Food Flavorings Exposures and Bronchiolitis Obliterans: A Case Series

摘要

Workers in industries that manufacture, distribute, and use food flavorings, particularly those containing diacetyl, have been reported to be at increased risk of developing fixed obstructive lung disease, including bronchiolitis obliterans (BO). BO is a rare and progressive lung disease that requires confirmation via biopsy, and is most commonly described in association with transplant rejection. We reviewed health information and occupational exposure histories for 11 workers who reportedly developed BO as a result of occupational exposures to diacetyl and/or other flavorings compounds. Information regarding the workers had been disclosed as part of litigation. The differential diagnoses from various physicians were compared and the strength of evidence regarding the diagnoses was evaluated. We found considerable diversity among the cases with respect to job responsibilities, durations and magnitudes of exposure, the agents to which the individuals were exposed, the clinical diagnoses identified by treating physicians prior to lung biopsy, and the tissue diagnoses provided by pathologists at the treating institutions. The available clinical, radiologic, and pathologic data indicate that these workers suffered from severe asthma, COPD, and hypersensitivity pneumonitis, among other conditions, rather than BO.