title: Diphenylmethane diisocyanate hypersensitivity pneumonitis: a serologic evaluation.
abstract: We describe the clinical and immunologic evaluation of a steel plant maintenance supervisor who had clinical symptoms consistent with hypersensitivity pneumonitis. No antigen was obvious but after a thorough occupational history and review of the industrial hygiene data, the most likely antigen appeared to be diphenylmethane diisocyanate. Precipitating antibodies were not detected in the worker's serum; however, significant antibody levels of IgG specific for diphenylmethane diisocyanate-human serum albumin were detected by other immunoassays. This case highlights the importance of a thorough occupational history and an aggressive laboratory immunologic evaluation in identifying the offending agent in a worker with hypersensitivity pneumonitis. Hypersensitivity pneumonitis due to an inhaled reactive chemical may be present without precipitins demonstrated in vitro due to the nature of the haptenized chemical protein conjugate or the concentration of IgG antibody.
authors.affiliation: Department of Medicine, Northwestern University Medical School, Chicago, IL 60611.
authors.forename: C L
authors.initials: CL
authors.lastname: Walker
authors.forename: L C
authors.initials: LC
authors.lastname: Grammer
authors.forename: M A
authors.initials: MA
authors.lastname: Shaughnessy
authors.forename: M
authors.initials: M
authors.lastname: Duffy
authors.forename: V D
authors.initials: VD
authors.lastname: Stoltzfus
authors.forename: R
authors.initials: R
authors.lastname: Patterson
mesh_terms: D000542:Alveolitis, Extrinsic Allergic / Q000139:chemically induced* / Q000276:immunology; D003485:Cyanates / Q000009:adverse effects* / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D017953:Isocyanates; D008297:Male; D008669:Metallurgy; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced* / Q000276:immunology; D011863:Radioimmunoassay; D012882:Skin Tests; D001559:Benzhydryl Compounds
chemical_list: D003485:Cyanates; D007073:Immunoglobulin E; D007074:Immunoglobulin G; D017953:Isocyanates; C005969:4,4'-diphenylmethane diisocyanate; D001559:Benzhydryl Compounds