Redlich C A, Stowe M H, Wisnewski A V, Eisen E A, Karol M H, Lemus R, Holm C T, Chung J S, Sparer J, Liu Y, Woskie S R, Appiah-Pippim J, Gore R, Cullen M R
Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Am J Ind Med. 2001 Jun;39(6):587-97. doi: 10.1002/ajim.1058.
Diisocyanates are potent sensitizing agents and currently the most commonly identified cause of occupational asthma in industrialized countries. However, diisocyanate asthma is difficult to diagnose and exposure and host risk factors are unclear. Auto body shops, one of the most common hexamethylene diisocyanate (HDI) exposure settings, are particularly difficult to study due to their small size and episodic exposures. Surveillance studies of such workers are limited.
We have initiated a cross-sectional field epidemiologic study, Survey of Painters and Repairers of Auto bodies by Yale (SPRAY), to characterize the effects of diisocyanate exposures on actively employed auto body shop workers. Methods and Results We present here questionnaire, physiologic, immunologic, and exposure data on 75 subjects enrolled in the study. No overt cases of clinically apparent diisocyanate asthma were identified based on spirometry, methacholine challenge, peak flows, and symptoms. HDI-specific lymphocyte proliferation was present in 30% of HDI-exposed workers and HDI-specific IgG in 34% of HDI-exposed workers, but they were not associated. HDI-specific IgE was detected in two workers. HDI-specific lymphocyte proliferation, increased methacholine responsiveness, and symptoms of chest tightness and shortness of breath were more common in the most heavily HDI-exposed workers, the painters. More long-term follow-up of this cohort should clarify the significance of these HDI-specific immunologic responses, physiologic changes, and symptoms.
These findings demonstrate the presence of HDI-specific immune responses in a large proportion of healthy HDI-exposed workers.
二异氰酸酯是强效致敏剂，目前是工业化国家职业性哮喘最常见的病因。然而，二异氰酸酯哮喘难以诊断，其暴露和宿主风险因素尚不清楚。汽车车身修理店是六亚甲基二异氰酸酯（HDI）暴露最常见的场所之一，由于规模小且暴露具有间歇性，特别难以进行研究。对此类工人的监测研究有限。
我们开展了一项横断面现场流行病学研究，即耶鲁汽车车身喷漆工和修理工调查（SPRAY），以描述二异氰酸酯暴露对在职汽车车身修理店工人的影响。方法与结果 我们在此展示了该研究中75名受试者的问卷、生理、免疫和暴露数据。根据肺活量测定、乙酰甲胆碱激发试验、峰值呼气流速和症状，未发现明显的临床显性二异氰酸酯哮喘病例。30%的HDI暴露工人存在HDI特异性淋巴细胞增殖，34%的HDI暴露工人存在HDI特异性IgG，但二者无相关性。在两名工人中检测到HDI特异性IgE。在HDI暴露最严重的工人即喷漆工中，HDI特异性淋巴细胞增殖、乙酰甲胆碱反应性增加以及胸闷和呼吸急促症状更为常见。对该队列进行更长时间的随访应能阐明这些HDI特异性免疫反应、生理变化和症状的意义。
这些发现表明，在大量健康的HDI暴露工人中存在HDI特异性免疫反应。
