M. Littorin et al., ACUTE RESPIRATORY DISORDER, RHINOCONJUNCTIVITIS AND FEVER ASSOCIATED WITH THE PYROLYSIS OF POLYURETHANE DERIVED FROM DIPHENYLMETHANE DIISOCYANATE, Scandinavian journal of work, environment & health, 20(3), 1994, pp. 216-222
OBJECTIVES - A case is described of complex reactions associated with
exposure to diphenylmethane diisocyanate (MDI), with some immunologic
observations. METHODS - Medical history, clinical examinations, and an
alyses of immunologic parameters and the 4,4'-MDI-related amine 4,4'-d
iaminodiphenylmethane (MDA) in hydrolyzed serum and urine were used. R
ESULTS - The patient, a mechanic whose medical history suggested repea
ted attacks of a work-related pulmonary or systemic disease, was exami
ned because of acute respiratory disorder, rhinoconjunctivitis, and a
late systemic reaction after exposure to polyurethane pyrolysis produc
ts, including 4,4'-MDI (air level 15 mug . m-3). Spirometry showed a p
artly reversible obstructive dysfunction, and a skin-prick test was po
sitive versus isocyanates conjugated with human serum albumin (HSA). M
DA was detected in hydrolyzed serum (5.6 ng . ml) and urine (1.6 mug .
g creatinine-1). In serum, there were specific immmunoglobulin (Ig) G
(IgG1 and IgG4) and IgE antibodies to 4,4'-MDI-HSA and other isocyana
tes (phenylisocyanate, toluene diisocyanate, p-toluene monoisocyanate,
hexamethylene diisocyanate) conjugated with HSA, a very high total Ig
E, a raised total IgG, and moderate neutrophilia and eosinophilia. The
specific antibodies declined, but were still increased five years lat
er. Furthermore, the values of circulating immune complexes were high.
In vitro, the circulating immune complexes in serum increased after t
he addition of 4,4'-MDI-HSA. The patient had anti-C1q antibodies, whic
h probably accounted for part of the circulating immune complexes. CON
CLUSIONS - The reactions associated with MDI exposure (in combination
with exposure to pyrolysis products) had features compatible with imme
diate hypersensitivity and with a complement-mediated immune-complex r
eaction.