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Diisocyanate Antigen-stimulated Monocyte Chemoattractant Protein-1 Synthesis Has Greater Test Efficiency than Specific Antibodies for Identification of Diisocyanate Asthma

Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio; Laboratoire de Pneumologie-Researche, Hôpital du Sacré Coeur de Montreal, Montreal; and Institut de Cardiologie et de Pneumologie de L'Université Laval, Hôpital Laval, Sainte-Foy, Québec, Canada

Correspondence and requests for reprints should be addressed to David I. Bernstein, MD, University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, 231 Albert Sabin Way, Cincinnati, OH 45267-0563. E-mail: bernstdd{at}email.uc.edu

We previously reported that diisocyanate-human serum albumin (DIISO-HSA) stimulated production of monocyte chemoattractant protein-1 (MCP-1) by peripheral blood mononuclear cells is significantly associated with a clinical diagnosis of diisocyanate asthma (DA). Others have reported that antibodies for DIISO-HSA are specific but insensitive markers of DA. This study was performed to evaluate test characteristics of the in vitro MCP-1 assay compared with DIISO-HSA–specific immunoglobulin (Ig) G and IgE in identifying workers with DA. MCP-1 was quantitated in peripheral blood mononuclear cell supernatants 48 hours after incubation with DIISO-HSA antigens. Assay results were compared with outcomes of specific inhalation challenge (SIC) testing. Nineteen of 54 (35%) workers assayed for antibodies and MCP-1 stimulation had SIC-confirmed DA. Mean MCP-1 produced by SIC-positive workers was greater than SIC-negative workers (p 0.001). Diagnostic sensitivity, specificity, and test efficiency for specific IgG were 47%, 74%, and 65%, respectively, and for specific IgE were 21%, 89%, and 65%, respectively. Sensitivity, specificity, and test efficiency of the MCP-1 test were 79%, 91%, and 87%, respectively. This study indicates that the MCP-1 stimulation assay has greater sensitivity and specificity than the specific antibody assays in correctly identifying DA.

Key Words: occupational asthma • diisocyanate • MCP-1 • antibody

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