Kim H, Kim Y D, Choi J
Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
Environ Res. 1997 Oct;75(1):1-6. doi: 10.1006/enrs.1997.3763.
Since type I allergy caused by specific IgE antibodies may play principal roles and IgG antibody-mediated reactions have been thought to be involved in some parts of the pathogenesis, this study was performed to investigate the role of IgE- or IgG-mediated hypersensitivity reactions in development of toluene diisocyanate (TDI) asthma in Korean workers. For 81 TDI spray painters, self-administrative questionnaires and direct interviews on respiratory symptoms, chest auscultation, and measurements of forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1.0) were performed. The TDI concentration in their working environments was measured. Levels of serum IgE and IgG specific to TDI were estimated by radioallergosorbent test (RAST) and ELISA using p-tolyl isocyanate-human serum albumin (TMI-HSA) as the antigen. When sputum, cough, and dyspnea aggravated by work or wheezing existed, when FVC or FEV1.0 was less than 80% of the normal reference value, or when IgE RAST for TDI was positive, the peak expiratory flow rate (PEFR) was recorded four times per day for over 2 weeks. If decrease of PEFR was over 20% of baseline PEFR and changing pattern of PEFR was closely related to workshift in time, then a diagnosis of TDI asthma was made. Changing patterns of PEFR of 8 (9.9%) workers corresponded to the diagnostic criteria of TDI-related occupational asthma. Levels of the specific IgE were increased in 9 (11.1%) of the 81 subject workers and in 3 (37.5%) of the 8 PEFR-positive workers. Levels of the specific IgG were increased in 9 (11.1%) workers, and in only 1 (12.5%) of the asthmatics sensitive to TDI. Neither elevated TDI-specific IgE levels nor PEFR test positivities were associated with increased IgG levels. The mean titer of the PEFR-test-positive workers was slightly lower than that of the PEFR-negative workers and that of the IgE RAST-positive workers lower than that of the test-negative workers, but there was no statistical significance. These results suggest that IgG is not deeply involved in the pathogenesis of TDI-induced occupational asthma in Korean workers.
由于由特异性IgE抗体引起的I型过敏可能起主要作用，并且IgG抗体介导的反应被认为参与了部分发病机制，因此进行了本研究，以调查IgE或IgG介导的超敏反应在韩国工人甲苯二异氰酸酯（TDI）哮喘发病中的作用。对81名TDI喷漆工进行了关于呼吸道症状的自我管理问卷调查和直接访谈、胸部听诊，并测量了用力肺活量（FVC）和1秒用力呼气量（FEV1.0）。测量了他们工作环境中的TDI浓度。使用对甲苯基异氰酸酯-人血清白蛋白（TMI-HSA）作为抗原，通过放射变应原吸附试验（RAST）和酶联免疫吸附测定（ELISA）评估血清中TDI特异性IgE和IgG的水平。当出现因工作加重的咳痰、咳嗽、呼吸困难或喘息，FVC或FEV1.0低于正常参考值的80%，或TDI的IgE RAST呈阳性时，每天记录4次呼气峰值流速（PEFR），持续超过两周。如果PEFR下降超过基线PEFR的20%，且PEFR的变化模式与轮班时间密切相关，则诊断为TDI哮喘。8名（9.9%）工人的PEFR变化模式符合TDI相关职业性哮喘的诊断标准。81名受试工人中有9名（11.1%）、8名PEFR阳性工人中有3名（37.5%）的特异性IgE水平升高。9名（11.1%）工人的特异性IgG水平升高，而在对TDI敏感的哮喘患者中只有1名（12.5%）升高。TDI特异性IgE水平升高和PEFR试验阳性均与IgG水平升高无关。PEFR试验阳性工人的平均滴度略低于PEFR阴性工人，IgE RAST阳性工人的平均滴度低于试验阴性工人，但无统计学意义。这些结果表明，IgG在韩国工人TDI诱导的职业性哮喘发病机制中没有深度参与。
