The publication describes the case of a healthy 58-year-old man who began to saw polyurethane parts at work. About two weeks later he developed a progressive cough and dyspnoea at work. At the weekend at home he was free of symptoms. After six weeks his coughing and dyspnoea became acutely so severe at work that he had to be referred to an intensive care unit for treatment of acute cardiopulmonary shock. Four weeks later, on his first day back after two hours at work his coughing and dyspnoea became so severe that again he has to be treated in an intensive care unit for cardiopulmonary shock. At this time the suspicion arose that the symptoms could be caused by an allergic reaction to isocyanates as components of the polyurethane. At the time of our assessment no clinical or functional impairment was to be found. In his blood specific IgG and IgG4 antibodies against isocyanate (HDI) are detectable. Unspecific bronchial provocation with histamine yielded normal reactions. The patient had recovered quickly and completely from the two extraordinarily severe episodes of allergic shock caused by reactions to isocyanates. An occupational disease according to German law was recognized without the need for compensation.
