Table 2.

Diagnosis of MDI hypersensitivity pneumonitis with evaluation points for isocyanate alveolitis

Routine diagnostic procedure for isocyanate alveolitis (with evaluation points)

Case history: typical exposure-related symptoms, see above (3 points)

Auscultation, crackles on lower lung fields (2 points)

Serological test: IgG antibodies to MDI-HSA conjugates (1 point)

Lung function tests: restrictive ventilation pattern, impaired diffusion capacity (2 points)

Chest X-ray: lung infiltrates ground or glass pattern (2 points)

Facultative diagnostic parameters

BAL: lymphocytosis, CD4/CD8 < 1 (3 points)

Serial lung functions testing demonstrating work-related FVC decline of at least 20 % points)

Specific inhalative challenge test: systemic inflammatory response plus restrictive ventilation response and/or impairment of diffusion capacity of at least 15 % (4 points)

Systemic inflammatory response (fever, leukocytosis) (3 points)

Positive diagnosis: when at least 10 points