Nonoccupational and occupational exposure to isocyanates.

PURPOSE OF REVIEW: This review aims to update the knowledge on the burden of disease due to exposure to isocyanates. Health effects of isocyanates and their major products, polyurethanes, are mainly determined by sensitization to isocyanates. Recent studies on the genetic factors to explain individual susceptibility to sensitization are reviewed. RECENT FINDINGS: Production of isocyanates has rapidly increased in the past and is predicted to increase at an annual rate of around 5%. Consumer products and the construction area are the main drivers of growth. This leads to increased nonoccupational exposure. The use of sprayed polyurethane foams for insulation in existing homes is one such example of nonoccupational exposure. The percentage of people exposed who show health effects is not known. Occupational exposure increases are mainly caused by the increase in the workforce. The percentage of workers exhibiting health effects remained fairly stable at 5-15% in the last decade. To explain why not all people exposed to isocyanates develop adverse health effects, recent findings on sensitization to isocyanate are reviewed. The skin is the most important route for sensitization. SUMMARY: Increased production of isocyanates and rising use of these substances in consumer products is leading to an increased burden of disease, with an increase in nonoccupational exposure as well. Sensitization to isocyanates is the main route for adverse health effects. The skin is the major route for sensitization. Recently, several genetic factors have been identified that play a role in the individual susceptibility for sensitization.

[Work-related disease]. / Ziek door blootstelling aan toxische stoffen op het werk.

Work-related health complaints occur frequently. Occupational health departments and primary and secondary care physicians are confronted with these patients. Awareness of work-related disease is crucial. Three case histories with work-related diseases are described. The first concerned a 39-year-old woman who showed acute neurotoxicity due to inhalation of formaldehyde and methanol after opening a coffin with an embalmed corpse. Within weeks the symptoms diminished and complete recovery occurred within nine months. The second was a 61-year-old carpenter who experienced acute and chronic pulmonary and neurotoxic effects after exposure to organic solvents during ground and carpenter's work on a terrain of a former gas plant. He developed severe chronic toxic encephalopathy. The last patient was a 61-year-old man who developed acute and chronic manganese toxicity leading to inability to work while employed at a brick factory where manganese was used to colour the bricks. The acute effects subsided, but chronic neuropsychological symptoms remained.