Developments in laboratory diagnostics for isocyanate asthma.
OBJECTIVE
Isocyanates, reactive chemicals used to generate polyurethane, are a leading cause of occupational asthma worldwide. Workplace exposure is the best-recognized risk factor for disease development, but is challenging to monitor. Clinical diagnosis and differentiation of isocyanates as the cause of asthma can be difficult. The gold-standard test, specific inhalation challenge, is technically and economically demanding, and is thus only available in a few specialized centers in the world. With the increasing use of isocyanates, efficient laboratory tests for isocyanate asthma and exposure are urgently needed.


RESULTS
The review focuses on literature published in 2005 and 2006. Over 150 articles, identified by searching PubMed using keywords 'diphenylmethane', 'toluene' or 'hexamethylene diisocyanate', were screened for relevance to isocyanate asthma diagnostics. New advances in understanding isocyanate asthma pathogenesis are described, which help improve conventional radioallergosorbent and enzyme-linked immunosorbent assay approaches for measuring isocyanate-specific IgE and IgG. Newer immunoassays, based on cellular responses and discovery science readouts are also in development.


CONCLUSIONS
Contemporary laboratory tests that measure isocyanate-specific human IgE and IgG are of utility in diagnosing a subset of workers with isocyanate asthma, and may serve as a biomarker of exposure in a larger proportion of occupationally exposed workers.
Wisnewski
Adam V
AV
Yale University School of Medicine, Department of Internal Medicine, New Haven, Connecticut 06520-8057, USA. adam.wisnewski@Yale.edu
D001249:Asthma / Q000139:chemically induced* / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D007159:Immunologic Tests; D017953:Isocyanates / Q000506:poisoning*; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000276:immunology; D016273:Occupational Exposure
D007074:Immunoglobulin G; D017953:Isocyanates; D007073:Immunoglobulin E