Factors associated with positive inhalation provocation test results in subjects suspected of having chronic bird-related hypersensitivity pneumonitis

Masuo, Masahiro; Miyazaki, Yasunari; Suhara, Kozo; Ishizuka, Masahiro; Fujie, Toshihide; Inase, Naohiko

doi:10.1016/j.resinv.2016.05.002

Cited by 12 publications

(17 citation statements)

References 35 publications

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“…We concluded that outdoor avian antigen entered the indoor environment, as suggested by a previous study [13]. Another study demonstrated that exposure to birds from the surrounding environment was a significant predictor of IPT results and diagnosis of chronic bird-related HP [21]. Therefore, chronic bird-related HP can develop from exposure to avian antigen that can come from outside the house.…”

Section: Discussionsupporting

confidence: 66%

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

Sema

Miyazaki²,

Tsutsui³

et al. 2017

Immunity Inflam & Disease

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BackgroundIn chronic hypersensitivity pneumonitis (chronic HP), antigen avoidance is critical for disease management; however, complete avoidance is difficult because of unrecognized exposure to antigens. Recently, we revealed that the amount of avian antigen (AAA) in household dust at the time of diagnosis predicted the progression of chronic bird‐related HP. The purpose of this study is to evaluate the relationship between the prognosis of chronic bird‐related HP and the AAA that remained in the environment during antigen avoidance.MethodsFirst, we measured the AAA in household dust of 28 consecutive patients (22 with chronic bird‐related HP and 6 with acute bird‐related HP) and 12 healthy volunteers. Second, we measured the AAA and collected questionnaires on the environmental conditions of the homes of 53 patients with various lung diseases, including bird‐related HP, to investigate the environmental parameters related to a higher AAA. Finally, we prospectively recruited 14 consecutive patients with chronic bird‐related HP, measured the AAA periodically, and collected clinical data.ResultsThe AAA was higher in patients with chronic bird‐related HP at the time of diagnosis compared to healthy volunteers and was highest in patients with acute bird‐related HP. Logistic regression analysis showed that birds frequenting a residence was the only significant factor for a higher AAA (odds ratio, 5.686; 95%CI, 1.263–25.59; P = 0.024). There was a correlation between the mean AAA and decline of vital capacity for 1 year (r = −0.55; 95%CI −0.84 to −0.01; P = 0.043).ConclusionMeasurements of the AAA after diagnosis predict the progression of chronic bird‐related HP. Avian antigen can exist in the indoor environment regardless of antigen avoidance. The presence of avian antigen in the indoor environment can be attributed to wild birds found outdoors.

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Section: Discussionsupporting

confidence: 66%

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

Sema

Miyazaki²,

Tsutsui³

et al. 2017

Immunity Inflam & Disease

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“…The latter shows merely a contact of the patient with a suspected antigen, and as such may be very helpful in diagnosis, but does not answer the question whether or not the patient has HP [3,6,69]. Therefore, the MIF test, and in particular inhalation challenge, the latter being regarded by some authors [6,70] as a 'gold standard', have much greater value for establishing the HP diagnosis than the precipitin test, which can be negative in otherwise well-documented cases of HP [6,33,69].…”

Section: Discussionmentioning

confidence: 99%

Acute hypersensitivity pneumonitis in woodworkers caused by inhalation of birch dust contaminated with <i>Pantoea agglomerans</i> and <i>Microbacterium barkeri</i>

Maćkiewicz

Dutkiewicz

Siwiec

et al. 2019

Ann Agric Environ Med.

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Case description. Five workers (2 males and 3 females) employed in a furniture factory located in eastern Poland developed hypersensitivity pneumonitis (HP) after the pine wood used for furniture production was replaced by birch wood. All of them reported onset of respiratory and general symptoms (cough, shortness of breath, general malaise) after inhalation exposure to birch dust, showed crackles at auscultation, ground-glass attenuations in HRCT examination, and lymphocytosis in the BAL examination. The diagnosis of acute HP was set in 4 persons and the diagnosis of subacute HP in one. Identification of specific allergen. Samples of birch wood associated with evoking disease symptoms were subjected to microbiological analysis with the conventional and molecular methods. Two bacterial isolates were found to occur in large quantities (of the order 10 8 CFU/g) in examined samples: Gram-negative bacterium of the species Pantoea agglomerans and a non-filamentous Gram-positive actinobacterium of the species Microbacterium barkeri. In the test for inhibition of leukocyte migration, 4 out of 5 examined patients showed a positive reaction in the presence of P. agglomerans and 2 in the presence of M. barkeri. Only one person showed the presence of precipitins to P. agglomerans and none to M. barkeri. In the inhalation challenge, which is the most relevant allergological test in the HP diagnostics, all patients reacted positively to P. agglomerans and only one to M. barkeri. The results indicate that P. agglomerans developing in birch wood was the main agent causing HP in the workers exposed to the inhalation of dust from this wood, while the etiologic role of M. barkeri is probably secondary. Conclusion. The results demonstrate that apart from fungi and filamentous actinobacteria, regarded until recently as causative agents of HP in woodworkers, Gram-negative bacteria and non-filamentous actinobacteria may also elicit disease symptoms in the workers processing wood infected with large amounts of these microorganisms. The results obtained also seem to indicate that cellular-mediated reactions are more significant for causing disease symptoms compared to those that are precipitin-mediated.

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“…One of recently published studies revealed positive results of a precipitin test for farmer's lung in 78% of patients with an acute form, but only in 48% of patients with a chronic form [181]. Specific antibodies were detected only in 52% of pigeon breeders with a chronic form of lung disease [182]. In a group of 86 bird breeders with lung disease, the presence of specific immunoglobulins was identified in 92% of patients (only in 2 radiographic signs of UIP were observed), while in the control group comprising healthy pigeon breeders specific antibodies were detected in as many as 87% of subjects [183].…”

Section: Question 5 Is It Necessary To Determine Serum Concentrationmentioning

confidence: 96%

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

Piotrowski

Bestry²,

Białas

et al. 2020

Advances in Respiratory Medicine

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Factors associated with positive inhalation provocation test results in subjects suspected of having chronic bird-related hypersensitivity pneumonitis

Cited by 12 publications

References 35 publications

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

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

Acute hypersensitivity pneumonitis in woodworkers caused by inhalation of birch dust contaminated with <i>Pantoea agglomerans</i> and <i>Microbacterium barkeri</i>

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

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