Occupational Asthma Reference

Baur X, Hypersensitivity pneumonitis (extrinsic allergic alveolitis) induced by isocyanates, J Allergy Clin Immunol, 1995;95:Pt 1):1004-10,

Keywords: isocyanate, Germany, history, xray, IgE, IgG, fever, X, ventilation, histology, diagnosis, causes, alveolitis, CXR, MDI, ch, bal, cross sectional, ep

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Xaver Baur, Institute of occupational medicine, Hamburg Xaver Baur

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BACKGROUND: Chemical-induced hypersensitivity pneumonitis has been so far rarely described. The purpose of this study was to find out whether hypersensitivity pneumonitis is a common disorder in isocyanate workers.

METHODS: Company physicians' case histories of 1780 isocyanate workers were evaluated. In 16 subjects suspected of having isocyanate-induced hypersensitivity pneumonitis, chest x-ray films were made; levels of IgE and IgG antibodies to isocyanate-human serum albumin were estimated; conjugates and isocyanate challenge tests, bronchoalveolar lavage fluid analyses, and/or lung histologic investigations were performed.

RESULTS: Each of the 14 study patients who had hypersensitivity pneumonitis had work-related dyspnea and fever occurring several hours after the start of work with isocyanates. Typical clinical findings were the reduction of lung diffusing capacity (n = 10), reticular or nodular lung patterns in the x-ray film (n = 9), and serum IgG antibodies specific to isocyanate-human serum albumin conjugates (n = 10). Restrictive ventilation patterns in the inhalation challenge tests (n = 5), lymphocytic and/or neutrophilic alveolitis seen in bronchoalveolar lavage fluid analyses (n = 7), and lymphohistiocytic patterns mostly associated with mild fibrosis in lung histology (n = 5) confirmed the diagnosis.

CONCLUSIONS: Occupational exposure to isocyanate vapors and aerosols induces typical hypersensitivity pneumonitis in at least 1% of the isocyanate workers with symptoms. Diphenylmethane diisocyanate was found to be the main cause of this disorder 0 (Allergens). 0 (IgG). 0 (Isocyanates). 101-68-8 (4,4'-diphenylmethane diisocyanate)

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