Occupational asthma, lung function decrement, and toluene diisocyanate (TDI) exposure: a critical review of exposure-response relationships

A novel treatment and derivatization for quantification of residual aromatic diisocyanates in polyamide resins

In the scientific context, the environmental and healthy impact of polymers is more related to the residual monomer content rather than their macromolecular structure, due to the monomer capability to interact with membrane cells. For this a novel method to stabilize and quantify residual monomeric isocyanates in high thermal resistance polyamide resins (PAs) has been developed. This new analytical method resulted in an improvement concerning the quantification of residual aromatic diisocyanates in viscous polymeric matrices by using a simple and cheap technique like HPLC-VWD. Diisocyanate monomers were derivatized with dibutylamine, resulting in stable urea derivatives that were simultaneously analysed and quantified. The method was applied to solvent-based polyamide resins, used as primary electrical insulation, for avoiding additional step of solvent removing before the analysis. The quantification of residual monomers answers to the provisions imposed by European Regulation N. 1907/2006 (REACH) for polymer registration, and the necessity of an early evaluation of the occupational risk associated with the use of diisocyanates, due to their toxicity and high reactivity towards moisture.

Recent advances in toxicological research and potential health impact of microplastics and nanoplastics in vivo

As emerging pollutants, direct and indirect adverse impacts of micro(nano)plastics (MPs/NPs) are raising an increasing environmental concern in recent years due to their poor biodegradability and difficulty in recycling. MPs/NPs can act as carriers of bacteria, viruses, or pollutants (such as heavy metals and toxic organic compounds), and may potentially change the toxicity and bioavailability of pollutants. Ingested or attached MPs/NPs can also be transferred from low-trophic level organisms to high-nutrient organisms or even the human body through the food chain transfer process. This article reviews the emerging field of micro- and nanoplastics on organisms, including the separate toxicity and toxicity of compound after the adsorption of organic pollutants or heavy metals, as well as possible mechanism of toxicological effects and evaluate the nano- and microplastics potential adverse effects on human health. The inherent toxic effects MPs/NPs mainly include the following: physical injury, growth performance decrease and behavioral alteration, lipid metabolic disorder, induced gut microbiota dysbiosis and disruption of the gut's epithelial permeability, neurotoxicity, damage of reproductive system and offspring, oxidative stress, immunotoxicity, etc. Additionally, MPs/NPs may release harmful plastic additives and toxic monomers such as bisphenol A, phthalates, and toluene diisocyanate. The vectors' effect also points out the potential interaction of MPs/NPs with pollutants such as heavy metals, polycyclic aromatic hydrocarbons, organochlorine pesticides, polychlorinated biphenyls, perfluorinated compounds, pharmaceuticals, and polybrominated diphenyl ethers. Nevertheless, these potential consequences of MPs/NPs being vectors for contaminants are controversial.

The relationship between toluene diisocyanate exposure and respiratory health problems: A meta-analysis of epidemiological studies

Human epidemiological studies have shown inconclusive results over the effects of diisocyanates on respiratory health problems. A meta-analysis combined evidence on the association between occupational asthma (OA), respiratory function, and toluene diisocyanate (TDI) inhalation exposure. Sixty-one articles on occupational toluene diisocyanate exposure were identified via two databases. Fourteen studies were included in the meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies. Odds ratios (OR_asthma) for the association between TDI exposure compared to non-exposure and OA were calculated. The difference in mean differences (MD) of forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC), and the annual mean change differences-in milliliters per year (mL/yr)-in FEV₁ and FVC pulmonary function between TDI exposed and non-exposed, were calculated. When applicable, a random effects meta-analysis was performed. The overall summary OR_asthma for TDI exposed versus non-exposed was 1.18 (95% CI = 0.78-1.79). The summary of the predicted mean percentage difference (MD_%predicted) between exposed versus non-exposed was 2.96% for FEV₁ and 3.75% for FVC. A very small decrease of 5 mL/yr for FEV₁ and 10 mL/yr for FVC, respectively, was observed between the exposed and the non-exposed groups. There was moderate to low heterogeneity between study results, and most studies were evaluated as high-quality. This meta-analysis found no statistically significant adverse association between TDI occupational exposure and OA. No meaningful differences in lung function were detected between exposed and unexposed groups.

Asthma and rhinitis in Greek furniture workers

Objective: The detection of asthma and rhinitis in furniture workers exposed to chemicals in the area of Thessaloniki Greece and the determination of the most useful tests for diagnosing the above occupational diseases.Methods: Eighty-three workers (76 men), 35 exposed to chemicals (CW), 23 to wood dust (WW), and 25 office workers (OW), serving as controls, filled in a specialized European Community Respiratory Health Survey (ECRHS) questionnaire for asthma and were submitted to clinical evaluation, spirometry, bronchodilation test, PEF computer algorithm OASYS-2, FeNO, skin prick tests (SPTs), rhinomanometry and methacholine inhalation challenge. Working conditions and protective measurements were also recorded. According to the results of all conducted tests, each subject was distributed to a subgroup: (a) normal, (b) asthma, (c) rhinitis, (d) asthma and rhinitis. Comparisons were performed among work groups.Results: The presence of asthma and/or rhinitis was higher among CW and WW compared to OW (p = 0.004). Significant differences among groups were observed in the questions «better weekend» (p < 0.034) and "improvement on vacation» (p < 0.000), in OASYS-2 Score (p < 0.000), in ABC Score (p < 0.000), and in methacholine score (p < 0.022). Rhinomanometry, FeNO, spirometry, and spirometry after bronchodilation had no significant differences among groups. Working conditions, ventilation system, work practice, use and type of mask revealed no significant differences.Conclusion: Asthma and rhinitis are significantly common among CW. Protective measurements used were not adequate to prevent asthma and or work related rhinitis. Early diagnosis might contribute to disease prevention and control.

Critique of the ACGIH 2016 derivation of toluene diisocyanate Threshold Limit Values

In 2016, the American Conference of Governmental Industrial Hygienists (ACGIH) lowered the 8-hr Threshold Limit Value - time-weighted average (TLV-TWA) for toluene diisocyanate (TDI) from 5 ppb to 1 ppb, and the 15-min short-term exposure limit (STEL) from 20 ppb to 5 ppb. We evaluated ACGIH's basis for lowering these values. It is our opinion that the ACGIH's evaluation of the evidence for occupational asthma and respiratory effects from TDI exposure does not fully integrate the results of all the available human and animal studies. We found that some studies reported occupational asthma cases at TWAs less than 5 ppb, but these cases were likely caused by peak exposures above 20 ppb. Advances in industrial hygiene have reduced peak exposures and the incidence of upset conditions, such as spills and accidents, in modern TDI facilities. Taken together, the human evidence indicates that adherence to the previous 8-hr TLV-TWA and 15-min STEL (5 ppb and 20 ppb, respectively) prevents most, if not all, cases of occupational asthma, and eliminates or reduces the risk of lung function decrements and other respiratory effects. While limited, the animal literature supports the human evidence and indicates that TDI-induced asthma is a threshold phenomenon. We conclude that ACGIH's decision to lower the TLV-TWA and STEL values for TDI is not adequately supported.

Occupational asthma risk from exposures to toluene diisocyanate: A review and risk assessment

BACKGROUND

Toluene Diisocyanate (TDI) is a known respiratory sensitizer linked to occupational asthma (OA). To better manage worker risks, an appropriate characterization of the TDI-OA dose-risk relationship is needed.

METHODS

The literature was reviewed for data suitable for dose-response modeling. Previous study data were fit to models to derive prospective occupational exposure limits (OELs), using benchmark dose (BMD) and low-dose extrapolation approaches.

RESULTS

Data on eight TDI-exposed populations were suitable for analysis. There were 118 OA cases in a population contributing 13 590 person-years. The BMD-based OEL was 0.4 ppb. The OEL based on low-dose extrapolation to working lifetime extra risk of 1/1000 was 0.3 ppb.

CONCLUSIONS

This study synthesized epidemiologic data to characterize the TDI-OA dose-risk relationship. This approach yielded prospective OEL estimates below recent recommendations by the American Conference of Governmental Industrial Hygienists, but given significant study limitations, this should be interpreted with caution. Confirmatory research is needed.

Longitudinal and Cross-sectional Analyses of Lung Function in Toluene Diisocyanate Production Workers

OBJECTIVE

The aim of this study was to investigate lung function among toluene diisocyanate (TDI) production workers.

METHODS

One hundred ninety-seven U.S workers performed spirometry from 2006 through 2012. Results were compared within the study cohort and with U.S. population measures. A mixed-effects model assessed factors affecting repeated forced expiratory volume in 1 second (FEV1) measurements.

RESULTS

The cohort's mean FEV1 and forced vital capacity (FVC) percent reference values, although greater than 90%, were significantly lower and the prevalence of abnormal spirometry (predominantly restrictive pattern) was significantly higher than in the U.S.

POPULATION

Differences in lung function among workers with higher cumulative TDI exposure were in the direction of an exposure effect, but not significant.

CONCLUSION

We found little evidence of an adverse effect of TDI exposure on longitudinal spirometry in these workers. The association between TDI exposure and the increasing prevalence of a restrictive pattern needs further exploration.

Dermal exposure to toluene diisocyanate and respiratory cancer risk

Human exposure to toluene diisocyanate (TDI) occurs mainly through inhalation of vapors in occupational settings where TDI is produced or used, but dermal exposure to TDI is also possible during some operations. Because of a recent epidemiology study reporting a possible association with lung cancer risk in workers with potential dermal exposure to TDI, we evaluated the evidence from epidemiological, toxicological, and toxicokinetic studies to assess whether it is likely that dermal exposure to TDI can cause human respiratory cancers. We found that the reported associations with respiratory cancers in the epidemiology studies do not support TDI as a causal factor, as there are other explanations that are more likely than causation, such as confounding by smoking and low socioeconomic status. Experimental animal and genotoxicity studies indicate that the carcinogenic potential of TDI depends on its conversion to toluene diamine (TDA), and there is no evidence of systemic availability of TDA after dermal or inhalation exposure to TDI. Also, systemic uptake of TDI is very low after dermal exposure, and any absorbed TDI is more likely to react with biomolecules on or below the skin surface than to form TDA. Even if some TDA formation occurred after dermal exposure to TDI, TDA does not induce respiratory tract tumors in experimental animals after either dermal or oral exposure. We conclude that the available evidence indicates that dermal TDI exposure does not cause respiratory cancers in humans.

Setting Occupational Exposure Limits for Chemical Allergens--Understanding the Challenges

Chemical allergens represent a significant health burden in the workplace. Exposures to such chemicals can cause the onset of a diverse group of adverse health effects triggered by immune-mediated responses. Common responses associated with workplace exposures to low molecular weight (LMW) chemical allergens range from allergic contact dermatitis to life-threatening cases of asthma. Establishing occupational exposure limits (OELs) for chemical allergens presents numerous difficulties for occupational hygiene professionals. Few OELs have been developed for LMW allergens because of the unique biological mechanisms that govern the immune-mediated responses. The purpose of this article is to explore the primary challenges confronting the establishment of OELs for LMW allergens. Specific topics include: (1) understanding the biology of LMW chemical allergies as it applies to setting OELs; (2) selecting the appropriate immune-mediated response (i.e., sensitization versus elicitation); (3) characterizing the dose (concentration)-response relationship of immune-mediated responses; (4) determining the impact of temporal exposure patterns (i.e., cumulative versus acute exposures); and (5) understanding the role of individual susceptibility and exposure route. Additional information is presented on the importance of using alternative exposure recommendations and risk management practices, including medical surveillance, to aid in protecting workers from exposures to LMW allergens when OELs cannot be established.

Inception cohort study of workers exposed to toluene diisocyanate at a polyurethane foam factory: initial one-year follow-up

BACKGROUND

Isocyanates are one of the most commonly reported causes of occupational asthma; however, the risks of developing isocyanate asthma in modern production facilities remain poorly defined. We evaluated TDI exposure and respiratory health among an inception cohort of workers during their first year of employment at a new polyurethane foam production factory.

METHODS

Forty-nine newly hired workers were evaluated pre-employment, 6-months, and 12-months post-employment through questionnaire, spirometry, and TDI-specific serology. Airborne TDI levels were monitored by fixed-point air sampling and limited personal sampling. Qualitative surface SWYPE™ tests were performed to evaluate potential sources of skin exposure.

RESULTS

Airborne TDI levels overall were low; over 90% of fixed-point air measurements were below the limit of detection (0.1 ppb). Over the first year of employment, 12 of the 49 original workers (24.5%) were lost to follow-up, no additional workers were enrolled, and seven of the 49 original workers (14.2%) developed either new asthma symptoms (N = 3), TDI-specific IgG (N = 1), new airflow obstruction (N = 1) and/or a decline in FEV1  ≥ 15% (N = 3), findings that could indicate TDI-related health effects. The prevalence of current asthma symptoms was significantly higher in the workers lost to follow-up compared to those who completed the 12-month follow-up (25% vs. 2.7%; P = 0.04).

CONCLUSIONS

The findings suggest possible early TDI-related health effects in a modern polyurethane production plant. These findings also highlight the need for further longitudinal evaluation of these workers and the challenges of studying workers at risk for isocyanate asthma.

Comparison of solvent/derivatization agent systems for determination of extractable toluene diisocyanate from flexible polyurethane foam

Flexible polyurethane foam (FPF) is produced from the reaction of toluene diisocyanate (TDI) and polyols. Limited and conflicting results exist in the literature concerning the presence of unreacted TDI remaining in FPF as determined by various solvent extraction and analysis techniques. This study reports investigations into the effect of several solvent/derivatization agent combinations on extractable TDI results and suggests a preferred method. The suggested preferred method employs a syringe-based multiple extraction of foam samples with a toluene solution of 1-(2-methoxyphenyl)-piperazine. Extracts are analyzed by liquid chromatography using an ion trap mass spectrometry detection technique. Detection limits of the method are ~10ng TDI g(-1) foam (10 ppb, w/w) for each TDI isomer (i.e. 2,4-TDI and 2,6-TDI). The method was evaluated by a three-laboratory interlaboratory comparison using two representative foam samples. The total extractable TDI results found by the three labs for the two foams were in good agreement (relative standard deviation of the mean of 30-40%). The method has utility as a basis for comparing FPFs, but the interpretation of extractable TDI results using any solvent as the true value for 'free' or 'unreacted' TDI in the foam is problematic, as demonstrated by the difference in the extracted TDI results from the different extraction systems studied. Further, a consideration of polyurethane foam chemistry raises the possibility that extractable TDI may result from decomposition of parts of the foam structure (e.g. dimers, biurets, and allophanates) by the extraction system.

Toluene diisocyanate emission to air and migration to a surface from a flexible polyurethane foam

Flexible polyurethane foam (FPF) is produced from the reaction of toluene diisocyanate (TDI) and polyols. Because of the potential for respiratory sensitization following exposure to TDI, concerns have been raised about potential consumer exposure to TDI from residual 'free TDI' in FPF products. Limited and conflicting results exist in the literature concerning the presence of unreacted TDI remaining in FPF as determined by various solvent extraction and analysis techniques. Because residual TDI results are most often intended for application in assessment of potential human exposure to TDI from FPF products, testing techniques that more accurately simulated human contact with foam were designed. To represent inhalation exposure to TDI from polyurethane foam, a test that measured the emission of TDI to air was conducted. For simulation of human dermal exposure to TDI from polyurethane foam, a migration test technique was designed. Emission of TDI to air was determined for a representative FPF using three different emission test cells. Two were commercially available cells that employ air flow over the surface of the foam [the Field and Laboratory Emission Cell (FLEC®) and the Micro-Chamber/Thermal Extraction™ cell]. The third emission test cell was of a custom design and features air flow through the foam sample rather than over the foam surface. Emitted TDI in the air of the test cells was trapped using glass fiber filters coated with 1-(2-methoxyphenyl)-piperazine (MP), a commonly used derivatizing agent for diisocyanates. The filters were subsequently desorbed and analyzed by liquid chromatography/mass spectrometry. Measurement of TDI migration from representative foam was accomplished by placing glass fiber filters coated with MP on the outer surfaces of a foam disk and then compressing the filters against the disk using a clamping apparatus for periods of 8 and 24 h. The sample filters were subsequently desorbed and analyzed in the same manner as for the emission tests. Although the foam tested had detectable levels of solvent-extractable TDI (56ng TDI g(-1) foam for the foam used in emissions tests; 240-2800ng TDI g(-1) foam for the foam used in migration tests), no TDI was detected in any of the emission or migration tests. Method detection limits (MDLs) for the emissions tests ranged from 0.03 to 0.5ng TDI g(-1) foam (0.002-0.04ng TDI cm(-2) of foam surface), whereas those for the migration tests were 0.73ng TDI g(-1) foam (0.16ng TDI cm(-2) of foam surface). Of the three emission test methods used, the FLEC® had the lowest relative MDLs (by a factor of 3-10) by virtue of its high chamber loading factor. In addition, the FLEC® cell offers well-established conformity with emission testing standard methods.

Trends in pulmonary function and prevalence of asthma in hexamethylene diisocyanate workers during a 19-year period

OBJECTIVE

To identify if 1,6-hexamethylene diisocyanate (HDI) workers demonstrated an increased prevalence of occupational asthma or accelerated decline in pulmonary function.

METHODS

Employees from two plants manufacturing or producing 1,6-HDI monomer and/or HDI polyisocyanates were matched to a control population by age, gender, race, and smoking status. A random coefficient regression analysis compared the decline in pulmonary function test values over time. Retrospective medical review was used to identify potential cases of occupationally induced asthma.

RESULTS

No significantly accelerated annual decline in force expiratory volume after 1 second in the HDI exposure group compared to the matched control group was observed. No cases of adult onset asthma, beyond those present at time of hire, and no cases of occupational asthma were identified.

CONCLUSIONS

This study provides support for the current American Conference of Governmental Industrial Hygienists threshold limit value time-weighted average of 5 ppb.

Respiratory symptoms and lung function in foundry workers exposed to low molecular weight isocyanates

BACKGROUND

This study investigated the prevalence of ocular and respiratory symptoms and lung function in foundry workers exposed to isocyanic acid (ICA) and methyl isocyanate (MIC).

METHODS

Foundry workers (n = 64) using the Hot Box binder technique and referents (n = 134) completed two questionnaires and a spirometry before and after a day shift. Findings were analyzed relating to exposure measurements of ICA, MIC, and formaldehyde.

RESULTS

Exposed workers reported more frequently ocular irritation and coughing. Pre-shift lung function was lower than predicted in both groups of workers, and was not associated with exposure duration. Decrease in lung function over shift was more pronounced in exposed workers, but this was not associated with quantitative measures of the exposures.

CONCLUSIONS

An increased prevalence of ocular and respiratory symptoms, as well as a small decrease in lung function over shift, was observed among exposed workers. No associations with exposure to monoisocyanates and formaldehyde were seen, thus suggesting that other irritants in the foundry environment might be the cause. The effects seemed to be small and not clinically relevant on an individual level. Further studies using a follow-up design may be warranted.

Th2 Cytokines in Skin Draining Lymph Nodes and Serum IgE Do Not Predict Airway Hypersensitivity to Intranasal Isocyanate Exposure in Mice

Isocyanate exposure in the workplace has been linked to asthma and allergic rhinitis. Recently, investigators have proposed that Th2 cytokine responses in lymph nodes draining the site of dermal application of chemicals including isocyanates may be used to identify sensitizers that cause asthma-like responses. The purpose of this study was to determine if the cytokine profile induced after dermal sensitization with isocyanates and serum IgE predict immediate (IHS) and methacholine-induced late (LHS) respiratory hypersensitivity responses after intranasal challenge. Dermal application of hexylmethane diisocyanate (HMDI), toluene diisocyanate (TDI), or methylene diisocyanate (MDI) significantly increased interleukin-4 (IL-4), IL-5, and IL-13 secretion in parotid lymph node cells. Isophorone diisocyanate (IPDI) increased IL-4 and IL-13, but not IL-5. Tolyl(mono)isocyanate (TMI), tetramethylene xylene diisocyanate (TMXDI), or the contact sensitizer dinitrochlorobenzene (DNCB), only induced minor increases in some of the Th2 cytokines. HMDI, TDI, MDI, and IPDI elicited greater increases in total serum IgE than DNCB, TMI, and TMXDI. All chemicals except TMXDI caused IHS after intranasal challenge of sensitized female BALB/c mice. Only HMDI-, TMI-, or TMXDI-sensitized and challenged mice had increases in LHS. All chemicals elicited epithelial cytotoxicity indicative of nasal airway irritation. The discordance between dermal cytokine profiles and respiratory responses suggests that dermal responses do not necessarily predict respiratory responses. Serum IgE also was not predictive of the respiratory responses to the isocyanates, suggesting that other unknown mechanisms may be involved.

Respiratory symptoms, sensitization, and exposure response relationships in spray painters exposed to isocyanates

RATIONALE

Associations between oligomeric isocyanate exposure, sensitization, and respiratory disease have received little attention, despite the extensive use of isocyanate oligomers.

OBJECTIVES

To investigate exposure-response relationships of respiratory symptoms and sensitization in a large population occupationally exposed to isocyanate oligomers during spray painting.

METHODS

The prevalence of respiratory symptoms and sensitization was assessed in 581 workers in the spray-painting industry. Personal exposure was estimated by combining personal task-based inhalatory exposure measurements and time activity information. Specific IgE and IgG to hexamethylene diisocyanate (HDI) were assessed in serum by ImmunoCAP assay and enzyme immunoassays using vapor and liquid phase HDI-human serum albumin (HDI-HSA) and HSA conjugates prepared with oligomeric HDI.

MEASUREMENTS AND MAIN RESULTS

Respiratory symptoms were more prevalent in exposed workers than among comparison office workers. Log-linear exposure-response associations were found for asthmalike symptoms, chronic obstructive pulmonary disease-like symptoms, and work-related chest tightness (prevalence ratios for an interquartile range increase in exposure of 1.2, 1.3 and 2.0, respectively; P </= 0.05). The prevalence of specific IgE sensitization was low (up to 4.2% in spray painters). Nevertheless, IgE to N100 (oligomeric HDI)-HSA was associated with exposure and work-related chest tightness. The prevalence of specific IgG was higher (2-50.4%) and strongly associated with exposure.

CONCLUSIONS

The results provide evidence of exposure-response relationships for both work-related and non-work-related respiratory symptoms and specific sensitization in a population exposed to oligomers of HDI. Specific IgE was found in only a minority of symptomatic individuals. Specific IgG seems to be merely an indicator of exposure.

Basic science and pathophysiology of ocular allergy

Ocular allergy includes several clinical subtypes ranging from the mild seasonal allergic conjunctivitis to the potentially sight-threatening atopic keratoconjunctivitis. Current therapies, particularly for the severe forms of disease, need to be more localized and with fewer side effects. For this to be achieved, it requires a better understanding of the basic mechanisms involved. In this chapter, recent findings are discussed that suggest that it is important to take an integrated approach, including both immune and structural elements of the eye. This provides potential new strategies for therapy, addressing the influence of structural cells in disease. These might influence the immune processes that take place and, as the structural cells are precisely localized, topical application is likely to be effective.

Occupational asthma

PURPOSE OF REVIEW

The scientific literature on occupational asthma is steadily increasing and no longer only describes case reports with prevalence figures and limited physiopathologic and immunologic data. Prospective cohort studies are currently carried out with relevant incidence figures and risk factors. Genetic susceptibility is explored. New diagnostic means are described. Surveillance programs are conducted and preventive measures are proposed.

RECENT FINDINGS

A relevant account was published on the respiratory consequences (irritant-induced asthma, a type of occupational asthma) of exposure of firefighters at the World Trade Center site. Glutathione-S-transferase appears to be an interesting susceptibility gene for occupational asthma as a result of isocyanates. Inflammation caused by neutrophils and not only by eosinophils is more often associated with occupational asthma. Examination of induced sputum and assessment of exhaled nitric oxide are becoming useful diagnostic tools. Cleaners are at increased risk of developing occupational asthma, although the causal agents are unknown. Surveillance programs currently combine strategies that aim to reduce exposure and identify cases early.

SUMMARY

New scientific information provides better, accurate figures on the frequency of occupational asthma and on risk factors, proposes relevant diagnostic tools more directly related to the physiopathology of the disease, and suggests effective surveillance programs in high-risk workplaces.

Frequency and trends of occupational asthma due to toluene diisocyanate: a critical review

In recent years, occupational asthma has become the most frequent occupational lung disease in many countries. Reports and statements on the frequency of occupational asthma due to isocyanates are quite contradictory. In order to clarify the issue, a critical review of the medical literature of the past half century worldwide has been performed, with special emphasis on toluene diisocyanate (TDI) as the main representative of the isocyanate family. Nine longitudinal workplace studies of 2,751 persons under risk allow calculation of incidences of occupational asthma due to toluene diisocyanate. Annual incidences had repeatedly been above five percent before 1980, and have decreased to zero to 0.7 percent since 1980. There is a downward trend during the last half century that clearly parallels the downward trend of toluene diisocyanate exposure in some studies. Prevalences of occupational asthma due to toluene diisocyanate can be estimated from 10 cross-sectional studies, based on 788 persons. Prevalences had repeatedly been above 10 percent before 1985, and have been mostly between zero and 10 percent in recent years.