Current diagnostic methods for diisocyanate induced occupational asthma.
BACKGROUND
Diisocyanates are among the most frequent causes of occupational asthma in industrialized countries. Early diagnosis of diisocyanate asthma followed by prompt termination of chemical exposure can prevent chronic morbidity due to persistent asthma. The accurate diagnosis of diisocyanate asthma requires a systematic approach that combines information obtained from the occupational history, immunologic tests and physiologic studies.


METHODS
The advantages, limitations and validity of various methods and diagnostic guidelines utilized in the evaluation of diisocyanate asthma are reviewed.


RESULTS
Recommended methods for evaluation of diisocyanates asthma are similar to approaches for other causative agents. Serologic assays of specific IgE are specific but insensitive diagnostic markers of diisocyanate asthma. If possible, workers should be evaluated, while at work, in order to demonstrate work-related changes in lung function associated with diisocyanate exposures. Specific bronchoprovocation challenge testing with diisocyanates, is reserved for situations where the diagnosis cannot be confirmed at work. Such tests can be performed safely but should be conducted exclusively at specialized centers by experienced personnel.


CONCLUSIONS
Published diagnostic guidelines for occupational asthma are directly applicable to the evaluation of diisocyanate asthma.
Bernstein
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DI
Division of Immunology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
Jolly
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A
D001249:Asthma / Q000139:chemically induced / Q000175:diagnosis* / Q000517:prevention & control; D016535:Bronchial Hyperreactivity / Q000175:diagnosis; D001985:Bronchial Provocation Tests; D003432:Cross-Linking Reagents / Q000009:adverse effects*; D003485:Cyanates / Q000009:adverse effects*; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D017953:Isocyanates / Q000009:adverse effects*; D009784:Occupational Diseases / Q000139:chemically induced / Q000175:diagnosis* / Q000517:prevention & control; D016273:Occupational Exposure; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D011108:Polymers / Q000009:adverse effects*; D015203:Reproducibility of Results
D003432:Cross-Linking Reagents; D003485:Cyanates; D017953:Isocyanates; D011108:Polymers; D007073:Immunoglobulin E