Extrinsic allergic alveolitis and asthma in a sawmill worker: case report and review of the literature.

Abstract

A 34 year old sawmill maintenance engineer developed a dry cough that was associated with widespread wheezes and crackles in his lungs. His symptoms worsened, with work related lethargy, fever, and breathlessness, and the loss of a stone in weight. At that time, while still at work, he had a neutrophil leucocytosis and increased concentration of y globulins. When seen subsequently some two months after stopping work, his chest radiograph and lung function tests were normal, but the cells recovered at bronchoalveolar savage showed an increase in lymphocytes and mast cells, a pattern consistent with extrinsic allergic alveolitis. Serum precipitins were identified to extracts of sawdust, wood chips, and bark from the sawmill, and to eight species of mould grown from these samples. Specific IgG binding inhibition studies suggested that a common epitope present on Trichoderma koningii might be responsible for the cross reactivity of the patient's serum with the wood and fungal extracts. A diagnosis of wood associated extrinsic allergic alveolitis was made and since changing his job the patient has remained well. Wood associated allergic alveolitis has not previously been described in British sawmill workers, but has been reported in Sweden, with a prevalence of 5%-10% in exposed workers. A review of published data suggests extrinsic allergic alveolitis in wood workers is primarily caused by inhalation of the spores of contaminating fungi, but inhaled wood dust may exert a synergistic effect. (Occup Environ Med 1994;51:160-164) Royal Brompton Hospital, Sydney Street, London SW3

Assessment of Particulates and Bioaerosols in Eastern Canadian Sawmills

“…(11,15) In Norway the presence of antibodies against Rhizopus microsporus and Paecilomyces variotii, the predominant mold in the sawmills studied, correlated with exposures. (11) Specific IgG against Rhizopus sp.…”

Exposure to Biohazards in Wood Dust: Bacteria, Fungi, Endotoxins, and (1 3)-beta-D-Glucans

“…(4) EAA in woodworkers is caused primarily by inhalation of the spores of contaminating fungi, but inhaled wood dust may exert a synergistic effect. (5) ODTS has been described in Swedish sawmills (6) and Norwegian sawmills (7) where the fungal spore concentrations were higher than 10 7 cfu/m 3 .…”

Effects of bioaerosol exposure on work-related symptoms among Swiss sawmill workers

“…Dust from soft wood (Wr, spruce white or red cedar) can be responsible for occupational asthma (reviewed in Demers et al 1997) and can also cause simple irritation by action of Wne particles resulting in non-allergic inXammation of eyes, nose, upper respiratory tract or skin. Working in the wood industry may therefore promote allergic and non allergic diseases, including rhinitis, conjunctivitis, dermatitis, chronic bronchitis, organic dust toxic syndrome, asthma and asthma-like syndrome (Pisaniello et al 1992;Hessel et al 1995;Halpin et al 1994;Chan-Yeung et al 1978;Wimander and Belin 1980;Vedal et al 1986;Brooks 1981).…”