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Volume 41, Number 4, August 2008

Asthma-like syndrome in school children after accidental exposure to xylene and methylene diphenyl diisocyanate

Ren-Long Jan, Shin-Hong Chen, Ho-Yuan Chang, Hui-Jung Yeh, Chi-Chang Shieh, Jiu-Yao Wang
Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan; Department of Pediatrics, Chi Mei Medical Center, Liou Ying Campus, Tainan; Department of Pediatrics, Ma-Do Shin-Lau Hospital, Tainan; and Department of Environmental and Occupational Health and 5Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Received: October 3, 2007    Revised: December 4, 2007    Accepted: January 26, 2008   


Corresponding author:

Dr. Jiu-Yao Wang, Division of Allergy and Clinical Immunology, Department of Pediatrics, National Cheng Kung University Medical College, 138 Sheng-Li Road, Tainan 70248, Taiwan. E- mail: Dr. Jiu-Yao Wang This e-mail address is being protected from spam bots, you need JavaScript enabled to view it



Background and purpose: 

We assessed the signs and symptoms, pulmonary function changes and residual chemical body burden of school children in the vicinity of an accidental exposure to volatile xylene and methylene diphenyl diisocyanate (MDI).




After the exposure episode, children with significant symptoms after MDI exposure (e.g., dizziness, nausea, sore throat, and breathing difficulties) were sent to nearby emergency medical units for evaluation and admission if necessary. Clinical work-up included pulmonary function tests and measurement of residual MDI in the body by high-performance liquid chromatography analysis of urine.




203 students appeared to develop symptoms associated with contaminant exposure, and 173 affected students were sent to nearby emergency units. In the subsequent surveillance, 22 of 203 affected students (10.8%) revealed a positive history of asthma, which was strongly correlated with the incidence of dyspnea arising from the incident. For children with no previous history of asthma, 60.8% (110 of 181) complained of dyspnea during the episode, and 16.2% required inhaled bronchodilator therapy at the emergency medical units for relief of wheezing symptoms. In a simulation, we found the raw material used for tract surfacing, primarily MDI dissolved in xylene, to be present at a concentration (870 ppm w/w) more than 8000-fold the level defined as safe for a working environment.




We have detected a direct cause-effect relationship between the accidental spillage of MDI and the appearance of an acute asthma-like syndrome among previously unexposed school children.



Key words:

Adhesives, adverse effects; Air pollutants, occupational; Asthma; Isocyanates; Xylenes



J Microbiol Immunol Infect. 2008;41:337-341.