600 -700/
2.	Dr Santosh,	2-3	300/
3.	Dr S.K. Bawniya,Anjad	2-3	250/
4.	Dr Modi,  Dist hospital, Barwani	8	90/ for a day.
5.	Dr Ramesh, Pvt, Segaon	2	200/
6.	Dr S.K. Bawniya, Anjad( Second time)	3	300/

  

Dr S.K.Bawniya had given Gin soma ( Vitamin%& minerals for Strength),Tab Nimuslide& paracetamol(Nimuwin plus), Meriprat Plus(Protien- Vitamin& Minerals)

This also shows that how due to the impact of Bt cotton on Peoples health and health expenditure of the family increases..Pl also refer Annexure 1. 

 

5.7    Some unanswered Questions    

If Bt cotton fibers are causing allergy than we need to find answers to certain questions i.e. What is it in the plant which causes allergy?, why in some people allergy is more and in others no allergy has occurred? Why in some cotton season the more allergy has occurred and in others less allergy has occurred? Why no such reports have come from other parts of the country? We have tried to answer some of these questions.

 

5.8    What is Allergy in Medical Practice and what is Contact Dermatitis?

 

 ”Allergy is altered state of reactivity to an antigen. For inducing allergic reaction the host should have contact with allergen. Exposure to allergen causes sensitization of body immune system by absorption by the skin. Cells of skin capture allergen which migrate to the draining lymph nodes where they present it to t-cells. The sensitized T-cell travel to skin site where on contacting
the allergen they release lymphokines which activate cells known as macrophages and increase influx of other types of cells called eosinophils. Repeat  contact of allergen with sensitized individual causes contact dermatitis lesion which varies from macules,papules to vesicles that breakdown leaving behind raw weeping areas typical of acute eczematous dermatitis.”[3]

 

An agent may act as an allergen or an irritant and cause lesions on the skin and the mechanism of action for both is different.

 

            “Irritant reaction in contrast to allergic reaction can occur upon first exposure to an agent, are typically dose related, can be induced in almost everybody with sufficient exposure are more likely to respond to use of protective barrier cream. A single agent can be both irritant and allergenic, depending on patient and on the conditions of exposure.” The reaction may vary in severity depending on the strength of irritant, on local skin factors like degree of skin hydration, thickness etc and allergen characteristics like chemical structure, dose and route of presentation of antigen.

           

            This to some extent explains the reason for different reactions of a person to any allergen or irritant and while on one hand a person may have severe allergy on the other hand certain  people would have no effect of an allergen or irritant.

 

 

Contact Dermatitis

When dermatitis is induced by contact with external agent ,it is called contact dermatitis. When an external agent directly damages the skin ,the ensuing eruption is referred to as an irritant contact dermatitis(ICD).That is different from allergic contact dermatitis (ACD), which is caused by an immunological reaction to an allergen which comes in contact with skin. Contact dermatitis is occupational related disease and represents a significant economic loss. The most common recognized form of ACD is Phytodermatitis or plant dermatitis. Plants like poison ivy,oak and sumac cause an allergic reaction marked by erythema (redness of skin), vesiculation, and severe pruritis (itching).[4]

 

5.9    Plausibility (or mechanism of action) 

 

Dr Debashish Banerji[5], agricultural bio-scientist, has opined that in Bt Cotton the Bt toxin is produced in all tissues- root, stem, leaves, bolls and even the cotton fibres. The plant is like a leaking barrel of a pesticide in this case the Bt toxin protein. In India, unlike America or other developed countries, the agriculture labour does not have access to protective overalls, gloves, masks etc. obviously the direct contact with the plant may induce allergies. The most unfortunate scenario is that even the farmers are not given any information about this obvious apparent danger. He further explained that the leaves, stem, roots have a skin similar to human skin and it is possible that direct contact with these parts may cause less or no allergy, however, the cotton fibre as such is without any such protective coating therefore direct contact can cause allergy.

 

According to him this is the most plausible explanation of allergic reactions reported by researchers.

 

In a Public Interest Litigation on Biosafety of Genetically Modified (GMOs) in 2005[6] reports of Independent Science Panel (ISP) an independent expert panel of scientist from 11 countries to review the hazards and problems of GM crops and one of the findings of this panel quoted in the PIL was that," ... Bt protien that kills insect pests include potent immunogens and allergens ..."

The PIL further goes on, "... several Cry protein in Bt products could be a source of allergens and antibodies".

The labourers working in the Ginning Factories also try to identify the cause of this problem and explain to the investigation team that “Jab kapas ka beej such jata hai to uske barik barik kan sarir pe pasine ke karan chipakte hai aur dhoop badhne par khujli suru ho jati hai.Is  tarah ki taklif do saal se B.T kapas aane se suru hui hai aur kapas ke beej sukhne par khujli suru ho jati hai.”

We asked  Satish Goswame a cotton growing  farmer of Bajrikhera about the possible cause of the symptoms and whether pesticide could be a cause. He said “Dawai (pesticide) se nahin hai, ham to 15-20 sal se kheti kar rahe hain or kabhi aisa nahin hua. Dawai jab chamri par girti hai to sabun se saaf karte hai ek din main dheek ho jata hai.hota to Bt. sai he hai. Mere khayal se Bt. ki gili rooi jab taji taji nikalti hai us se hota hai.”

 

Some of the possible explanations to the question that what is it in the plant which causes allergy?

 

 

8.         To Summarize

 

All the evidence gathered during the investigation shows that Bt. has been causing skin, Upper respiratory tract and eye allergy among persons exposed to cotton. The symptoms vary from mild, moderate to very severe to the extent that one women had to be  admitted for 9 days as a result of allergy. The allergy is not restricted to farm labourers involved in picking cotton but has affected labour involved in loading and unloading Bt from villages to market, those involved in its weighment, labourers working in ginning factories, people who carried out other operations in the field of BT cotton, or farmers who stored cotton in their homes etc. Thus the symptom is affecting people widely exposed at different places. The symptoms were not restricted to one particular farm but several farms in 6 villages spread around 4 tehsils of 2 districts. The  doctor of this area also has reported a spurt of allergic cases  in the last 2 seasons in the cotton season. The agro scientist and some farmers and labourers have also pointed a finger on the Bt cotton and given explanations for this type of allergies. After considering all evidences,  statement and openinons we an say that BT cotton is causing allergy to people.

 

The  authorities  concerned with approving, promoting  and monitoring the Bt cotton need to conduct a detailed investigation on this aspect and appropriate corrective measures are needed. There is a need to spread awareness in cotton growing regions abot the allergic characteristic of the plant so that people can identify the cause and take preventive measures.

 

Annexure-1 Details of Persons got treatment.

 

Sr.	Name of the person got treatment	Age	village	Symtoms	Where	Expense
1.	Devkar bai	35F	Khaparkheda	Itching	Pvt Clinic	Rs 420/
2.	Devram bhai	45M	Khaperkheda	Itching, redness in body	Pvt doctor	Rs 3300/
3.	Babita Mukesh	20F	kotra	Black spot in Skin,Itching and redness in eyes	Pvt Doctor	Not able to remember
4.	Bacchi Bai and her daughter Kali	50F	Kotra	Swelling, spots and itching	Pvt doctor	Rs 80/ Rs 130/- on her daughter
5.	Kali bai	40F	Vill.Kothra, Teh.Manawar, Dist. Dhar	Infection in eyes, Jalan hona	Pvt doctor	Rs 182/
6.	Jyoti Khemendra Case history	24F	Bajrikhera	Skin disease,Red spots, Itching	Pvt Doctor	1200/ Treatment taken for  3 months
7.	Sakri Tantia,	50F	Bajri Kheda,	Black spots,Jalan hona,Swelling	Pvt doctor	Rs 40/
8.	Narendra Poonamchand	35M	Khaparkheda	Itching	Pvt doctor	Rs 100/
9.	Madhubala Mansaram	25F	kotda	Itching,Black spots,Red Skin	Pvt Doctor	Rs 300/
10.	Aanu Bhagatiya	45F	Kotda	Black, white spots,Swelling,	Pvt	1000/
11.	Deepak Shobharam	26M	Kotda	Swelling, skin disesase	Pvt	500/
12.	Suka bai	50F	Kotda	Jalan Hua, Swelling	Pvt	25/ and
13.	Kishore	45M	Karmal	Itching,Swelling, Red spot	Pvt, Nisarpur	450/
14.	Bhura Bai	35F	Khaperkheda	Itching,Black Spots,Swelling	Pvt Nisarpur	400/
15.	Purva Bai	36F	Khaperkheda	Itching, Rash, irritation in eyes	No treatment
16.	Yashoda Bat	F	Awli	Itching, Rash.	No Treatment
17.	Dooda Lal	M	Bagud	Itching, redness of skin, Rash.	No Treatment
18.	Durga Lal	M	Bagud	Itching.	No Treatment
19.	Kamal	30M	Karmal	Itching, redness of skin, Swelling.	No Tratment
20.	Babu Bhallu	M	Bagud	Itching, redness of skin, Rash.	Took Treatment from Barwani	Not available
21.	Mangilal Ramesh	M	Awli	Itching, redness of skin, Rash.	No Treatment
22.	Chandra Bai	F	Awli	Itching, redness of skin, swelling, Rash.	No Treatment	-
23.	Rekha Keshore	F	Awli	Itching, swelling, Rash.	No Treatment	-