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The present study assesses the potential contribution of methylene diphenyl diisocyanate (MDI) to a workplace fatality. Examination of medical records, tissue, and blood from the deceased worker were undertaken. Formalin\u2010fixed paraffin\u2010embedded lung tissue sections were assessed through histologic and immunochemical stains. Serum MDI\u2010specific IgE and IgG, and total IgE, were measured by enzyme\u2010linked immunosorbent assays and\/or Western blot. Information about potential chemical exposures and industrial processes in the workplace were provided by the employer and through interviews with co\u2010workers. Review of the worker's medical records, occupational history, and autopsy findings were consistent with severe asthma as the cause of death, and ruled out cardiac disease, pulmonary embolism, or stroke. Lung pathology revealed hallmarks of asthma including smooth muscle hypertrophy, eosinophilia, basement membrane thickening, and mucus plugging of bronchioles. Immunochemical staining for MDI was positive in the thickened basement membrane of inflamed airways. MDI\u2010specific serum IgE and IgG were significantly elevated and demonstrated specificity for MDI versus other diisocyanates, however, total serum IgE was normal (24\u2009IU\/ml). The workplace had recently introduced MDI into the foundry as part of a new process, but MDI air levels had not been measured. Respirators were not required. In summary, post\u2010mortem findings support the diagnosis of diisocyanate asthma and a severe asthma attack at work as the cause of death in a foundry worker.<\/jats:p>","DOI":"10.1002\/ajim.23323","type":"journal-article","created":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T09:08:26Z","timestamp":1642151306000},"page":"166-172","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Severe asthma and death in a worker using methylene diphenyl diisocyanate MDI asthma death"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2461-9409","authenticated-orcid":false,"given":"Adam V.","family":"Wisnewski","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9323-1574","authenticated-orcid":false,"given":"Ryan","family":"Cooney","sequence":"additional","affiliation":[{"name":"Occupational Safety and Health Administration Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hodgson","sequence":"additional","affiliation":[{"name":"Occupational Safety and Health Administration Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristinza","family":"Giese","sequence":"additional","affiliation":[{"name":"Office of the Chief Medical Examiner Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6486-6725","authenticated-orcid":false,"given":"Carrie A.","family":"Redlich","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1567-5769(01)00174-6"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.4.1276"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0156141"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-1983"},{"key":"e_1_2_13_6_1","volume-title":"MDI and TDI: A Safety, Health and the Environment: A Source Book and Practical Guide","author":"Allport DC","year":"2003"},{"key":"e_1_2_13_7_1","unstructured":"Global Insulation Staff;2018. 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