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Contact allergy to isocyanates after accidental spillage

A 31-year-old man working as process operator in the manufacture of polyurethane adhesives was referred to the Department of Occupational and Environmental Dermatology in Malmö (DOED) with suspected allergic contact dermatitis caused by isocyanates. His main work task was to monitor the manufacturing process, which he did from a separate control room. Three months prior to the visit, he changed a barrel containing a mixture comprised mainly of diphenylmethane diisocyanate (MDI) when the hose burst. He was wearing a protective facemask and gloves, but the MDI mixture splashed up under the mask. At the time, he did not notice any splashes on his skin, but he experienced an uncomfortable feeling in the throat. The next day, he developed dermatitis, which remained for ∼ 2 weeks on the shoulders, arms, and lower parts of the face. He experienced some itching on the forearms, but none on the face. Five years earlier, he had experienced a similar accident when there was a breakdown in a machine and he accidentally spilled