RATIONALE: RJ was a 49 year-old Caucasian female infant mattress seamstress, who had been employed at the same factory for many years without experiencing respiratory complaints. Several months before her initial visit, she developed symptoms of coughing, wheezing, shortness of breath, and excessive mucus production. Her symptoms coincided with the introduction of a new flame resistant mattress filler (acrylonitrile).METHODS: Physicians treated her symptoms with inhaled steroids, bronchodilators, and anti-leukotriene agents. Her allergy investigation was negative for IgE reactivity to inhalant aeroallergens. Lung functions were normal while on medications, including an oral steroid, inhaled combinations of salmeterol and a steroid, montelukast, and prednisone. Symptoms resolved when removed from the workplace, and then returned immediately upon her re-exposure to the acrylonitrile fibers, which filled the air in the sewing area and covered the floor around her machine.RESULTS: Actylonitrile is known to activate innate immunity, and as such, it is the likely cause of her symptoms of chemical bronchitis / asthma.CONCLUSIONS: Actylonitrile causes chemical bronchitis-like symptoms in exposed workers, and it must be considered as a cause of asthma. Early detection, total avoidance of its inhalation, and oral steroid use can reverse untoward effects of acylonitrile inhalation. Importantly, the acrylonitrile fibers have been seen to fly out of the vents of these infant mattresses, raising the potential for inhalation of this irritant into developing human respiratory tissues. Reconsideration of withdrawing its use in mattresses intended for infant use. RATIONALE: RJ was a 49 year-old Caucasian female infant mattress seamstress, who had been employed at the same factory for many years without experiencing respiratory complaints. Several months before her initial visit, she developed symptoms of coughing, wheezing, shortness of breath, and excessive mucus production. Her symptoms coincided with the introduction of a new flame resistant mattress filler (acrylonitrile). METHODS: Physicians treated her symptoms with inhaled steroids, bronchodilators, and anti-leukotriene agents. Her allergy investigation was negative for IgE reactivity to inhalant aeroallergens. Lung functions were normal while on medications, including an oral steroid, inhaled combinations of salmeterol and a steroid, montelukast, and prednisone. Symptoms resolved when removed from the workplace, and then returned immediately upon her re-exposure to the acrylonitrile fibers, which filled the air in the sewing area and covered the floor around her machine. RESULTS: Actylonitrile is known to activate innate immunity, and as such, it is the likely cause of her symptoms of chemical bronchitis / asthma. CONCLUSIONS: Actylonitrile causes chemical bronchitis-like symptoms in exposed workers, and it must be considered as a cause of asthma. Early detection, total avoidance of its inhalation, and oral steroid use can reverse untoward effects of acylonitrile inhalation. Importantly, the acrylonitrile fibers have been seen to fly out of the vents of these infant mattresses, raising the potential for inhalation of this irritant into developing human respiratory tissues. Reconsideration of withdrawing its use in mattresses intended for infant use.