異氰酸鹽作業之勞工屋塵蟎與異氰酸鹽過敏之相互關係

The relationship between the specific IgE of Dermatophagoides pteronyssinus and Isocyanate in the workers of Isocyanates

異氰酸鹽類是一種常見的工業原料，也是至今被瞭解最容易弓l起職業性氣喘的工業化學物質之一，這種物質可經呼吸道、眼睛及皮膚進入勞工體內。本研究針對常接觸異氰酸鹽類勞工以問卷方式調查此類勞工健康狀況，並赴工作現場進行肺部檢查，挑選自覺有過敏問題的勞工，進行抽血及呼氣流速測定， 藉著比較血清中的二異氰酸甲苯（Toluene diisocyanate, TDI）或二異氰酸二苯甲院(Diphenylmethane 4,4'-diisocyanate, MDI)及屋塵璊(Dermatophagoides pteronyssinus, Dp）專一性IgE抗體並探討其相關性。由578位勞工之問卷篩選出55位疑似職業性氣喘勞工，以其冷凍血清樣本，檢測TDI或MDI專一 性IgE抗體及恥專一性IgE抗體之出現頻率，並統計分析兩者的相關性。由疑似職業性氣喘勞工的血 樣檢測結果發現出現恥專一性IgE抗體之比率在工作年資五年內有3人佔5.4%，十年以上者增為10 人佔18.2%。同時這些勞工出現TDI或MDI專一性IgE抗體之比率在工作年資五年內有5人佔9.1%， 十年以上者增為9人佔16.4%。在18位有恥專一性IgE抗體之勞工出現TDI或MDI專一性IgE抗體 之比率，在工作年資五年內之勞工有2人（2/3, 66.6%）有TDI或MDI專一性IgE抗體；在工作年資五 到十年之間之勞工有4人（4/5, 80%）有TDI或MDI專一性IgE抗體，比五年內之勞工顯著增加p<0.05；工作年資十年以上之勞工有8人（ 8/10, 80%）有TDI或MDI專一性IgE抗體，也比五年內之勞工顯著增加（p<0.05）。 此結果顯示，勞工對異氰酸鹽及屋塵瞞產生過敏的機率會隨著在異氰酸鹽暴露時間之增長而增高，對屋塵瞞過敏併有異氤酸鹽過敏的機率也隨著工作年資之增長而增加。由於屋塵瞞專一性IgE抗體比異氰酸鹽容易檢測，因此年資高之勞工應先檢測屋塵瞞過敏，如有屋塵瞞過敏就應注意防患異氰酸鹽過敏。在台灣地區，由於屋塵瞞過敏的盛行率甚高，這些過敏者如果再接觸異氰酸鹽，很容易弓―起過敏。 因此建議有屋塵瞞過敏之勞工應做好防護措施，如戴口罩及穿防護衣，並減少異氰酸鹽接觸之時間。

Inhaled Isocyanate, one of the most common agent used by the manufacturers of plastics, may cause airway, eye and skin hypersensitivity. To assess the relationship between the environmental exposure condition and the development of allergic symptoms, serum specific IgE to toluene diisocyanate (TDI), diphenylmethane 4,4-diisocyanate (MDI) and Dermatophagoides pteronyssinus (Dp) were measured simultaneously to elucidate the possible involvement of Dp allergy in the causing of TDI/MDI hypersensitivity. A total of 578 workers were included in this study. However, there were only 55 workers who fulfilled the questionnaire-based diagnosis of asthma. The results showed that there were 3 subjects (5.4%) and 10 subjects (18.2%) possessed Dp-specific IgE five and ten years after occupationally exposure. There were 5 subjects (9.1%) and 9 subjects (16.4%) possessed TDI/MDI-specific IgE after similar duration of exposure. Among 18 subjects who have Dp-specific IgE, there were 2 subjects (2/3, 66.6%) possessed TDI/MDI-specific IgE five years after occupational exposure. The percentages were significantly increased to 80% (4/5 and 8/10, p 0.05) ten and fifteen years after occupational exposure. The presence of Dp-specific and TDI/MDI-specific IgE were both increased while the periods of occupational exposure were prolonged. The concurrent allergy to Dp and TDI/MDI were also increased in the same period. Since Dp specific IgE can be detected in the allergy clinic routinely, the measurement of Dp specific IgE may be used as an indicator of TDI/MDI allergy for the workers of long-term occupational exposure.