including penicillin, sulfa, and spiramycin, are known to induce specific IgE, positive skin tests, and asthma (Davies and Pepys, 1975; Davies et al., 1974). Other pharmacologic agents including cimetidine and alpha-methyldopa can cause asthma on an immunologic basis, that is, as a result of an antigen being recognized by specific antibody or sensitized cells (Butcher et al., 1989).

Metal salts of nickel, platinum, and chromates can cause rhinitis, conjunctivitis, or asthma (Block and Chan-Yeung, 1982; Cromwell et al., 1979; Dolovich et al., 1984; Malo et al., 1982; McConnell et al., 1973; Novey et al., 1983; Pepys et al., 1972, 1979; Pickering, 1972). Positive skin tests, specific IgE, and positive bronchial challenges have all been reported. Exposure occurs in processing or plating facilities. Some investigators believe that sensitization to platinum is virtually universal, given a large enough exposure.

Acid anhydrides are used as curing agents in the manufacture of epoxy resins. Exposure may occur in a variety of industries including those that manufacture curing agents, plasticizers, or anticorrosive coating agents. In addition to allergic rhinitis, conjunctivitis, and asthma, two other allergic reactions or diseases, LRSS and PDA, described above, may result from TMA. Other anhydrides, including phthalic anhydride and tetrachlorophthalic anhydride, have also caused asthma (D. I. Bernstein et al., 1982; Topping et al., 1986).

Isocyanates are used to produce a number of products including paints, surface coatings, and polyurethane foam. They are also found in some home improvement products such as refinishing agents. In contrast to people who react to TMA, many individuals affected by isocyanates do not have specific IgE or positive skin tests (I. L. Bernstein, 1982). Isocyanate asthma is a major cause of LMW chemical-induced asthma, but to date, the mechanism (i.e., allergy versus nonimmunologic sensitivity) is unknown. In addition to asthma, reports have linked isocyanates with hypersensitivity pneumonitis and an immunologically mediated hemorrhagic pneumonitis (Patterson et al., 1990).

Research has shown that ethylenediamine induces asthma in individuals exposed to shellac or lacquer (Gelfand, 1983; Lam and Chan-Yeung, 1980). Positive skin tests and positive bronchial responses, both immediate and delayed, have been reported. Azo-dyes, such as azodicarbonamide, can also cause asthma (Park et al., 1991; Slovak, 1981). These studies describe positive skin tests and changes in pulmonary functions after a work shift. Exposure to such chemicals may occur in plants that manufacture or weigh dyes.

Formaldehyde is a chemical that is often found at very low levels in homes, offices, and schools and at higher levels in workplaces that use the substance. Asthma is sometimes reported following gaseous formaldehyde



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