Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy.
Clin Toxicol (Phila). 2011 Jul;49(6):506-7. doi: 10.3109/15563650.2011.590141.
Isocyanates represent a leading cause of occupational asthma, and sputum neutrophilia or eosinophilia has been described in subjects with isocyanate-induced occupational asthma after exposure to these chemicals. One case of non-asthmatic eosinophilic bronchitis due to methylene diphenil isocyanates has been reported, but a similar condition in the instance of neutrophilic bronchial inflammation has never been described.
We report a 34-year-old woman, who, 18 months after beginning work in a plastic industry, reported the onset of dry cough at work. Spirometry was normal, reversibility and methacholine challenge tests were negative. A specific inhalation challenge with toluene diisocyanate elicited dry cough without significant changes in respiratory function. Sputum induction showed a post-challenge neutrophil increase.
The results of our case suggest that the occurrence of a neutrophilic bronchial inflammation without the functional characteristics of occupational asthma as a consequence of exposure to toluene diisocyanate may also be considered, suggesting a diagnosis of occupational non-asthmatic neutrophilic bronchitis.
异氰酸酯是职业性哮喘的主要病因，接触异氰酸酯后可诱发职业性哮喘，患者痰液中会出现中性粒细胞或嗜酸性粒细胞增多。曾有报道称，接触亚甲基二苯基二异氰酸酯可引起非哮喘性嗜酸性支气管炎，但从未有报道称接触中性粒细胞性支气管炎症会出现类似情况。
我们报告了一例 34 岁女性，在从事塑料行业 18 个月后，开始出现工作时干咳。肺量测定正常，支气管扩张试验和乙酰甲胆碱激发试验均为阴性。甲苯二异氰酸酯特异性吸入激发试验引起干咳，无明显的呼吸功能变化。诱导痰显示激发后中性粒细胞增加。
我们的病例结果表明，接触甲苯二异氰酸酯后可能会发生无职业性哮喘功能特征的中性粒细胞性支气管炎症，也可考虑诊断为职业性非哮喘性中性粒细胞性支气管炎。
