Occupational Asthma Reference

Pronk A, Preller L, Raulf-Heimsoth M, Jonkers ICL, Lammers J-W, Wouters IM, Doekes G, Wisnewski AV, Heederik D, Respiratory Symptoms, Sensitization, and Exposure–Response Relationships in Spray Painters Exposed to Isocyanates, Am J Respir Crit Care Med, 2007;176:1090-1097,
(Plain text: Pronk A, Preller L, Raulf-Heimsoth M, Jonkers ICL, Lammers J-W, Wouters IM, Doekes G, Wisnewski AV, Heederik D, Respiratory Symptoms, Sensitization, and Exposure-Response Relationships in Spray Painters Exposed to Isocyanates, Am J Respir Crit Care Med)

Keywords: Polyisocyanate, isocyanate pre-polymer, HDI, HDI biuret, HDI isocyanurate, air measuremene, cross-sectional, spray painter, aircraft, furniture, car, Holland, bronchial reactivity, isocyanate oligomer, IgE, IgG

Known Authors

Dick Heederik, Institute of Risk Assessment Sciences, Utrecht Dick Heederik

Monika Raulf-Heimsoth, Bochum Monika Raulf-Heimsoth

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Abstract

Rationale: Associations between oligomeric isocyanate exposure, sensitization, and respiratory disease have received little attention, despite the extensive use of isocyanate oligomers.

Objectives: To investigate exposure–response relationships of respiratory symptoms and sensitization in a large population occupationally exposed to isocyanate oligomers during spray painting.

Methods: The prevalence of respiratory symptoms and sensitization was assessed in 581 workers in the spray-painting industry. Personal exposure was estimated by combining personal task-based inhalatory exposure measurements and time activity information. Specific IgE and IgG to hexamethylene diisocyanate (HDI) were assessed in serum by ImmunoCAP assay and enzyme immunoassays using vapor and liquid phase HDI–human serum albumin (HDI–HSA) and HSA conjugates prepared with oligomeric HDI.

Measurements and Main Results: Respiratory symptoms were more prevalent in exposed workers than among comparison office workers. Log–linear exposure–response associations were found for asthmalike symptoms, chronic obstructive pulmonary disease–like symptoms, and work-related chest tightness (prevalence ratios for an interquartile range increase in exposure of 1.2, 1.3 and 2.0, respectively; P 0.05). The prevalence of specific IgE sensitization was low (up to 4.2% in spray painters). Nevertheless, IgE to N100 (oligomeric HDI)–HSA was associated with exposure and work-related chest tightness. The prevalence of specific IgG was higher (2–50.4%) and strongly associated with exposure.

Conclusions: The results provide evidence of exposure–response relationships for both work-related and non–work-related respiratory symptoms and specific sensitization in a population exposed to oligomers of HDI. Specific IgE was found in only a minority of symptomatic individuals. Specific IgG seems to be merely an indicator of exposure.

Plain text: Rationale: Associations between oligomeric isocyanate exposure, sensitization, and respiratory disease have received little attention, despite the extensive use of isocyanate oligomers. Objectives: To investigate exposure-response relationships of respiratory symptoms and sensitization in a large population occupationally exposed to isocyanate oligomers during spray painting. Methods: The prevalence of respiratory symptoms and sensitization was assessed in 581 workers in the spray-painting industry. Personal exposure was estimated by combining personal task-based inhalatory exposure measurements and time activity information. Specific IgE and IgG to hexamethylene diisocyanate (HDI) were assessed in serum by ImmunoCAP assay and enzyme immunoassays using vapor and liquid phase HDI-human serum albumin (HDI-HSA) and HSA conjugates prepared with oligomeric HDI. Measurements and Main Results: Respiratory symptoms were more prevalent in exposed workers than among comparison office workers. Log-linear exposure-response associations were found for asthmalike symptoms, chronic obstructive pulmonary disease-like symptoms, and work-related chest tightness (prevalence ratios for an interquartile range increase in exposure of 1.2, 1.3 and 2.0, respectively; P 0.05). The prevalence of specific IgE sensitization was low (up to 4.2% in spray painters). Nevertheless, IgE to N100 (oligomeric HDI)-HSA was associated with exposure and work-related chest tightness. The prevalence of specific IgG was higher (2-50.4%) and strongly associated with exposure. Conclusions: The results provide evidence of exposure-response relationships for both work-related and non-work-related respiratory symptoms and specific sensitization in a population exposed to oligomers of HDI. Specific IgE was found in only a minority of symptomatic individuals. Specific IgG seems to be merely an indicator of exposure.

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Associated Questions

Registered users of this website have associated this reference with the following questions. This association is not a part of the BOHRF occupational asthma guidelines.

Which agents cause occupational asthma and which workers are at risk?
burgeps Epidemiological study showing increased respiratort symptoms with increasing exposure to isocyanate pre-polymers based on HDI (oligomers, HDI biuret, HDI isocyanurate)
Is exposure to agents in the workplace a risk factor for developing occupational asthma?
burgeps Dose response with cumulative exposure demonstrated
What are the sensitivity and the specificity of specific IgE testing in the diagnosis of validated cases of occupational asthma?
burgeps IgE to Desmodur N100 (trimeric biuret) and Desmodur N3300 (HDI oligomer) present in no controls and 1-4.2% of exposed groups. Work-related chest tightness more common in those with specific IgE.

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Comments

Cross-sectional study of paint sprayers using HDI prepolymers in Holland. 67% response rate in individual workplaces, but only 10-30% workplaces took part. Questionnaire diagnosis of occupational asthma required symptoms to occur during or shortly after work (rather than improve on days away from work). This may have reduced ability to recognise work-related symptoms. No biological monitoring attempted. nevertheless dose response relationships found between asthma symptoms and cumulative polyisocyanate exposure (is current exposure a better measure than cumulative exposure, as those resistant to sensitisation are likely to have the largest cumulative exposures?).
4/18/2008

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