OBJECTIVES: Isocyanates are known to induce occupational diseases. The aim of this work was to assess the health effects of exposure to isocyanates and to test the sensitivity of selected parameters for early detection of isocyanate-related allergic diseases. METHODS: In total, 35 employees from one factory were tested: 26 workers exposed to isocyanates (exposed group) and nine office workers (control group). All subjects filled in a questionnaire regarding possible health problems. Fractional exhaled nitric oxide (FeNO) and spirometry were measured for each subject at the same time during two consecutive working days. A urine sample was taken for a biological exposure test (BET). RESULTS: No significant difference was found between the exposed and control groups for spirometry parameters and FeNO. However, in the exposed group, FeNO was highly elevated (> 50 ppb) in five subjects (all reporting health problems at the workplace, all with normal spirometry and non-smokers). The BET revealed a significant difference (p < 0.001) between the exposed and control groups for 4,4´-methylenediphenyl diamine (MDA) in the urine. CONCLUSIONS: Our examination showed the usefulness of the BET in monitoring of workplace exposure to isocyanates and the importance of FeNO in monitoring of allergic inflammation of airways in non-smoking employees with normal spirometry.

Centre of Occupational Health National Institute of Public Health Prague Czech Republic

Department of Occupational Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

J Heyrovsky Institute of Physical Chemistry Czech Academy of Sciences Prague Czech Republic

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Fisseler-Eckhoff A, Bartsch H, Zinsky R, Schirren J. Environmental isocyanate-induced asthma: morphologic and pathogenetic aspects of an increasing occupational disease. Int J Environ Res Public Health. 2011;8(9):3672-87. PubMed

Watts MM, Grammer LC. Hypersensitivity pneumonitis. Allergy Asthma Proc. 2019;40(6):425-8. PubMed

Goossens A, Detienne T, Bruze M. Occupational allergic contact dermatitis caused by isocyanates. Contact Dermatitis. 2002;47(5):304-8. PubMed

Wisnewski AV. Developments in laboratory diagnostics for isocyanate asthma. Curr Opin Allergy Clin Immunol. 2007;7(2):138-45.

Fenclová Z, Havlová D, Votíšková M, Urban P, Pelclová D, Žofka J. Occupational diseases in the Czech Republic 2012. Prague: NIPH; 2013. (In Czech.)

Klusackova P, Viest B, Lebedova J, Navratil T. Increase in isocyanate-induced occupational asthma in Czech Republic. Eur Respir J. 2018;52(Suppl 62):PA1206. doi: 10.1183/13993003.congress-2018.PA1206. DOI

Government Regulation amending the Government Regulation No. 361/2007 Coll. laying down conditions for the protection of health at work, as amended. Sbírka zákonů ČR. 2021 May 17;Part 82:1618-72. (In Czech.)

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319-38. PubMed

Horvath I, Hunt J, Barnes PJ, Alving K, Antczak A, Balint B, et al. Exhaled breath condensate: methodological recommendations and unresolved questions. Eur Respir J. 2005;26(3):523-48. PubMed

American Thoracic Society; European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide. Am J Respir Crit Care Med. 2005;171(8):912-30.

Schneiderka P, Pacakova V, Stulik K, Kloudova M, Jelinkova K. High-performance liquid-chromatographic determination of creatinine in serum, and a correlation of the results with those of the jaffe and enzymic methods. J Chromatogr. 1993;614(2):221-6.

Deutsche Forschungsgemeinschaft. List of MAK and BAT Values 2018: permanent senate commission for the investigation of health hazards of chemical compounds in the work area. Wiley-VCH; 2018.

Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011 Sep 1;184(5):602-15.

Walters GI, Moore VC, McGrath EE, Burge S. Fractional exhaled nitric oxide in the interpretation of specific inhalational challenge tests for occupational asthma. Lung. 2014 Feb;192(1):119-24. PubMed

Pedrosa M, Barranco P, López-Carrasco V, Quirce S. Changes in exhaled nitric oxide levels after bronchial allergen challenge. Lung. 2012 Apr;190(2):209-14. PubMed

Ferrazzoni S, Scarpa MC, Guarnieri G, Corradi M, Mutti A, Maestrelli P. Exhaled nitric oxide and breath condensate ph in asthmatic reactions induced by isocyanates. Chest. 2009 Jul;136(1):155-62. PubMed

Sabbioni G, Wesp H, Lewalter J, Rumler R. Determination of isocyanate biomarkers in construction site workers. Biomarkers. 2007 Sep-Oct;12(5):468-83. PubMed

Mirmohammadi S, Najafpour G, Ahmad A, Hakimi I. Biomonitoring of 2,4 '-methylene diphenyldianiline for assessment of exposure to methylene diphenyl diisocyanate aerosol. Atmosph Pollution Res. 2013;4(2):208-13.

Sennbro CJ, Littorin M, Tinnerberg H, Jönsson BAG. Upper reference limits for biomarkers of exposure to aromatic diisocyanates. Int Arch Occup Environ Health. 2005;78(7):541-6.