Occupational lung disease induced by reactive chemicals.

Abstract

In industry, a wide variety of reactive chemicals are employed that can cause respiratory disease in exposed workers) As an example, two general classes of chemicals that cause occupational lung disease in the plastic industry include the anhydrides and the isocyanates. Phthalic anhydride has been a known cause of asthma since the late 1930s. ~ The isocyanates have been known to cause respiratory reactions characterized by dyspnea, wheezing, and cough for over 30 years. 3 The spectacular growth of the plastics industry over the last 30 years is indicated by the annual production of phthalic anhydride in this country, which in 1940 was 58 million pounds and has increased to well over one billion pounds a year in 1975. For trimellitic anhydride, annual production will exceed 100 million pounds in 1985 and will double in 10 years. This growth has resulted in an increased number of workers who develop respiratory tract disease, 4 which covers a wide spectrum both in clinical presentation and severity. In the spectrum of respiratory reactions caused by the inhalation of low molecular weight chemicals, the asthmatic syndromes have received the most attention and research emphasis and have been well summarized in recent reviews of occupational asthma. 4-7 A few low molecular weight chemicals will be discussed to illustrate the range of work that has been done. The complex salts of platinum have been known for years to cause a spectrum of asthma in sensitized workers. ~ Sensitized individuals have a high degree of skin reactivity to the platinum salts, and sensitivity has been reproduced by bronchial provocation. 9 It was not until 1979 that specific in vitro tests were able to detect IgE antibody to a conjugate of the platinum salts and human serum albumin} ° Phthalic anhydride is illustrative of a chemical that has been known for years to induce asthma, as shown by history, skin testing, bronchial provocation, and more recently by detection of specific IgE antibody in the serum of affected individuals to a conjugate of this low molecular weight chemical and a protein carrier} I