Abstract
Diacetyl is a diketone flavouring agent that is commonly employed for buttery taste as well as other purposes. Industrial exposure to flavouring agents, particularly diacetyl, has recently been associated with bronchiolitis obliterans, a severe respiratory illness producing fibrosis and obstruction of the small airways. This has been most commonly reported in the microwave popcorn production industry, but it has occurred elsewhere. In addition to bronchiolitis obliterans, spirometry abnormalities (fixed airflow obstruction) and respiratory symptoms have been associated with exposure. A direct effect on the respiratory epithelium with the disorganised fibrotic repair appears most likely as the underlying mechanism. Current data suggest that diacetyl is the agent responsible, although it is possible that diacetyl is simply a marker for another causative agent.
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The predominance of neutrophilic (rather than lymphocytic) response in laboratory animals is consistent with the lack of response to corticosteroid therapy in humans.
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Acknowledgements
The authors thank Noe Sanchez and Yanjapriya Kunasaleen for assistance in preparing the manuscript. The authors also thank Drs Allen Parmet, Matthew Sies, Arthur Gelb and Richard Lubman for their advice. In particular, the authors acknowledge the insight provided by our patients with diacetyl-induced bronchiolitis obliterans.
Supported in part by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health grant for the UCLA Occupational Medicine Residency. UCLA has an educational affiliation agreement with CAL-OSHA. Dr Harber has spoken with attorneys for his patients.
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Harber, P., Saechao, K. & Boomus, C. Diacetyl-Induced Lung Disease. Toxicol Rev 25, 261–272 (2006). https://doi.org/10.2165/00139709-200625040-00006
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DOI: https://doi.org/10.2165/00139709-200625040-00006