Are High-Dose Toxic Exposures Always Associated with Reactive Airways Dysfunction Syndrome (RADS)?

Abstract Bottling plant workers were evaluated for respiratory symptoms following an accidental exposure to a chlorine dioxide aerosol. Six exposed employees underwent medical and occupational histories, skin testing to common allergens, spirometry before and after use of bronchodilators and methacholine challenge. The reported exposure to chlorine dioxide ranged from 30 min to 12 hr. Physical examinations were all normal. Four workers had positive prick skin tests to common aeroallergens. None of the workers demonstrated significant changes in forced expiratory volume in 1 sec following use of bronchodilators and none experienced methacholine hyperresponsiveness. These cases suggest that the occurrence of reactive airways dysfunction syndrome is unpredictable and may not always occur in heavily exposed individuals.