Hypersensitivity pneumonitis (extrinsic allergic alveolitis) induced by isocyanates

J Allergy Clin Immunol. 1995 May;95(5 Pt 1):1004-10. doi: 10.1016/s0091-6749(95)70101-x.


Background: Chemical-induced hypersensitivity pneumonitis has been so far rarely described. The purpose of this study was to find out whether hypersensitivity pneumonitis is a common disorder in isocyanate workers.

Methods: Company physicians' case histories of 1780 isocyanate workers were evaluated. In 16 subjects suspected of having isocyanate-induced hypersensitivity pneumonitis, chest x-ray films were made; levels of IgE and IgG antibodies to isocyanate-human serum albumin were estimated; conjugates and isocyanate challenge tests, bronchoalveolar lavage fluid analyses, and/or lung histologic investigations were performed.

Results: Each of the 14 study patients who had hypersensitivity pneumonitis had work-related dyspnea and fever occurring several hours after the start of work with isocyanates. Typical clinical findings were the reduction of lung diffusing capacity (n = 10), reticular or nodular lung patterns in the x-ray film (n = 9), and serum IgG antibodies specific to isocyanate-human serum albumin conjugates (n = 10). Restrictive ventilation patterns in the inhalation challenge tests (n = 5), lymphocytic and/or neutrophilic alveolitis seen in bronchoalveolar lavage fluid analyses (n = 7), and lymphohistiocytic patterns mostly associated with mild fibrosis in lung histology (n = 5) confirmed the diagnosis.

Conclusions: Occupational exposure to isocyanate vapors and aerosols induces typical hypersensitivity pneumonitis in at least 1% of the isocyanate workers with symptoms. Diphenylmethane diisocyanate was found to be the main cause of this disorder.

MeSH terms

  • Adolescent
  • Adult
  • Allergens / adverse effects*
  • Allergens / immunology
  • Alveolitis, Extrinsic Allergic / etiology*
  • Antibody Specificity
  • Biopsy
  • Bronchoalveolar Lavage Fluid / cytology
  • Bronchoscopy
  • Chemical Industry*
  • Female
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin G / immunology
  • Isocyanates / adverse effects*
  • Isocyanates / immunology
  • Lung / pathology
  • Male
  • Middle Aged
  • Occupational Exposure*
  • Radiography, Thoracic
  • Respiratory Mechanics


  • Allergens
  • Immunoglobulin G
  • Isocyanates
  • 4,4'-diphenylmethane diisocyanate