PT  - JOURNAL ARTICLE
AU  - J. Schreiber
AU  - J. Knolle
AU  - J. Sennekamp
AU  - K. T. Schulz
AU  - J. U. Hahn
AU  - K. G. Hering
AU  - M. Raulf-Heimsoth
AU  - R. Merget
TI  - Sub-acute occupational hypersensitivity pneumonitis due to low-level exposure to diisocyanates in a secretary
AID  - 10.1183/09031936.00060507
DP  - 2008 Sep 01
TA  - European Respiratory Journal
PG  - 807--811
VI  - 32
IP  - 3
4099  - http://erj.ersjournals.com/content/32/3/807.short
4100  - http://erj.ersjournals.com/content/32/3/807.full
SO  - Eur Respir J2008 Sep 01; 32
AB  - There is virtually no information in the literature about the exposure levels needed to induce hypersensitivity pneumonitis (HP) by diisocyanates. The present study reports a case of occupational HP due to diisocyanates after low-level exposure. A 53-yr-old female never-smoker developed progressive shortness of breath on exertion, cough, fatigue and flu-like symptoms shortly after she began work as a secretary of a car body repair shop. A diagnosis of HP was made 2 yrs later, based on a restrictive ventilatory defect, a reticulonodular and discrete ground-glass pattern on high-resolution computed tomography, lymphocytosis in bronchoalveolar lavage and specific immunoglobulin G antibodies to diisocyanate human serum albumin conjugates in the patient’s serum. The diagnosis was confirmed by recovery after exposure cessation and deterioration after re-exposure. Ambient monitoring revealed air concentrations of different diisocyanate monomers below the detection limit in both the patient’s work station and in front of the paint spray booths, with the exception of one measurement that showed 4,4-methylenediphenyl diisocyanate concentrations of 3 µg·m−3 in front of one booth (corresponding to a total reactive isocyanate group concentration of 1 µg·m−3). The present authors conclude that concentrations of diisocyanates far below current exposure limits may induce hypersensitivity pneumonitis in susceptible subjects.