title: Occupational exposure to toluene diisocyanate and neutrophilic bronchitis without asthma.
abstract: BACKGROUND
  Isocyanates represent a leading cause of occupational asthma, and sputum neutrophilia or eosinophilia has been described in subjects with isocyanate-induced occupational asthma after exposure to these chemicals. One case of non-asthmatic eosinophilic bronchitis due to methylene diphenil isocyanates has been reported, but a similar condition in the instance of neutrophilic bronchial inflammation has never been described.
  
  
  METHODS
  We report a 34-year-old woman, who, 18 months after beginning work in a plastic industry, reported the onset of dry cough at work. Spirometry was normal, reversibility and methacholine challenge tests were negative. A specific inhalation challenge with toluene diisocyanate elicited dry cough without significant changes in respiratory function. Sputum induction showed a post-challenge neutrophil increase.
  
  
  CONCLUSIONS
  The results of our case suggest that the occurrence of a neutrophilic bronchial inflammation without the functional characteristics of occupational asthma as a consequence of exposure to toluene diisocyanate may also be considered, suggesting a diagnosis of occupational non-asthmatic neutrophilic bronchitis.
authors.affiliation: Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy. giannipalass@libero.it
authors.forename: Gianni
authors.initials: G
authors.lastname: Pala
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pignatti
authors.forename: Gianna
authors.initials: G
authors.lastname: Moscato
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis; D016535:Bronchial Hyperreactivity / Q000150:complications; D001991:Bronchitis / Q000139:chemically induced* / Q000473:pathology*; D002908:Chronic Disease; D003371:Cough / Q000139:chemically induced; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D009504:Neutrophils / Q000473:pathology*; D009784:Occupational Diseases / Q000139:chemically induced; D016273:Occupational Exposure / Q000009:adverse effects*; D013147:Spirometry; D013183:Sputum / Q000166:cytology; D014051:Toluene 2,4-Diisocyanate / Q000633:toxicity*
chemical_list: D014051:Toluene 2,4-Diisocyanate