Also, matrix metalloproteinase-9 (MMP-9), ferritin, and transferr

Also, matrix metalloproteinase-9 (MMP-9), ferritin, and transferrin (Palikhe et al. 2011 and monocyte chemotractant protein-1 (MCP-1) (Bernstein et al. 2002) were proposed. Further studies are necessary. Comprehensive clinical diagnosis is necessary The diagnosis isocyanate asthma is known to be difficult as its patterns might be associated with isolated late asthmatic reaction, a biphasic dual reaction

or an atypical reaction (Tarlo et al. 2008; Curwick et al. 2006; Hendrick 2002). Diagnosis of isocyanate asthma may be also difficult due to concurrent inflammatory rhinoconjunctivitis or COPD, leading to false-positive as well as false-negative diagnoses. OICR-9429 datasheet Careful utilization of several diagnostic parameters is required for the evaluation of data. (Curwick et al. 2006; Hendrick 2002). Frequently,

analyses of reported clinical cases relay simply on the opinions of individuals, and reliance on publications is further compromised by the frequency of misdiagnosis of occupational I-BET151 asthma. Though the positive SIC result is considered as a “gold standard” for isocyanate asthma, the comprehensive clinical asthma diagnosis is far more than SIC only. We found that all SIC-positive patients with sIgE antibodies and the MDI-asthma diagnosis have also shown positive MDI-SPT reaction, whereas SIC-positive hypersensitivity pneumonitis patients were negative for MDI-SPT response. Since SIC can only be performed in a few highly specialized centers, this result might be interesting for those having no access to this diagnostic test. The attributable proportion of occupational agents to the total asthma burden is in the range of 5–25 %, with isocyanates as one of the most important causes worldwide, reinforcing the acute need for a reliable diagnostic tests (Hendrick 2002). Conclusions The isocyanate-specific IgE antibodies are not always detectable

but their presence can be predictive of isocyanate asthma and supportive for the diagnosis of Thiamet G occupational asthma. In contrast, the presence of IgG antibody only appears to be indicative in hypersensitivity pneumonitis and not relevant in cases of isocyanate asthma. The MDI-specific prick test may provide additional supportive information, allowing differentiation between isocyanate asthma and MDI-provoked hypersensitivity pneumonitis. Thus, a carefully evaluated clinical diagnosis is paramount in each individual case. Acknowledgments We would like to thank Ms Elke Finsel, MSc, and Ms Cai Brandenstein for their contribution to the preparation of the MDI conjugates and the collection of the immunological data, respectively. The authors also thank Dr. Kevan Willey for his critical appraisal of the manuscript, Ms S. Lebens and Ms F. Koops for technical assistance. We would like to acknowledge that this work could not have been performed without the support of colleagues and coworkers with the isocyanate challenge tests and spirometry.

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