Hypersensitivity pneumonitis (extrinsic allergic alveolitis) induced by isocyanates,☆☆,

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Abstract

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 lymphohistocytic patterns mostly associated with mild fibrosis in lung histology (n = 5) confirmed the diagnosis. Conclusion: Occupational exposure to isocyanate vapors and aerosols induces typical hypersensitivity pneumonitis in at least 1% of the isocyanate workers with symptoms. Diphenylmethan diisocyanate was found to be the main cause of this disorder. (J ALLERGY CLIN IMMUNOL 1995;95:1004-10.)

Section snippets

METHODS

Sixteen patients were initially recruited from a group of 1780 isocyanate workers. Two hundred ninety-four workers from this group comprised the whole staff of four car and chemical factories. The remaining subjects were involved in medical surveillance programs for isocyanate workers or were patients of our outpatient department. All subjects underwent physical examination by a company physician who also recorded detailed case histories. Furthermore, chest x-ray films and lung function testing

Clinical investigations

Table I shows individual data on patients, occupational exposure to isocyanates, and symptoms. The subjects produced polyurethane foam, performed injection molding in foundries, sprayed paint, or worked in various other industrial branches. The preponderance of MDI exposure was noticeable (nine cases). Three paint sprayers had contact with an HDI biuret, and three handled TDI and other isocyanates. Workers' mean exposure period to isocyanates was 6.0 years (range, 0.5 to 20 years).

Each worker

DISCUSSION

Hypersensitivity pneumonitis is caused by the inhalation of different organic substances and mediated by cytotoxic mechanisms and various cellular and humoral immune responses. Although the individual pathogenetic role of these responses is not clear, it can be assumed that diagnostically used parameters such as specific IgG antibodies (which may lead to the formation of immune complexes and the activation of the complement cascade) and antigen-specific lymphocytic reactions are also operative

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    From the Professional Associations' Research Institute for Occupational Medicine, Ruhr University.

    ☆☆

    Reprint requests: Prof. X. Baur, Buerkle de la Comp-Pl. 1, D-44789 Bochum, Germany.

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