oa Current Allergy & Clinical Immunology - Isocyanate exposure - an unusual case of spray painter's lung : allergies in the workplace

Volume 27, Issue 4
  • ISSN : 1609-3607



Isocyanates are most commonly responsible for occupational asthma and rarely cause hypersensitivity pneumonitis (HP). Spray painters are particularly at high risk of developing these adverse respiratory outcomes associated with exposure to isocyanates. Hypersensitivity pneumonitis is a poorly understood entity characterised by a variety of clinical presentations, which can also overlap with other lung diseases. There are no validated diagnostic criteria for HP. Specific IgE to isocyanates will only be found in a minority of symptomatic individuals while specific IgG for isocyanates seem to be merely an indicator of exposure. Sensitisation may occur due to skin or inhalational exposure. This case report highlights the insidious onset of the disease associated with progressive respiratory impairment and symptoms that can occur without clearly documented acute episodes, as well as the complex diagnostic and management aspects related to isocyanate induced HP. A high index of suspicion, a careful history and a multidisciplinary approach is key to accurate diagnosis. Avoidance of exposure to the offending agent is the mainstay of treatment and prevention of progression to chronic disease. The Compensation for Occupational Injuries and Diseases Act (COIDA) recognises HP due to toluene diisocyanate (TDI) as an occupational disease. Workplace exposure risk management is required to protect the affected worker as well as other unaffected workers.

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