A decision tree for assessing effects from exposures to multiple substances

Background The Cefic Mixtures Industry Ad-hoc Team (MIAT) has investigated how risks from combined exposures can be effectively identified and managed using concepts proposed in recent regulatory guidance, new advances in risk assessment, and lessons learned from a Cefic-sponsored case study of mixture exposures. Results A series of tools were created that include: a decision tree, a system for grouping exposures, and a graphical tool (the MCR-HI plot). The decision tree allows the division of combined exposures into different groups, exposures where one or more individual components are a concern, exposures that are of low concern, and exposures that are a concern for combined effects but not for the effects of individual chemicals. These tools efficiently use available data, identify critical data gaps for combined assessments, and prioritize which chemicals require detailed toxicity information. The tools can be used to address multiple human health endpoints and ecological effects. Conclusion The tools provide a useful approach for assessing risks associated with combined exposures to multiple chemicals.