Bronchoalveolar Lavage and Morphology of the Airways after Cessation of Exposure in Asthmatic Subjects Sensitized to Toluene Diisocyanate

Paggiaro, Pierluigi; Bacci, Elena; Paoletti, Paolo; Bernard, P; Dente, Federico L.; Marchetti, Gabriella; Talini, D; Menconi, G; Giuntini, C.

doi:10.1378/chest.98.3.536

Cited by 78 publications

(34 citation statements)

References 23 publications

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“…Previous studies on the inflammatory changes in OA after removal from exposure were performed in six subjects exposed to toluene diisocyanate (TDI) [22,29]. Our results extend these findings to a larger group of subjects and to HMW agents, which cause sensitization through an IgE-dependent mechanism, similar to "extrinsic asthma".…”

Section: Discussionsupporting

confidence: 78%

“…These results should, therefore, not be interpreted as showing that atopy per se can influence airway inflammation. In keeping with the persistence of airway inflammation after cessation of exposure to a sensitizing substance at work, PAGGIARO et al [29] also showed that after cessation from exposure to TDI, persistence of airway hyperresponsiveness in sensitized subjects was associated with an increased number of eosinophils in BAL fluid.…”

Section: Discussionmentioning

confidence: 79%

See 1 more Smart Citation

Airway inflammation after removal from the causal agent in occupational asthma due to high and low molecular weight agents

Boutet²,

Laviolette³

et al. 1994

Eur Respir J

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A Ai ir rw wa ay y i in nf fl la am mm ma at ti io on n a af ft te er r r re em mo ov va al l f fr ro om m t th he e c ca au us sa al l a ag ge en nt t i in n o oc cc cu up pa at ti io on na al l a as st th hm ma a d du ue e t to o h hi ig gh h a an nd d l lo ow w m mo ol le ec cu ul la ar r w we ei ig gh ht t a ag ge en nt ts s L-P. Boulet*, M. Boutet*, M. Laviolette*, M. Dugas**, J. Milot*, C. Leblanc**, L. Paquette**, J. Côté*, A. Cartier**, J-L. Malo** ABSTRACT: In order to determine 1) the features of airway inflammation after removal from exposure to high (HMW) and low (LMW) molecular weight agents 2) if there are any differences in the pattern of inflammation induced by these two types of agents, we studied 18 subjects with a recently confirmed diagnosis of occupational asthma (OA) due to HMW (n=11) and LMW (n=7) agents. The duration of asthma symptoms varied from 2 to 108 months (mean 33 months), and withdrawal from exposure to the sensitizing agent from 3 to 24 weeks (mean 10 weeks). All subjects underwent measurements of expiratory flow rates, methacholine inhalation tests, and a flexible bronchoscopy with bronchoalveolar lavage (BAL) and bronchial biopsies. Endoscopic findings were compared with a group of 10 normal subjects. At the time of the bronchoscopy, asthma symptoms were minimal in most subjects.Although 15/18 subjects had normal forced expiratory volume in one second (FEV 1 >80% pred), all subjects had increased airway responsiveness to methacholine (provocation concentration producing a 20% fall in FEV 1 =0.2-10.0 mg·ml -1 ). BAL analysis showed similar median percentages of the total number of cells and differentials in control subjects and those exposed to HMW and LMW agents. Bronchial biopsies showed that mean inflammatory cell count, both epithelial and sub-epithelial, was similarily raised in OA subjects exposed to either HMW or LMW agents, compared to controls, except for epithelial lymphocyte count. In contrast to the controls, bronchial biopsy of both groups with OA also showed other changes such as extensive epithelial desquamation, ciliary abnormalities of the epithelial cells, smooth muscle hyperplasia and subepithelial fibrosis.Bronchial biopsies from subjects with occupational asthma showed similar significant inflammatory changes after withdrawal from exposure to either high or low molecular weight sensitizing agent, even when symptoms were minimal.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 79%

Airway inflammation after removal from the causal agent in occupational asthma due to high and low molecular weight agents

Boutet²,

Laviolette³

et al. 1994

Eur Respir J

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“…Isocyanate asthma has been difficult to diagnose and control, in part because the mechanisms by which isocyanates cause asthma and the determinants of exposure have not been well defined ( 2 -4 ) . Most of the prior clinical and animal investigations have involved methylene diphenyl diisocyanate (MDI) and toluene diisocyanate (TDI), rather than hexamethylene diisocyanate (HDI), which is increasingly being used in place of TDI (4)(5)(6)(7)(8)(9)(10). To our knowledge, none of the diisocyanates have previously been identified or localized in the human respiratory tract.…”

mentioning

confidence: 99%

Airway isocyanate-adducts in asthma induced by exposure to hexamethylene diisocyanate

Redlich

Mh²,

Graham³

et al. 1997

Scand J Work Environ Health

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“…There are lethal cases because of continuing work 26,32) . For this reason, for the process of improving working health, such as by adjustment and improvement of workplace, it is important to remove cause materials completely 63) . In one case that lung function improve after avoidance of causative materials, hypersensitivity is slight.…”

Section: Treatment and Prevensionmentioning

confidence: 99%

Occupational Hypersensitivity Pneumonitis Due to Isocyanates: Mechanisms of Action and Case Reports in Japan.

2001

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Isocyanates are very useful chemicals, and these are important for our daily life. Various products, especially urethane resin, are made from these chemicals. There is no substitute for isocyanates at the present. Isocyanates are patent agents to provoke immunological responses. This article deals with the case reports of hypersensitivity pneumonitis (HP) induced by isocyanates in Japan. It is said that HP is one of the rare diseases induced by isocyanate with very low frequency so far in the world. Certainly there are rare cases of isocyanate-HP also in Japan, but these are the cases only in large enterprises that pay attention to their working places. In Japan, there are several cases of isocyanate-induced HP, which happened in minor enterprises such as those with less than 50 workers. In clinical appearance, there are few conflicts with Western studies. The best choice for sensitized people is isolation from working places. It is important for the workers to understand the diseases. In these days, several tests for diagnosis are developed. It is indispensable to put these tests for prevention of these diseases and improvement of their working places.

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Bronchoalveolar Lavage and Morphology of the Airways after Cessation of Exposure in Asthmatic Subjects Sensitized to Toluene Diisocyanate

Cited by 78 publications

References 23 publications

Airway inflammation after removal from the causal agent in occupational asthma due to high and low molecular weight agents

Airway inflammation after removal from the causal agent in occupational asthma due to high and low molecular weight agents

Airway isocyanate-adducts in asthma induced by exposure to hexamethylene diisocyanate

Occupational Hypersensitivity Pneumonitis Due to Isocyanates: Mechanisms of Action and Case Reports in Japan.

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