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3. Recommendation for Exposure-Based Assessment of Joint Toxic Action of the Mixture

Because suitable data, joint action models, and PBPK models are lacking for the complete mixture, the recommended approach for the exposure-based assessment of joint toxic action of this mixture is to use the hazard index method with the TTD modification and qualitative WOE method to assess the potential consequences of additive and interactive joint action of the components of the mixture. These methods are to be applied only under circumstances involving significant exposure to the mixture, i.e., only if hazard quotients for two or more of the compounds equal or exceed 0.1 (Figure 2 of ATSDR 2004). Hazard quotients are the ratios of exposure estimates to noncancer health guideline values, such as MRLs. If only one or if none of the compounds has a hazard quotient that equals or exceeds 0.1, then no further assessment of the joint toxic action is needed because additivity and/or interactions are unlikely to result in significant health hazard. As discussed by ATSDR (1992, 2004), the exposure-based assessment of potential health hazard is used in conjunction with biomedical judgment, community-specific health outcome data, and community health concerns to assess the degree of public health hazard.