Specific IgG response to monomeric and polymeric diphenylmethane diisocyanate conjugates in subjects with respiratory reactions to isocyanates

Abstract Background: Isocyanates are a frequent cause of occupational asthma and can also induce hypersensitivity pneumonitis. Objectives: It is still unclear whether antibodies to diphenylmethane diisocyanate (MDI), which are elicited in some subjects with these conditions, are specific for this type of isocyanate. Moreover, preparation of conjugates to human serum albumin (HSA) with the polymeric formulation rather than monomeric MDI might result in improved detection of antibodies. Methods: We addressed these issues by testing the sera of 13 subjects with asthma (n = 12) and hypersensitivity pneumonitis (n = 1) induced by MDI (n = 4 or 5, see below) by comparing them with sera obtained from subjects with occupational asthma caused by toluene diisocyanate (TDI; n=5) and hexamethylene diisocyanate (HDI; n=2). Conjugate preparations were compared by using SDS-PAGE, absorbance spectral analysis, and isolectric focusing. Immunologic screening was done by ELISA. Results: Specific IgG antibodies that recognize MDI-HSA conjugates were detected in all but 1 of the MDI-exposed workers and could not be found in TDI-exposed and HDI-exposed workers. The levels of specific IgG antibodies were more elevated when tested against the HSA conjugates formed with polymeric MDI compared with the HSA conjugates formed with monomeric MDI. Conclusion: This study shows that specific IgG antibodies to MDI appear to be specific for MDI without cross-reactivity with TDI and HDI and higher by use of polymeric rather than monomeric MDI-HSA test antigens. (J Allergy Clin Immunol 1999;103:749-55.)