Respiratory and systemic reaction following exposure to heated electrostatic polyester paint

A 39 year old nonatopic man developed episodes of cough, dyspnoea, sweating and shivers within 2-3 weeks of starting a new job in a factory where metallic boards were treated with an electrostatic powder paint, made of an epoxy resin and a carboxylated polyester containing polyethylene terephthalate and polybutylene terephthalate. The subject sprayed the metallic boards which were then heated in 200 degrees C ovens. The subject was first seen in an emergency room after being at work for 4 h. The physical examination revealed bilateral wheezing with fever (39 degrees C), hypoxaemia (arterial oxygen tension (PaO2) 58 torr (7.7 kPa), leucocytosis (white blood count cells.mm-3 17,000 (17 x 10(9) cells.l-1) and severe airway obstruction (forced expiratory volume in one second (FEV1)/forced vital capacity, (FVC) 1.3/2.4 l, improving to 2.2/3.8 l after bronchodilator; predicted values = 3.4/4.1 l). The subjects condition improved after being treated with oral steroids. His spirometry was normal two weeks later, although he showed mild bronchial hyperresponsiveness to methacholine with the (provocative concentration producing a 20% fall in FEV1 (PC20) being 1.7 mg.ml-1). The subject underwent specific inhalation challenges at the workplace 4 months later. After being exposed at work for 4 h, he developed a significant fall in FEV1 (-40%), fever, leucocytosis, and a fall in diffusing capacity. Lung function tests were back to normal two weeks later. Exposing the subject to heated granulated polyester for one hour in a hospital laboratory produced a fall in FEV1 of 41%, fever, leucocytosis and a fall in diffusing capacity.(ABSTRACT TRUNCATED AT 250 WORDS)