Severe Asthma and Death in a Worker Using Methylene Diphenyl Diisocyanate MDI Asthma Death

Details

• Personal Author:
  Cooney R ; Giese K ; Hodgson, Michael J. ; Liu J ; Redlich CA ; Wisnewski AV
• Description:
  Diisocyanates are well-recognized to cause occupational asthma, yet diisocyanate asthma can be challenging to diagnose and differentiate from asthma induced by other allergens. The present study assesses the potential contribution of methylene diphenyl diisocyanate (MDI) to a workplace fatality. Examination of medical records, tissue, and blood from the deceased worker were undertaken. Formalin-fixed paraffin-embedded lung tissue sections were assessed through histologic and immunochemical stains. Serum MDI-specific IgE and IgG, and total IgE, were measured by enzyme-linked immunosorbent assays and/or Western blot. Information about potential chemical exposures and industrial processes in the workplace were provided by the employer and through interviews with co-workers. Review of the worker's medical records, occupational history, and autopsy findings were consistent with severe asthma as the cause of death, and ruled out cardiac disease, pulmonary embolism, or stroke. Lung pathology revealed hallmarks of asthma including smooth muscle hypertrophy, eosinophilia, basement membrane thickening, and mucus plugging of bronchioles. Immunochemical staining for MDI was positive in the thickened basement membrane of inflamed airways. MDI-specific serum IgE and IgG were significantly elevated and demonstrated specificity for MDI versus other diisocyanates, however, total serum IgE was normal (24 IU/ml). The workplace had recently introduced MDI into the foundry as part of a new process, but MDI air levels had not been measured. Respirators were not required. In summary, post-mortem findings support the diagnosis of diisocyanate asthma and a severe asthma attack at work as the cause of death in a foundry worker. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Blood Chemistry Environmental Exposure Enzymes Hypersensitivity Isocyanates Lung Mortality Musculoskeletal System Occupational Health Pathology Respiratory System Respiratory Tract Diseases Risk Assessment Risk Factors Safety Workplace

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• Keywords:
  Allergens Author Keywords: Allergen Bronchial Asthma Chemical Chemical Composition Chemical Properties Chemicals Diisocyanates Exposure Levels Fatal Fatalities Foundry Foundry Workers IgE IgG Immunocytochemistry Lung Tissue Methylene Diphenyl Diisocyanate (MDI) Muscles Occupational Risk Factors Tissue Culture Work Environment Workers

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• ISSN:
  0271-3586
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; District of Columbia ; OSHA Region 1 ; OSHA Region 3
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  166-172
• Volume:
  65
• Issue:
  3
• NIOSHTIC Number:
  nn:20064365
• Citation:
  Am J Ind Med 2022 Mar; 65(3):166-172
• Contact Point Address:
  Adam V. Wisnewski, PhD, D(ABMLI), Yale University School of Medicine, 1 Gilbert St, TAC-S420, New Haven, CT 06519, USA.
• Email:
  adam.wisnewski@Yale.edu
• CAS Registry Number:
  Diphenylmethane diisocyanate (CAS RN 101-68-8)
• Federal Fiscal Year:
  2022
• Performing Organization:
  Yaler University, New Haven, Connecticut
• Peer Reviewed:
  True
• Start Date:
  20130901
• Source Full Name:
  American Journal of Industrial Medicine
• End Date:
  20160831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d8c8e24578dd42b1bb2e57bb25dab4cc5f78b92e08aa70b281beb161045b541825210ec69475b11964d809eebdcfd47454a72114192e32ac445eb2bd4e831185
• Download URL:
  https://stacks.cdc.gov/view/cdc/222844/cdc_222844_DS1.pdf
• File Type:
  [PDF - 1.29 MB ]