Current diagnostic methods for diisocyanate induced occupational asthma

Bernstein, David I.; Jolly, Athena T.

doi:10.1002/(sici)1097-0274(199910)36:4<459::aid-ajim7>3.0.co;2-w

Cited by 42 publications

(14 citation statements)

References 25 publications

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“…Dicarbonsäureanhydride gehören in die Gruppe der niedermolekularen Inhalationsallergene mit hoher Sensibilisierungspotenz [4, 20, [8]. Die Prävalenz der Erkrankungen an Isozyanat-Asthma unter exponierten Arbeitern wird zwischen 5 und 15% geschätzt.Die Pathogenese des Isocyanat-Asthmas ist weiterhin nicht vollständig aufgeklärt [69].…”

Section: Dicarbonsäureanhydrideunclassified

“…Die Mehrheit der berufsbedingten obstruktiven Atemwegserkrankungen durch Diisocyanate ist nicht IgE vermittelt. Charakteristisch für Isocyanat-Asthma ist eine asymptomatische Latenzphase am Arbeitsplatz, die der Asthmaauslösung vorangeht,Auslösung durch DiisocyanatMengen, die unterhalb der irritativen Schwelle liegen, aktivierte Eosinophile und T-Zellen in Bronchialbiopsien, Vorkommen von asthmatischen Sofort-und verzögerten ("late-phase") Reaktionen, wobei viele Betroffene ausschließlich die verzögerte asthmatische Reaktion nach 4-12 h nach Diisocyanat-Exposition aufweisen [8]. Diisocyanat-spezifische IgEAntikörper sind häufig von prädiktivem Wert für Isocyanat-Asthma,jedoch ist dieser Test als Screening-Methode nicht ausreichend sensitiv.…”

Section: Dicarbonsäureanhydrideunclassified

“…Die Expositionsbedingungen am Arbeitsplatz sind im Einzelnen schwer zu quantifizieren und zu kontrollieren. Funktionelle Untersuchungen wie serielle arbeitsplatzbezogene exspiratorische Peak-Flow-Messungen,unspezifische bronchiale Provokation (Methacholin-Test) und spezifische bronchiale Provokation mit Diisocyanat sind zur Diagnosesicherung erforderlich [8], die ausschließlich spezialisierten Zentren vorbehalten bleiben müssen. Zur Überprüfung der klinischen Relevanz anderweitig nachgewiesener Typ-ISensibilisierungen können Provokationstestungen mit dem verdächtigen Allergen durchgeführt werden, z.…”

Section: Dicarbonsäureanhydrideunclassified

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Berufsdermatologisch relevante Typ-I-Allergien

Mahler

Drexler

2004

Der Hautarzt

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In Germany the most frequent initial report of occupational disease is due to occupational skin diseases ("Berufskrankheitenanzeige nach Nr. 5101 der Berufskrankheitenverordnung") defined as "severe or recurrent skin diseases that force the discontinuation of any activity that causes or that could be causing the development, the worsening, or the recurrence of the skin disease". The majority of these occupational skin diseases consists of irritant and allergic contact dermatitis. In contrast, work place- related Type I allergy (contact urticaria syndrome) is less frequent, but carries the risk of systemic reactions. The clinical manifestations and pattern of exposure to Type I allergens in the work place are described.

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Section: Dicarbonsäureanhydrideunclassified

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Berufsdermatologisch relevante Typ-I-Allergien

Mahler

Drexler

2004

Der Hautarzt

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“…The reader should be aware that more extensive evaluations, particularly inclusion of prolonged periods away from the workplace (7) and earlier referral to occupational lung disease specialists (5) have been recommended.…”

Section: Diagnosismentioning

confidence: 99%

Experience with Early Detection of Toluene Diisocyanate-Associated Occupational Asthma

Conner

2002

Applied Occupational and Environmental Hygiene

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There is good reason to expect that regular respiratory surveillance and early removal of workers who develop toluene diisocyanate (TDI)-associated occupational asthma can effectively protect these workers from accelerated pulmonary function decline. Application of this simple principle in operating industrial workplaces presents numerous challenges. The experience of one corporation is presented. One approach is to remove from future diisocyanate work, all workers who develop symptoms consistent with occupational asthma. However, the experience within this one corporation concurs with earlier, more carefully controlled investigations that such a strategy would be unduly restrictive of workers' occupational options. Fewer than half of the workers, who might have triggered such a practice, have required removal after more thorough occupational medical evaluation. Diisocyanates are such well known occupational asthmagens that other exposures tend to be ignored when considering respiratory health problems in a workplace. A small series of workers with work-related respiratory symptoms will be discussed. The usual industrial hygiene air monitoring demonstrated excellent control of the polyisocyanate hazard. Further investigation demonstrated poor control of a mold-release solution. Control of that exposure has allowed previously restricted workers to return to their former work making polyurethane parts. The number of cases available for analysis and discussion from this single, albeit large, corporation is small. Significant advances in understanding whether time-weighted average (TWA), task-specific, or dermal exposures to TDI and other polyisocyanates are most hazardous will require either many more years of experience within one corporation, or pooling of experience across the industry.

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“…Several authors (Bernstein and Jolly 1999;Elms et al 2001;Redlich et al 2001) have suggested immunologically mediated mechanisms to explain the hypersensitivity pneumonitis and the asthma caused by isocyanates. However, a classical specific IgE-mediated type I reaction fails to explain some 80% of clinical asthma cases believed to be caused by occupational exposure to diisocyanates (Butcher and Banks 1992;Kennedy and Brown 1992).…”

Section: Introductionmentioning

confidence: 99%