title: Subclinical immunologic and physiologic responses in hexamethylene diisocyanate-exposed auto body shop workers.
abstract: BACKGROUND
  Diisocyanates are potent sensitizing agents and currently the most commonly identified cause of occupational asthma in industrialized countries. However, diisocyanate asthma is difficult to diagnose and exposure and host risk factors are unclear. Auto body shops, one of the most common hexamethylene diisocyanate (HDI) exposure settings, are particularly difficult to study due to their small size and episodic exposures. Surveillance studies of such workers are limited.
  
  
  OBJECTIVE
  We have initiated a cross-sectional field epidemiologic study, Survey of Painters and Repairers of Auto bodies by Yale (SPRAY), to characterize the effects of diisocyanate exposures on actively employed auto body shop workers. Methods and Results We present here questionnaire, physiologic, immunologic, and exposure data on 75 subjects enrolled in the study. No overt cases of clinically apparent diisocyanate asthma were identified based on spirometry, methacholine challenge, peak flows, and symptoms. HDI-specific lymphocyte proliferation was present in 30% of HDI-exposed workers and HDI-specific IgG in 34% of HDI-exposed workers, but they were not associated. HDI-specific IgE was detected in two workers. HDI-specific lymphocyte proliferation, increased methacholine responsiveness, and symptoms of chest tightness and shortness of breath were more common in the most heavily HDI-exposed workers, the painters. More long-term follow-up of this cohort should clarify the significance of these HDI-specific immunologic responses, physiologic changes, and symptoms.
  
  
  CONCLUSIONS
  These findings demonstrate the presence of HDI-specific immune responses in a large proportion of healthy HDI-exposed workers.
authors.affiliation: Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, Connecticut 06510, USA. carrie.redlich@yale.edu
authors.forename: C A
authors.initials: CA
authors.lastname: Redlich
authors.forename: M H
authors.initials: MH
authors.lastname: Stowe
authors.forename: A V
authors.initials: AV
authors.lastname: Wisnewski
authors.forename: E A
authors.initials: EA
authors.lastname: Eisen
authors.forename: M H
authors.initials: MH
authors.lastname: Karol
authors.forename: R
authors.initials: R
authors.lastname: Lemus
authors.forename: C T
authors.initials: CT
authors.lastname: Holm
authors.forename: J S
authors.initials: JS
authors.lastname: Chung
authors.forename: J
authors.initials: J
authors.lastname: Sparer
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.forename: S R
authors.initials: SR
authors.lastname: Woskie
authors.forename: J
authors.initials: J
authors.lastname: Appiah-Pippim
authors.forename: R
authors.initials: R
authors.lastname: Gore
authors.forename: M R
authors.initials: MR
authors.lastname: Cullen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000395:Air Pollutants, Occupational / Q000009:adverse effects / Q000276:immunology*; D000704:Analysis of Variance; D001249:Asthma / Q000139:chemically induced / Q000276:immunology*; D001336:Automobiles; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003485:Cyanates / Q000009:adverse effects / Q000276:immunology*; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D017953:Isocyanates; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced / Q000276:immunology*; D016273:Occupational Exposure / Q000009:adverse effects; D010150:Paint; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
chemical_list: D000395:Air Pollutants, Occupational; D003485:Cyanates; D017953:Isocyanates; C015262:1,6-hexamethylene diisocyanate