Perfetti Luca, Bramé Barbara, Ferrari Massimo, Moscato Gianna
Servizio Autonomo di Allergologia e Immunologia Clinica, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Pavia, via Ferrata 8, 27100 Pavia, Italy.
Am J Ind Med. 2003 Sep;44(3):325-8. doi: 10.1002/ajim.10262.
Two types of OA are distinguished: immunological (OA with sensitization) and non-immunological, i.e., irritant induced asthma or reactive airways dysfunction syndrome (RADS).
We describe the case of a worker who developed respiratory symptoms after a spill of diphenylmethane diisocyanate (MDI) at the workplace. RADS was initially diagnosed and the worker resumed working. The progressive worsening of symptoms and the appearance of symptoms-work relationship one year later, when concentrations of isocyanates were no longer "irritant," suggested immunological OA.
The diagnosis was confirmed by specific inhalation challenge test, followed by removal from exposure and complete recovery.
In the case of RADS due to an agent with both irritant and sensitizing properties, history should be repeatedly assessed for a possible symptom-work relationship. If this is found, further investigations should be carried out, including specific inhalation challenges, to confirm the possibility of immunological OA.
骨关节炎分为两种类型：免疫性（致敏性骨关节炎）和非免疫性，即刺激性诱导哮喘或反应性气道功能障碍综合征（RADS）。
我们描述了一名工人在工作场所二苯基甲烷二异氰酸酯（MDI）泄漏后出现呼吸道症状的病例。最初诊断为RADS，该工人随后恢复工作。一年后，当异氰酸酯浓度不再具有“刺激性”时，症状逐渐恶化且出现症状与工作的关系，提示为免疫性骨关节炎。
通过特异性吸入激发试验确诊，随后脱离接触并完全康复。
对于由具有刺激性和致敏性的物质引起的RADS病例，应反复评估病史以确定可能的症状与工作的关系。如果发现这种关系，应进行进一步调查，包括特异性吸入激发试验，以确认免疫性骨关节炎的可能性。
