Summary
We performed diisocyanate inhalation tests (maximal concentration, 20 ppb; exposure time, 1–2h) using toluene diisocyanate (TDI, n = 15) and diphenylmethane diisocyanate(MDI, n = 7) as well as methacholine challenges in 19 workers who had a clinical history of TDI/MDI-induced asthma. Additionally we tested volunteers who had no previous contact with diisocyanates: 10 healthy individuals with a negative methacholine test and 14 patients with asthma and a positive methacholine test were exposed to TDI. In all, 1 of the normal volunteers and 3 of the patients with asthma unrelated to diisocyanates showed a positive airway reaction to TDI, and 13 of the 19 diisocyanate workers displayed a positive result in the TDI/MDI inhalation test; however, only 6 of these 13 individuals reacted to methacholine. Furthermore, 3 of the 6 patients with a negative TDI/MDI challenge test demonstrated a significant response to methacholine. We conclude that bronchial hyperreactivity as evaluated by the methacholine challenge test is not closely related to isocyanate-induced bronchoconstriction and, therefore, the metacholine challenge is only of limited diagnostic value in patients with suspected isocyanate-induced asthma.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Banks DE, Barkman WH, Butcher BT, Hammad YY, Rando RJ, Glindmeyer HW, Jones RN, Weill H (1986) Absence of hyperresponsiveness to metacholine in a worker with methylene diphenyl diisocyanate (MDI)-induced asthma. Chest 89:389–393
Banks DE, Sastre J, Butcher BT, Ellis E, Rando RJ, Barkman HW, Hamad YY, Glindmeyer HW, Weill H (1989) Role of inhalation challenge testing in the diagnosis of isocyanate-induced asthma. Chest 95:414–423
Banks DE, Rando RJ, Barkman HW (1990) Persistence of toluene diisocyanate-induced asthma despite negligible workplace exposures. Chest 97:121–125
Baur X (1983) Immunologic cross-reactivity between differrent albumin-bound isocyanates. J Allergy Clin Immunol 71:197–205
Baur X, Dewair M, Fruhmann G (1984) Detection of immunologically sensitized isocyanate workers by RAST and intracutaneous skin tests. J Allergy Clin Immunol 73:610–618
Bayer O (1947) Das Diisocyanat-Polyadditionsverfahren (Polyurethane) Angew Chem 9:257–288
Burge PS (1982) Non-specific bronchial hyper-reactivity in workers exposed to toluene di-isocyanate, diphenyl methane di- isocyanate and colophony. Eur J Respir Dis 63 [Suppl 123]:91–96
Butcher BT, Jones RN, O'Neill CE, Glindmeyer HW, Diem JE, Dharmarajan V, Weill H, Salvaggio JE (1977) Longitudinal study of workers employed in the manufacture of toluene-diisocyanate. Am Rev Respir Dis 116:411–421
Butcher BT, Karr RM, O'Neil CE, Wilson MR, Dharmarajan V, Salvaggio JE, Weill H (1979) Inhalation challenge and pharmacologic studies of toluene diisocyanate (TDI)-sensitive workers. J Allergy Clin Immunol 64:146–152
Butcher BT, O'Neil CE, Reed MA, Salvaggio JE (1980) Radioallergosorbent testing of toluene diisocyanate, reactive individuals using p-tolyl isocyanate antigen. J Allergy Clin Immunol 66:213–216
Dharmarajan V, Rando RJ (1979) A new method for the generation of standard atmospheres of organo isocyanates. Am Ind Hyg Assoc J 40:870–876
Diem JE, Jones RN, Hendrick DJ, Glindmeyer HW, Dharmarajan V, Butcher BT, Salvaggio JE, Weill H (1982) Five-year longitudinal study of workers employed in a new toluene diisocyanate manufacturing plant. Am Rev Respir Dis 126:420–428
Dodge R (1986) Sensitivity of metacholine testing in occupational asthma (editorial). Chest 89:324–325
Fabbri LM, Boschetto P, Zocca E, Milani G, Pivirotto F, Plebani M, Burlina A, Licata B, Mapp CE (1987) Bronchoalveolar neutrophilia during late asthmatic reactions induced by toluene diisocyanate. Am Rev Respir Dis 136:36–42
Fruhmann G (1987) Arbeitsmedizinische Vorsorgeuntersuchungen von Diisocyanat-Exponierten nach G 27. Arbeitsmed Sozialmed Präventivmed 3:58–60
Fruhmann G, Baur X, Vogelmeier C (1987) Inhalative Provokation mit Isocyanaten im Vergleich mit Methacholin und mit dem Hauttest. Arbeitsmed Sozialmed Präventivmed 4:94–97
Gonsior E, Krueger M, Meier-Sydow J (1976) Die Durchführung inhalativer Antigen-Provokationsproben mit Hilfe der Ganzkörperplethysmographie. Acta Allergol 31:283–296
Gonsior E, Krueger M, Meier-Sydow J (1980) Influence of physiological method and criterion of evaluation on results of bronchial antigen provocation tests. Prog Respir Res 14:104–108
Koenig G, Luderschmidt CH, Hammer C, Adelmann-Grill B, Braun-Falco O, Fruhmann G (1984) Lung involvement in scleroderma. Chest 85:318–324
Lozewicz S, Assoufi BK, Hawkins R, Newman Taylor AJ (1987) Outcome of asthma induced by isocyanates. Br J Dis Chest 81:14–22
Moller CR, Brooks SM, McKay RT, Cassedy K, Kopp S, Bernstein IL (1986) Chronic asthma, due to toluene diisocyanate. Chest 90:494–499
Munn A (1965) Hazards of isocyanates. An Occup Hyg 8:163–169
O'Brien M, Harries MG, Burge PS, Pepys J (1979) Toluene diisocyanate-induced asthma: I. Reactions of TDI, MDI, HDI and histamine. Clin Allergy 9:1–6
O'Brien M, Newman-Taylor AJ, Burge PS, Harries MG, Fawcett IW, Pepys J (1979) Toluene diisocyanate-induced asthma: II. Inhalation challenge tests and bronchial reactivity studies. Clin Allergy 9:7–15
Author information
Authors and Affiliations
Additional information
This work was supported by grant 07 ALL 016 from the BMFT (FRG)
Rights and permissions
About this article
Cite this article
Vogelmeier, C., Baur, X. & Fruhmann, G. Isocyanate-induced asthma: results of inhalation tests with TDI, MDI and methacholine. Int. Arch Occup Environ Heath 63, 9–13 (1991). https://doi.org/10.1007/BF00406191
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00406191