4,4-methylene-bismorpholine; new cause of occupational asthma

Agent	4,4-methylene-bismorpholine (biocide in metalworking fluid)
Job	machine tool setter operator
Specific IgE	not done
Skin prick test	positive to 4,4-methylene-bismorpholine (3mm)
Non-specific reactivity	normal (>4800ug Jan) at work, 587ug post SIC
Serial Peak Flow	Positive Oasys score 3.4, ABC 23.4 l/min/hr
Induced sputum	not done
FENO	71ppb exposed
Specific Challenge	positive to 0.7% in water with dual reaction with rhinitis
Follow-up	dismissed from work, asthma continued, FeNO 56ppb 9 months later

References

	Walters GI, Moore VC, Robertson AS, McGrath EE, Parkes E, Burge PS, Occupational asthma from sensitization to 4, 4-methlyene bismorpholine in clean metalworking fluid, Eur Respir J, 2013;42:1137-1139,

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