Environmental levels of avian antigen are relevant to the progression of chronic hypersensitivity pneumonitis during antigen avoidance

Sema, Manabu; Miyazaki, Yasunari; Tsutsui, Toshiharu; Tomita, Makoto; Eishi, Yoshinobu; Inase, Naohiko

doi:10.1002/iid3.202

Cited by 29 publications

(21 citation statements)

References 17 publications

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“…We confirmed the exposition to birds' antigens in 60% of HP patients, to hay or hay products in 49%, and to any of above mentioned antigens in 77% of patients. These data are in agreement with observations from other studies where birds' antigens were responsible for the most HP cases in their series [12,13].…”

Section: Discussionsupporting

confidence: 93%

The value of serum precipitins against specific antigens in patients diagnosed with hypersensitivity pneumonitis – retrospective study

Szturmowicz¹,

Garczewska²,

Jędrych³

et al. 2019

cejoi

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Introduction:Hypersensitivity pneumonitis (HP) is the third most common interstitial lung disease, and is often under-recognized, especially in patients who are not aware of their occupational or environmental contact with organic antigens. The aim of the present study was to assess the results of serum specific IgG antibodies (ssIgG) in HP patients and their correlation with clinical data.Material and methods: 128 HP patients, median age 53 years, participated in the study. The control group consisted of 102 patients with interstitial lung diseases (ILDs) other than HP. Assessment of pretreatment ssIgG to thermophilic actinomycetes and protein antigens from bird droppings (pigeons, hens, ducks, parrots, turkeys) was performed by double diffusion in agar gel according to Ouchterlony method.Results: Positive precipitins were obtained in 57% of all HP patients and in 61% of those exposed to above mentioned antigens. Positive results in the control group were obtained in 7% of patients. Sensitivity of ssIgG in HP group was 0.57 and specificity 0.93. Precipitins to at least one bird antigen was confirmed in 64% of HP patients exposed to birds. Precipitins to thermophilic bacteria were found in 29% of HP patients exposed to hay or hay products.Conclusions: The results of the study indicate that ssIgG against birds' allergens were the valuable diagnostic tool in HP patients. Low-rate of confirmation of ssIgG to thermophilic bacteria in patients exposed to hay or hay products indicate that other microorganisms, most likely molds, could be responsible for the disease development.

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Section: Discussionsupporting

confidence: 93%

The value of serum precipitins against specific antigens in patients diagnosed with hypersensitivity pneumonitis – retrospective study

Szturmowicz¹,

Garczewska²,

Jędrych³

et al. 2019

cejoi

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“…In another study, CT findings of airspace consolidation and honeycombing were found to be predictive of mortality in chronic HP [6]. From another perspective, the levels of exposure to avian antigen have been found to be related to disease progression and prognosis in chronic bird-related HP [7, 8]. To date, there are no established biomarkers to predict the worsening of lung function.…”

Section: Introductionmentioning

confidence: 99%

Serum CXCL9 and CCL17 as biomarkers of declining pulmonary function in chronic bird-related hypersensitivity pneumonitis

et al. 2019

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The clinical course of chronic hypersensitivity pneumonitis (HP) with fibrosis is similar to that of idiopathic pulmonary fibrosis (IPF). Current research is expected to identify biomarkers effective in predicting the deterioration of lung function in a clinical setting. Our group analyzed the relationships between the following parameters in chronic bird-related HP: patient characteristics, serum markers, lung function, HRCT findings, BALF profiles, and the worsening of lung function. We also analyzed serum levels of CXCL9, CCL17, and Krebs von den Lungen 6 (KL-6) as serum markers. Patients showing declines in vital capacity (VC) of over 5% at 6 months after first admission were categorized as the “decline group”; the others were categorized as the “stable group.” The serum level of CCL17 and the percentage of BALF macrophages were significantly higher in the decline group compared to the stable group. Serum levels of CXCL9 and CCL17 were significant variables in a multivariate logistic regression analysis of factors associated with VC decline. Patients with a chemokine profile combining lower serum CXCL9 and higher serum CCL17 exhibited significantly larger VC decline in a cluster analysis. Higher serum CCL17 and lower serum CXCL9 were important predictors of worsening lung function in patients with chronic bird-related HP.

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“…The mainstay of management for BFL is antigen avoidance and steroid treatment 58 . If the amount of avian antigen is not reduced, the patients’ pulmonary function could dramatically decline 59 . Steroid treatment is also expected to improve lung function in BFL patients 60 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy and safety of inhalation challenge tests for bird fancier’s lung—Systematic review and meta‐analysis

Shiroshita

Jin

Tanaka

et al. 2020

Clin Experimental Allergy

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Objective To assess the diagnostic accuracy of inhalation challenge tests for bird fancier's lung and related adverse reactions. Design We performed a systematic review and meta‐analysis for the diagnostic test accuracy of inhalation challenge tests and a systematic review for adverse events of the tests. We evaluated the risk of bias and applicability of the included articles for diagnostic test accuracy with the modified Quality Assessment of Diagnostic Accuracy Studies‐2 tool. We used hierarchical summary receiver operating characteristic (HSROC) curve analysis to evaluate the sensitivity and specificity of challenge tests and assessed subjective adverse reactions and steroid treatment use. Sensitivity was calculated by fixing specificity at 99% from the HSROC curve. Data sources We searched for articles evaluating the diagnostic accuracy of inhalation challenge tests or describing adverse reactions in Medline, Embase, the Cochrane Library, the International Clinical Trials Registry Platform, and Web of Science. Eligibility criteria for selecting studies We included randomized control trials, prospective or retrospective cohort studies, or case‐control studies assessing the diagnostic test accuracy of inhalation challenge tests for bird fancier's lung. For adverse effects review, we included the same articles, and case series or case reports reporting adverse reactions of inhalation challenge tests. Results In our review of 12 articles, the diagnostic accuracy of inhalation challenge tests was substantially high. Point estimate of sensitivity when calculated with a fixed specificity of 99% was 99%. Among 873 patients, 6 needed steroid treatment for adverse reactions; however, no death occurred due to acute exacerbation following a challenge test. Conclusions Inhalation challenges for bird fancier's lung could be accurate and safe diagnostic procedures and may be considered both as rule‐in and rule‐out tests in tertiary care centres. However, caution is required regarding overestimation of diagnostic yield due to risk of bias. Systematic review registration: University hospital Medical Information Network Clinical Trials Registry (UMIN000038799).

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Environmental levels of avian antigen are relevant to the progression of chronic hypersensitivity pneumonitis during antigen avoidance

Cited by 29 publications

References 17 publications

The value of serum precipitins against specific antigens in patients diagnosed with hypersensitivity pneumonitis – retrospective study

The value of serum precipitins against specific antigens in patients diagnosed with hypersensitivity pneumonitis – retrospective study

Serum CXCL9 and CCL17 as biomarkers of declining pulmonary function in chronic bird-related hypersensitivity pneumonitis

Diagnostic accuracy and safety of inhalation challenge tests for bird fancier’s lung—Systematic review and meta‐analysis

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