Diisocyanates and nonoccupational disease: a review.

More than 32 million people in the United States suffer from chronic lung diseases; 12 million experienced at least one asthma attack in 2002. The causes of this "epidemic" are complex and uncertain; however, there is a strong possibility that environmental exposures play a role. The most common and well-studied cause of occupational asthma is diisocyanates, but their use in consumer products as a potential cause of respiratory disease in the general population has been overlooked. These substances are found in or are used to produce an array of polyurethane-containing products, including adhesives, sealants, paints, flexible foams, and rigid foams, among others. The world market for polyurethane products has tripled since 1985 to more than 9.3 billion kg in the year 2000. In this article, the author reviews biologically plausible explanations, as well as the epidemiologic, experimental, and clinical evidence for the role of diisocyanates and polyurethanes in the genesis of nonoccupational allergy and respiratory disease.