Skin exposure to aliphatic polyisocyanates in the auto body repair and refinishing industry: III. A personal exposure algorithm

Residual Isocyanates in Medical Devices and Products: A Qualitative and Quantitative Assessment

We conducted a pilot qualitative and quantitative assessment of residual isocyanates and their potential initial exposures in neonates, as little is known about their contact effect. After a neonatal intensive care unit (NICU) stockroom inventory, polyurethane (PU) and PU foam (PUF) devices and products were qualitatively evaluated for residual isocyanates using Surface SWYPE™. Those containing isocyanates were quantitatively tested for methylene diphenyl diisocyanate (MDI) species, using UPLC-UV-MS/MS method. Ten of 37 products and devices tested, indicated both free and bound residual surface isocyanates; PU/PUF pieces contained aromatic isocyanates; one product contained aliphatic isocyanates. Overall, quantified mean MDI concentrations were low (4,4'-MDI = 0.52 to 140.1 pg/mg) and (2,4'-MDI = 0.01 to 4.48 pg/mg). The 4,4'-MDI species had the highest measured concentration (280 pg/mg). Commonly used medical devices/products contain low, but measurable concentrations of residual isocyanates. Quantifying other isocyanate species and neonatal skin exposure to isocyanates from these devices and products requires further investigation.

Isocyanates and work-related asthma: Findings from California, Massachusetts, Michigan, and New Jersey, 1993-2008

BACKGROUND

Isocyanates remain a leading cause of work-related asthma (WRA).

METHODS

Two independent data systems were analyzed for the period 1993-2008: (1) State-based WRA case surveillance data on persons with isocyanate-induced WRA from four states, and (2) Occupational Safety and Health Administration (OSHA) Integrated Management Information System (IMIS) isocyanate air sampling results.

RESULTS

We identified 368 cases of isocyanate-induced WRA from 32 industries and 678 OSHA isocyanate air samples with detectable levels from 31 industries. Seventeen industries were unique to one or the other dataset.

CONCLUSION

Isocyanate-induced WRA continues to occur in a wide variety of industries. Two data systems uncovered industries with isocyanate exposures and/or illness. Improved control measures and standards, including medical surveillance, are needed. More emphasis is needed on task-specific guidance, spill clean-up procedures, skin and respiratory protection, and targeted medical monitoring to mitigate the hazards of isocyanate use.

Transferability of aliphatic isocyanates from recently applied paints to the skin of auto body shop workers

Isocyanates, the essential cross-linking chemicals used to make polyurethane, are potent sensitizers and a common cause of occupational asthma. In addition, isocyanate (NCO) skin contact may contribute to the development of isocyanate asthma. Prior work has shown that unbound NCO can persist on recently spray coated auto body parts after appearing dry. The purpose of this study was to assess whether isocyanate skin exposure can result from handling such surfaces. Quantitative surface and skin wipe sampling for total NCO was performed on test panels sprayed with aliphatic isocyanate coatings, and on paired skin samples obtained from participants who had rubbed the recently dried surfaces. Surface and skin samples, obtained from 18 workers in five auto body shops, were prepared following NIOSH method 5525 (modified for skin samples), and isocyanate species derived from hexamethylene diisocyanate and isophorone diisocyanate were analyzed using high-performance liquid chromatography with ultraviolet and fluorescence detectors. Quantifiable unbound NCO species were detected on 84.2% of all sprayed surfaces sampled after initially considered dry. Only 7 out of a total of 104 (6.7%) non-compounded skin samples obtained after contact with the recently dried coatings had detectable quantities of free NCO. The 7 positive samples, all obtained at the initial sampling time (t(0)), had a geometric mean of 0.016 μg NCO cm(-2) (range: 0.002-0.88 μg NCO cm(-2)). Only 1 of 12 (8.3%) of skin samples obtained after compounding contained detectable free NCO. The risk of substantial human isocyanate skin exposure from contact with the dry appearing (yet not fully cured) isocyanate coatings evaluated in this study appears to be low, although other isocyanate coatings and tasks may pose a greater risk of NCO skin exposure.

Immune sensitization to methylene diphenyl diisocyanate (MDI) resulting from skin exposure: albumin as a carrier protein connecting skin exposure to subsequent respiratory responses

Background

Methylene diphenyl diisocyanate (MDI), a reactive chemical used for commercial polyurethane production, is a well-recognized cause of occupational asthma. The major focus of disease prevention efforts to date has been respiratory tract exposure; however, skin exposure may also be an important route for inducing immune sensitization, which may promote subsequent airway inflammatory responses. We developed a murine model to investigate pathogenic mechanisms by which MDI skin exposure might promote subsequent immune responses, including respiratory tract inflammation.

Methods

Mice exposed via the skin to varying doses (0.1-10% w/v) of MDI diluted in acetone/olive oil were subsequently evaluated for MDI immune sensitization. Serum levels of MDI-specific IgG and IgE were measured by enzyme-linked immunosorbant assay (ELISA), while respiratory tract inflammation, induced by intranasal delivery of MDI-mouse albumin conjugates, was evaluated based on bronchoalveolar lavage (BAL). Autologous serum IgG from "skin only" exposed mice was used to detect and guide the purification/identification of skin proteins antigenically modified by MDI exposure in vivo.

Results

Skin exposure to MDI resulted in specific antibody production and promoted subsequent respiratory tract inflammation in animals challenged intranasally with MDI-mouse albumin conjugates. The degree of (secondary) respiratory tract inflammation and eosinophilia depended upon the (primary) skin exposure dose, and was maximal in mice exposed to 1% MDI, but paradoxically limited in mice receiving 10-fold higher doses (e.g. 10% MDI). The major antigenically-modified protein at the local MDI skin exposure site was identified as albumin, and demonstrated biophysical changes consistent with MDI conjugation.

Conclusions

MDI skin exposure can induce MDI-specific immune sensitivity and promote subsequent respiratory tract inflammatory responses and thus, may play an important role in MDI asthma pathogenesis. MDI conjugation and antigenic modification of albumin at local (skin/respiratory tract) exposure sites may represent the common antigenic link connecting skin exposure to subsequent respiratory tract inflammation.

Field comparison of air sampling methods for monomeric and polymeric 1,6-hexamethylene diisocyanate

This study was to critically compared 13 different air samplers for their ability to monitor air exposures to monomeric and polymeric 1,6-hexamethylene diisocyanate (HDI) in the automotive refinishing industry. Using both fast- and slow-drying clearcoat, we tested the following types of samplers: single- and dual-stage 37-mm polypropylene (PP) and polystyrene (PS) samplers (open- and closed-face), IOM (with plastic and stainless steel inserts), OSHA42, IsoChek, and WA-DOSH samplers. Midget impingers with frit were used as reference samplers. We observed the PP, PS, and IOM samplers to measure greater levels of HDI monomer and biuret when a fast-drying clearcoat was applied compared with a slow-drying clearcoat. When a slow-drying clearcoat was applied, the open-face PP and PS samplers measured significantly more monomeric and polymeric HDI (2-fold; p < 0.003) than the closed-face PP and PS samplers. We determined that significantly more monomeric and polymeric HDI were measured by impingers (1.3-1.9-fold) compared with single-stage PP/PS (N = 59), dual-stage PP/PS (N = 59), or IOM (N = 24) samplers. However, when stratified by cassette characteristics, the open-face single-stage PP and PS samplers performed equally to the impingers for HDI monomer when a fast-drying clearcoat was applied, and for all analytes when a slow-drying clearcoat was applied. Significantly higher HDI monomer concentrations (1.2-3.1-fold; p = 0.001) were measured with OSHA42 compared with the impinger. The IsoChek did not detect HDI monomer, and of the three samplers analyzed by laboratories other than UNC (i.e., OSHA42, IsoChek, and WA-DOSH), the WA-DOSH was in the best agreement with the impingers. The influence of clearcoat drying time on the sampler's ability to measure monomeric and polymeric HDI emphasizes the importance of the speciation of diisocyanates in chemical analysis and the careful consideration for the selection of the air sampler to be used when measuring exposures during automotive spray painting.

Sensitization to contact allergens and bronchial hyper-responsiveness

BACKGROUND

Exposure to contact allergens and specific allergic sensitization to them are common, but possible related health effects have been rarely studied.

OBJECTIVES

We aimed to analyse possible associations between contact sensitization to nickel sulfate and fragrance mix I and lung function parameters or bronchial hyper-responsiveness.

METHODS

Within a population-based study in Augsburg, 1052 adults performed lung function tests, including forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC) and bronchial hyper-responsiveness (BHR). Patch tests were performed, and information was assessed by medical examinations and interviews. Logistic regression models were applied to study associations between contact allergies and lung function parameters.

RESULTS

Women were sensitized significantly more often than men to nickel [odds ratio (OR) 3.97, 95% confidence interval (CI) 2.50-6.29] and fragrance mix I (OR 2.28, 95% CI 1.50-3.46). Patch test results for nickel and fragrance mix I did not influence mean FEV(1) and FVC % predicted values. However, in women, a higher rate of BHR was associated with positive patch test reactions to fragrance mix I (OR 2.24, 95% CI 1.11-4.52).

CONCLUSIONS

Contact sensitization to fragrance mix I is associated with a higher rate of BHR in women. Thus, in women with contact allergy to fragrances, airway obstruction should be considered as a possible co-morbidity.

Skin exposure and asthma: is there a connection?

Numerous occupational and environmental exposures that increase asthma risk have been identified. Research and prevention have focused primarily on the respiratory tract. However, recent studies suggest that the skin may also be an important route of exposure and site of sensitization that contributes to asthma development. Factors that impair skin barrier function, such as filaggrin gene mutations or skin trauma, may facilitate allergen entry and promote Th2-like sensitization and subsequent asthma. Animal studies demonstrate that skin exposure to chemical and protein allergens is highly effective at inducing sensitization, with subsequent inhalation challenge eliciting asthmatic responses. A similar role for human skin exposure to certain sensitizing agents, such as isocyanates, is likely. Skin exposure methodologies are being developed to incorporate skin exposure assessment into epidemiology studies investigating asthma risk factors.