{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T13:15:45Z","timestamp":1791033345495,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2006,4,3]],"date-time":"2006-04-03T00:00:00Z","timestamp":1144022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Industrial Med"],"published-print":{"date-parts":[[2006,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Occupational exposure to metal working fluids (MWF) is common with over 1.2 million workers in the United States involved in machine finishing, machine tooling, and other metalworking operations. MWF is a known cause of hypersensitivity pneumonitis (HP). Recent reports of outbreaks of hypersensitivity HP secondary to exposure to MWF are reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cases were identified through the Occupational Disease surveillance system in the State of Michigan and from referrals for evaluation to the Division of Occupational and Environmental Medicine at Michigan State University (MSU). Each patient underwent a clinical examination including an occupational history, lung function studies, radiographic imaging, and in some cases lung biopsies. Following the diagnosis of definite HP, an industrial hygiene investigation was carried out, which included a plant walk\u2010through, and review of the \u201cInjury and Illness\u201d log. Air monitoring and microbial sampling results were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>As part of Michigan's mandatory surveillance system for occupational illnesses, seven cases of suspected HP were identified in 2003\u20132004 from three facilities manufacturing automobile parts in Michigan. Each plant used semi\u2010synthetic MWFs, and conducted a MWF management program including biocide additions. Two facilities had recently changed the MWF before the cases arose. Growth of mycobacteria was found in these two MWFs. Breathing zone samples for particulates of two employees in plant A (two cases) ranged from 0.48 to 0.56 mg\/m<jats:sup>3<\/jats:sup>. In plant B (four cases), two employees' sampling results ranged from 0.10 to 0.14 mg\/m<jats:sup>3<\/jats:sup>. No air sampling data were available from plant C.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hypersensitivity pneumonitis due to exposure to MWFs is under\u2010recognized by health care providers, and current surveillance systems are inadequate to provide a true estimate of its occurrence. HP arose from environments with exposures well below the Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) for MWF, and in one case from exposures well below the National Institute of Occupational Safety and Health (NIOSH) recommended exposure limit (REL). The sporadic nature of reports of HP in relationship to MWF probably represents a combination of workplace changes that cause the disease and inadequate recognition and reporting of the disease when it does occur. Physician awareness of HP secondary to MWF and an effective medical surveillance program are necessary to better understanding the epidemiology and prevention of this disease. Am. J. Ind. Med. 2006. \u00a9 2006 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajim.20312","type":"journal-article","created":{"date-parts":[[2006,4,3]],"date-time":"2006-04-03T13:54:16Z","timestamp":1144072456000},"page":"423-433","source":"Crossref","is-referenced-by-count":39,"title":["Hypersensitivity pneumonitis due to metal working fluids: Sporadic or under reported?"],"prefix":"10.1002","volume":"49","author":[{"given":"Amit","family":"Gupta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth D.","family":"Rosenman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,4,3]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.108.3.636"},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200409-1205WS"},{"key":"e_1_2_1_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0274(199901)35:1<58::AID-AJIM8>3.0.CO;2-5"},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0274(199810)34:4<387::AID-AJIM13>3.0.CO;2-Z"},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.1061"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.femsec.2005.04.009"},{"key":"e_1_2_1_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0274(199710)32:4<423::AID-AJIM16>3.0.CO;2-5"},{"key":"e_1_2_1_9_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200301-137OC"},{"key":"e_1_2_1_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/44.4.183"},{"key":"e_1_2_1_11_1","first-page":"311","article-title":"Hypersensitivity pneumonitis and exposure to acid\u2010fast bacilli in coolant aerosols","volume":"911","author":"Muilenburg ML","year":"1993","journal-title":"J Allergy Clin Immunol"},{"key":"e_1_2_1_12_1","first-page":"369","volume-title":"National occupational hazard survey","author":"NIOSH","year":"1977"},{"key":"e_1_2_1_13_1","unstructured":"NIOSH.1998a.Criteria for a recommended standard: Occupational exposure to metal\u2010working fluids. 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