Baur X, Dewair M, Römmelt H
J Occup Med. 1984 Apr;26(4):285-7.
A rare combination of an acute asthmatic reaction followed by hypersensitivity pneumonitis after exposure to diphenylmethane diisocyanate (MDI) is described. The patient, who was nonatopic and did not show bronchial hyperreactivity to metacholine, was occasionally engaged at the workplace in spraying a mixture of MDI and polyol to produce a polyurethane foam for use as a packing material. Challenge testing by MDI resulted first in a significant immediate bronchial obstruction indicated by decreases in specific airway conductance and forced expiratory volume at 1 s, and then in a significant decrease in vital capacity and diffusing capacity, associated with systemic reactions such as anorexia, malaise, fever, and leukocytosis three to eight hours after challenge. Challenge testing by toluene diisocyanate produced a mild systemic reaction. This finding, as well as the detection of specific IgG antibodies to various isocyanate-human serum albumin conjugates, suggests immunologic cross-reactivity between different isocyanates. Neither skin testing nor the radioallergosorbent test indicated a type I sensitization. After contact with isocyanates was terminated, the disease did not recur.
本文描述了一例罕见的病例，患者在接触二苯基甲烷二异氰酸酯（MDI）后，先出现急性哮喘反应，随后发生过敏性肺炎。该患者为非特应性体质，对乙酰甲胆碱无支气管高反应性，其工作偶尔涉及在 workplace 喷洒MDI与多元醇的混合物以生产用作包装材料的聚氨酯泡沫。用MDI进行激发试验时，首先出现明显的即刻支气管阻塞，表现为比气道传导率和第1秒用力呼气量降低，随后肺活量和弥散量显著下降，激发后3至8小时出现全身反应，如厌食、不适、发热和白细胞增多。用甲苯二异氰酸酯进行激发试验产生轻度全身反应。这一发现以及针对各种异氰酸酯 - 人血清白蛋白缀合物的特异性IgG抗体检测结果表明，不同异氰酸酯之间存在免疫交叉反应。皮肤试验和放射变应原吸附试验均未显示I型致敏。停止接触异氰酸酯后，疾病未复发。 （注：原文中“workplace”翻译为“工作场所”更合适，但按照要求保留原文；“skin testing”翻译为“皮肤试验”，“radioallergosorbent test”翻译为“放射变应原吸附试验” ）
