Long-term follow-up of hexamethylene diisocyanate-, diphenylmethane diisocyanate-, and toluene diisocyanate-induced asthma

• Published in: American journal of respiratory and critical care medicine 2000-08, Vol.162 (2), p.516-522
• Main Authors: PIIRILÄ, P. L, NORDMAN, H, KESKINEN, H. M, LUUKKONEN, R, SALO, S.-P, TUOMI, T. O, TUPPURAINEN, M
• Format: Article
• Language: English
• Subjects: Adult; Air Pollutants - adverse effects; Allergens - adverse effects; Asthma - chemically induced; Asthma - drug therapy; Asthma - immunology; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Cyanates - adverse effects; Female; Follow-Up Studies; Humans; Immunoglobulin E - blood; Isocyanates - adverse effects; Male; Medical sciences; Pneumology; Surveys and Questionnaires; Toluene 2,4-Diisocyanate - adverse effects
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.162.2.9909026

In 1976-1992 245 new cases of asthma induced by diisocyanates were diagnosed, caused by hexamethylene diisocyanate (HDI) in 39%, diphenylmethane diisocyanate (MDI) in 39%, and toluene diisocyanate (TDI) in 17% of the cases. Our aim was to study the clinical outcome of diisocyanate-induced asthma. A questionnaire was sent to the 235 patients alive in 1995, and validated by reexamining clinically 91 of them. The study was carried out on average 10 () yr after the diagnosis. Of the patients 82% experienced symptoms of asthma, 34% used no medication, and 35% were on regular medication. The patients having displayed immunoglobulin E (IgE) antibodies to isocyanates used less medication (OR 0.273; CI 0.098, 0.758) and had fewer symptoms of asthma (OR 0.329; CI 0.124, 0.875) than the IgE-negative ones. They also had a significantly shorter duration of symptoms (p = 0.0025), latency period (p = 0.0249), and duration of exposure (p = 0.0008) than the IgE-negative patients. This did not, however, entirely explain the more favourable outcome of the IgE-positive patients. Patients with HDI-induced asthma used less medication (OR 0.412; CI 0.229, 0.739) than patients with MDI- and TDI-induced asthma. The results confirm the generally rather poor medical outcome of diisocyanate-induced asthma; the persistence of symptoms and unspecific bronchial reactivity were pronounced in TDI-induced asthma. A more favourable outcome was associated with IgE mediation and HDI inducement.