Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Information Sources and Search Strategies
- PubMed
- ○
- ((isocyanate * [MeSH Terms]) OR (isocyanate * [Title/Abstract])) AND ((((asthma, occupational [MeSH Terms]) OR (asthma, occupational [Title/Abstract]) OR (work related asthma [Title/Abstract]))
- Cochrane
- ○
- #1 MeSH descriptor: [asthma, occupational] explode all trees
- ○
- #2 (asthma, occupational): ti, ab, kw
- ○
- #3 MeSH descriptor: [Isocyanates] explode all trees
- ○
- #4 (isocyanate *): ti, ab, kw
- ○
- #5 #1 OR #2
- ○
- #6 #3 OR #4
- ○
- #7 #5 AND #6
2.2. Selection of Articles
2.3. Data Collection and Analysis
3. Results
3.1. Automotive Industry
3.2. Chemical Industry
3.3. Wood Industry
3.4. Foundries and Molding Plants
3.5. Other Industries
3.6. Literature Reviews
3.7. Epidemiological Public Health Registers
4. Discussion
4.1. Limitations of the Review
4.2. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Study ID (First Author, Year) [REF] | Study Design/Location (N) | Isocyanate | Follow-Up | Asthma Diagnosis | Causality Assessment | Results | Limitations |
---|---|---|---|---|---|---|---|
Simpson 1996 [7] | Case series/no details (34) | BIC | None | PFT + methacholine or bronchodilator challenge test | Temporality PFT | 41% suspected OA cases after 10 weeks exposure without IPE All cases resolved after introduction of IPE | Exposure to BIC not measured Previous exposure for four subjects |
Cullen 1996 [12] | Cross-sectional/New Haven, CT, USA (102) | HDI | None | Questionnaire Peak flow | Occupational exposure matrix | 19.6% had respiratory symptoms Proportional to extent of exposure (35.7% vs. 6.7%) Atopy not associated with risk The use of air-supply masks was associated with risk reduction No link between questionnaire and change in PFT Increased risk in small, confined spaces Often sporadic forms of asthma | Insufficient IPE (surgical mask) Possible healthy worker bias Non-specific questionnaire (Modified ATS) |
Ucgun a 1998 [8] | Observational/Eskisehir, Turkey (312) | TDI | None | Questionnaire PFT Peak flow Methacholine challenge test | Temporality | OA incidence for painters = 9.6% OA incidence proportional to the length of exposure. | Non-optimal use of IPE |
Redlich 2002 [10] | Cohort/New Haven, USA (45) | HDI | One year (2001) | Questionnaire PFT Methacholine challenge test Serology | Declarative | PFT and stable symptoms after one-year exposure No OA cases during one-year follow-up | Small sample size Exposure not measured Short follow-up Previous exposure Unclear diagnosis |
Hur 2008 [13] | Observational/South Korea (58) | MDI | None | Questionnaire Specialist consultation Prick tests ELISA PFT BCT | Temporality | 22.4% of subjects symptomatic 8.6% OA Poor respiratory symptoms and presence of specific IgG were prognostic factors for the development of OA | |
Stocks 2015 [9] | Cohort/UK (15,006) | HDI | 8 years (2006–2014) | Notification of OA to SWORD register | Urine assay | Concomitant decreases in positive urine samples and isocyanate OA cases: prognostic factor? | Underreporting bias |
Dey 2017 [11] | Cross-sectional/Assam, India (60) | ND | None | Questionnaire PFT | Work history | PFT reduction (OLD ± RLD) proportional to exposure duration | Exposure not measured Small sample size |
Study ID (First Author, Year) [REF] | Study Design/Location (N) | Isocyanate | Follow-Up | Asthma Diagnosis | Causality Assessment | Results | Limitations |
---|---|---|---|---|---|---|---|
Kraw & Tarlo 1999 [14] | Case series/Ontario, Canada (39) | MDI/TDI | Five years (1992–1997) | Prick test Methacholine challenge test Peak flow | Temporality | One and two confirmed and suspected OA cases, respectively, for 39 subjects in five years | Small sample size Spontaneous consultations Sensitive but non-specific questionnaire |
Ott et al., 2000 [15] | Retrospective cohort/Louisiana, USA (313) | TDI | Minimum five years (1967–1992) | Medical files Symptoms PFT | Medical files | 6.4% suspected OA cases, from files Concentration and cumulative dose had an impact on PFT only in women More cases among new employees and those with a history of TDI exposure | Selection bias Reported symptoms Data from medical files |
Cassidy et al., 2010 [16] | Retrospective cohort/southern USA (100) | HDI | Minimum two years (1987–2007) | Consultation PFT (FRV1) | Temporality Measures of exposure | FEV1 and FVC are lower in those unexposed aged >19 years Reduction in PFT results occurs more rapidly in unexposed subjects No OA cases No increase in skin sensitization | Possible healthy worker bias Smoker status not taken into account |
Hathaway et al., 2014 [17] | Retrospective cohort/southern USA (73) | HDI | Up to 20 years (1991–2011) | Medical files Symptoms PFT Questions to the patient or last attending physician | Medical files Air monitoring records | No OA cases No exposure above exposure limit values Occasional and brief exposure accidents appear benign | No control group No biomonitoring Small sample size |
Gui et al., 2014 [18] | Inception cohort/Eastern Europe (49) | TDI | One year (dates not given) | Questionnaire PFT | Serology Measures of exposure | 14.2% subjects symptomatic after one-year exposure No exposure above exposure limit values No OA Potential skin sensitization | Prior exposure is not well defined Initial PFT not systematic Short study period Small sample size |
Collins et al., 2017 [19] | Cohort/Texas and Louisiana, USA (197) | TDI | Five years (2007–2012) | Questionnaire PFT | Symptoms suggesting OA formal diagnosis | OA incidence = 0.009 cases/person-year OR = 2.08 (95% CI 1.07 to 4.05) per logarithm parts per billion-years and peak TDI exposures OR = 1.18 (95% CI 1.06 to 1.32) | Potential selection bias because fixed-term contract workers not included No systematic medical examination |
Study ID (First Author, Year) [REF] | Study Design/Location (N) | Isocyanate | Follow-Up | Asthma Diagnosis | Causality Assessment | Results | Limitations |
---|---|---|---|---|---|---|---|
Petsonk et al., 2000 [20] | Inception cohort/ND (178) | MDI | Two years (1995–1996) | Questionnaire PFT Methacholine challenge test Peak flow Serology | Self-reported Exposure not measured | 12% of exposed workers were symptomatic Symptomatology highly correlated with reported exposure, correct use of IPE, and reported skin exposure | Symptoms and exposure were self-reported and not very specific |
Wang & Petsonk 2004 [21] | Inception cohort/ND (132) | MDI | Two years (1995–1996) | Symptoms reported in the questionnaire | Study of job type Exposure not measured | Main symptoms = wheezing, chest tightness, cough, dyspnea | Study based on the appearance of symptoms Confusion bias between different symptoms Poorly comparable groups Missing data No exposure measure |
Study ID (First Author, Year) [REF] | Study Design/Location (N) | Isocyanate | Follow-Up | Asthma Diagnosis | Causality Assessment | Results | Limitations |
---|---|---|---|---|---|---|---|
Bernstein et al., 1993 [22] | Cohort/Cincinnati, USA a (243) | MDI | Three years (1991–1993) | Questionnaire Immunological assays Peak flow Methacholine challenge test | Peak flow evaluation by a physician Temporality Continuous monitoring | Prevalence of OA = 1% for exposure < 0.05 ppb Prevalence decreased proportionally with exposure intensity | Peak flows too soon after avoidance Non-specific questionnaire |
Cherry et al., 2002 [23] | Retrospective cohort/England b (991) | ND | Five years (dates not given) | Bronchial challenge test PFT Peak flow | Questionnaire Undetectable exposure measurements | No increased risk of PA if measurements remain undetectable Chest tightness reported by 16.1% of exposed individuals | Exposed women not included |
Study ID (First Author, Year) [REF] | Study Design/Location (N) | Isocyanate | Type of Industry | Follow-Up | Asthma Diagnosis | Causality Assessment | Results | Limitations |
---|---|---|---|---|---|---|---|---|
Park et al., 1992 [24] | Transversal study/South Korea (31) | TDI | Textiles industry | No follow-up | Questionnaire Prick tests RAST Methacholine challenge test | Specific inhalation test | 26% of subjects were symptomatic 13% of inhalation tests were positive | Duration of exposure not provided |
Baur et al., 1994 [25] | Retrospective cohort/Germany (1780) | MDI/TDI | Various | ND | Medical files Inhalation test | Specific inhalation test | MDI is more asthmatogenic because not easily measured and polymerizes rapidly 1–2% of exposed subjects were symptomatic | Archived data Diverse population |
Al-Batanony et al., 2012 [26] | Transversal study/Egypt (100) | TDI | Bone-glue factory | No follow-up | Questionnaire Symptoms PFT | Urinary hippuric acid Absence of temporality | Impaired spirometry (FEV1 and FVC) proportional to the exposure time Exposure time correlated with the severity | Poorly comparable groups Link to work not clear |
El-Zaemey et al., 2018 [27] | Descriptive study | MDI/TDI | Australian workers from all sectors aged 18–65 years | No follow-up | Evaluation of exposure prevalence | Self-reported via questionnaire | MDI less volatile than TDI. Most exposed trades: painting, wood, construction | Non-response bias Self-reported data No exposure measurement |
Study ID (First Author, Year) [REF] | Isocyanate | Number of Studies Included | Follow-Up | Asthma Diagnosis | Causality Assessment | Results | Limitations |
---|---|---|---|---|---|---|---|
Van Kampen et al., 2000 [28] | All | 300 | No follow-up | PFT Inhalation test | Questionnaire | Prevalence respiratory disease = 5% | Possible selection bias Non-exhaustive review No assessment of study quality No comparison between substances and reported symptoms |
Diller 2002 [29] | TDI | 19 | Variable | Diverse | Occupational history | Prevalence >10% before 1985, and mostly between 0 and 10% in recent years | Unclear selection criteria Populations and study dates varied Unclear diagnosis |
Ott et al., 2003 [30] | TDI | ND | No follow-u | ND | ND | OA incidence decreased from 5% in 1970 to <1% No avoidance after symptom onset correlated with impaired lung function tests TDI-induced asthma causes bronchospasm even at 1 ppb | |
Jarvis et al., 2005 [31] | All | ND | Variable | Clinical diagnosis | Diverse | Risk increased with the number of groups No mono-isocyanate-induced OA reported | Possible interactions between substances |
Bello et al., 2007 [32] | All | 800 | No follow-up | Diverse | Reported cutaneous exposure | Indirect evidence of skin sensitization | Measurement of cutaneous exposure difficult Included animal studies |
Study ID (First Author, Year) [REF] | Location | Population | Participants | Follow-Up | Asthma Diagnosis | Causality Assessment | Results | Limitations |
---|---|---|---|---|---|---|---|---|
Gannon & Burge 1993 [33] | West Midlands, UK | Workers in the region | Cases reported by volunteer specialists | 1989–1991 | Peak flow | Actual or previous exposure at time of diagnosis | Incidence rate = 43/M active workers; 1883/M car body painters Isocyanates first cause (20.4%) Mainly allergic mechanism | Under-reporting bias Diagnostic methods underused outside specialized centers A region with high industrial activity |
McDonald et al., 2000 [34] | UK | UK working population | Cases reported by volunteer specialists | 1989–1997 | Physician-dependent | Physician-dependent | Incidence rate = 1464/M car body painters Reduction in isocyanate-related OA since 1991 (from 22 to 14%) | Under-reporting bias |
Esterhuizen et al., 2001 [35] | South Africa | All working population | Cases reported by volunteer specialists | 1997–1999 | Peak flow IgE Prick tests | Temporality | Incidence rate = 17.5/M active workers Main causative agents: isocyanates (16.7%) and flour (16.0%) The sector most at risk: health (16.4%) | Under-reporting bias Inconsistent diagnostic methods RADS classified as OA |
Hnizdo et al., 2001 [36] | South Africa | All working population | Cases reported by volunteer specialists | 1996–1998 | Physician-dependent | Physician-dependent | Incidence rate = 13.1/M active workers Main causative agents: latex (24.1%) and isocyanates (19.5%) | Under-reporting bias Inconsistent diagnostic methods |
Kopferschmitt-Kubler et al., 2002 [37] | France | All working population | Cases reported by volunteer specialists | 1996 | Peak flow IgE Prick tests Bronchial methacholine challenge test | Temporality | Incidence rate = 25.7/M active workers Main causative agents: flour (23.3%) and isocyanates (16.6%) | Under-reporting bias RADS classified as OA |
Ameille et al., 2003 [38] | France | All working population | Cases reported by volunteer specialists | 1996–1999 | Physician-dependent | Physician-dependent | Main causative agents: flour (20.3%) and isocyanates (14.1%) Incidence rate = 24/M active workers Sectors most at risk: car body painter (326/M) and woodworkers (218/M) | Under-reporting bias Inconsistent diagnostic methods |
Di Stefano et al., 2004 [39] | West Midlands, UK | All working population | Cases reported by volunteer specialists | 1990–1997 | Peak flow Bronchial methacholine challenge test | Temporality | Main causative agent: isocyanates (17.3%) Incidence rate = 41.2/M active workers The sector most at risk: car body painter Increasing avoidance after diagnosis (82.3% vs. 71.7%) | Under-reporting bias A region with high industrial activity |
Vandenplas et al., 2005 [40] | Belgium | All working population | Cases reported by volunteer specialists | 2000–2002 | BHR IgE Prick tests PFT Bronchial methacholine challenge test | Temporality | Main causative agent: isocyanates (17.3%) Incidence rate = 23.5/M active workers | Under-reporting bias |
Bakerly et al., 2008 [41] | West Midlands, UK | All working population in the region | Cases reported by volunteer specialists | 1991–2005 | Peak flow | Temporality Monitoring | Main causative agent: isocyanates (21%) Incidence rate = 42/M active workers No change in incidence in the study period. The sector most at risk: car body painter | Under-reporting bias |
Mackie 2008 [42] | UK | Motor vehicle repair workers | Cases reported by volunteer specialists | 1995–2000 | Questionnaire PFT | Temporality | Incidence rate = 79/M motor vehicle repair workers 8/9 spray paints contain isocyanates No diagnostic benefit from PFT vs. questionnaire and temporality One in two cases still in work one year after diagnosis | Under-reporting bias High rate of lost-to-follow-up |
Vandenplas et al., 2011 [43] | Belgium | Workers in Belgium | Retrospective review of compensation claims | 1993–2002 | Questionnaire PFT Prick tests Bronchial methacholine challenge test | Temporality | Main causative agents: flour (33.6%) et isocyanates (19.6%) Incidence rate = 29.4/M active workers The rate decreased from 35.5 to 25.8 | Under-reporting bias Inconsistent diagnostic methods |
Paris et al., 2012 [44] | France | All working population | Cases reported by specialists | 2001–2009 | Questionnaire Specialist consultation | Medical files | The incidence rate of isocyanate-related OA decreased from 64 (12.7%) à 15 (6.2%) | Under-reporting bias Inconsistent diagnostic methods |
Reilly et al., 2020 [45] | Michigan, USA | All working population | Cases reported by volunteer specialists | 1988–2018 | Medical files Telephone interviews | Monitoring | Main causative solvents and isocyanates Incidence rate = 35/M active workers in 1988 20/M active workers in 2018 20% of workers exposed to isocyanates in 1988 vs. 7% in 2018 The sector most at risk: manufacturing | Under-reporting bias |
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Coureau, E.; Fontana, L.; Lamouroux, C.; Pélissier, C.; Charbotel, B. Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review. Int. J. Environ. Res. Public Health 2021, 18, 13181. https://doi.org/10.3390/ijerph182413181
Coureau E, Fontana L, Lamouroux C, Pélissier C, Charbotel B. Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review. International Journal of Environmental Research and Public Health. 2021; 18(24):13181. https://doi.org/10.3390/ijerph182413181
Chicago/Turabian StyleCoureau, Elie, Luc Fontana, Céline Lamouroux, Carole Pélissier, and Barbara Charbotel. 2021. "Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review" International Journal of Environmental Research and Public Health 18, no. 24: 13181. https://doi.org/10.3390/ijerph182413181
APA StyleCoureau, E., Fontana, L., Lamouroux, C., Pélissier, C., & Charbotel, B. (2021). Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review. International Journal of Environmental Research and Public Health, 18(24), 13181. https://doi.org/10.3390/ijerph182413181