Hypersensitivity pneumonitis: Problems in diagnosis†

Krasnick, Jane; Meuwissen, Hillaire J.; Nakao, Michael A.; Yeldandi, Anjana V.; Patterson, Roy

doi:10.1016/s0091-6749(96)80080-7

Cited by 37 publications

(19 citation statements)

References 4 publications

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“…Hypersensitivity pneumonitis (HP) 1 is a syndrome caused by sensitization to and repeated inhalation of an inhaled antigen (1)(2)(3)(4)(5)(6)(7)(8). The clinical and laboratory features of the disease have been well defined, but many of the immune mechanisms involved in the development of the disease have not been well defined.…”

Section: Introductionmentioning

confidence: 99%

Interferon-gamma is necessary for the expression of hypersensitivity pneumonitis.

Guðmundsson¹,

Hunninghake²

1997

J. Clin. Invest.

148

132

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Farmers lung disease is a common form of hypersensitivity pneumonitis (HP) and is characterized by inflammation and granuloma formation in the lung. Interferon-␥ is important for the expression of granulomatous diseases caused by infectious agents; however, the role this mediator in regulating expression of the granulomatous response to inhaled antigen is not known. To evaluate this, we compared the response to inhaled antigen of mice that do not express the gene coding for interferon-␥ (GKO) with that of their normal littermates (WT). GKO and WT mice on a BALB/c background were exposed to 150 g of the thermophilic bacteria Saccharopolyspora rectivirgula or saline alone, for three consecutive days a week, for 3 wk. After exposure to antigen, WT mice developed a marked granulomatous inflammation associated with an increase in lung weight and numbers of cells in bronchoalveolar lavage fluid (BAL). Although GKO mice also exhibited an increase in lung weight and numbers of cells in BAL fluid, they developed minimal inflammation and no granulomas after a similar exposure to antigen. To further evaluate if the lack of a response to antigen in GKO mice was due to lack of IFN -␥ , we replaced this mediator via intraperitoneal injections. When given replacement IFN-␥ , the GKO mice developed granulomatous inflammation in the lung. These studies show that IFN-␥ is essential for the expression of hypersensitivity pneumonitis. ( J. Clin. Invest. 1997. 99:2386-2390.)

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Section: Introductionmentioning

confidence: 99%

Interferon-gamma is necessary for the expression of hypersensitivity pneumonitis.

Guðmundsson¹,

Hunninghake²

1997

J. Clin. Invest.

148

132

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“…Among the above-mentioned indicators, the diagnostic value of serum precipitins has long been controversial [6], particularly because of their lack of sensitivity and, especially, of specificity [7]. These limitations may be due to the use of poorly purified antigens, the lack of the specific inciting antigen in the test panel, inappropriate techniques [8] or, in epidemiological studies, the use of inappropriate control groups [5,9,10]. Despite the pitfalls presented above, a recent multicentre study by LACASSE et al [4] identified serum precipitins as a significant predictor of HP, regardless of exposure (odds ratio 5.3 (95% confidence interval (CI) 2.7-10.4)).…”

mentioning

confidence: 99%

Diagnostic value of serum precipitins to mould antigens in active hypersensitivity pneumonitis

Fenoglio¹,

Reboux²,

Súdre³

et al. 2006

Eur Respir J

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Serum precipitins have a controversial diagnostic value in hypersensitivity pneumonitis (HP). The present authors' objective was to assess their diagnostic value by developing scores from a panel of specific antigens tested by two techniques (electrosyneresis and double diffusion) to discriminate active HP from other interstitial lung diseases.Consecutive patients presenting with a condition for which HP was considered in the differential diagnosis were included in the study. All patients underwent the same standardised diagnostic procedure, including precipitin tests performed in routine conditions. Clinical manifestations, bronchoalveolar lavage and high-resolution computed tomography defined the presence or absence of HP. Receiver-operating characteristic curves and logistic regression were used to develop the serological scores.A total of 122 patients (including 31 cases of HP) were included in the study. Five antigens from the panel were selected for the serological scores (Absidia corymbifera, Eurotium amstelodami, Wallemia sebi, Saccharopolyspora rectivirgula and mesophilic Streptomyces sp.). Electrosyneresis was more discriminative than the double-diffusion technique. Predictive negative values varied 81-88% and predictive positive values varied 71-75% for prevalence of HP 20-35%.In conclusion, serological scores using a panel of relevant antigens may guide both biological and clinical practice in areas of high prevalence of hypersensitivity pneumonitis.

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“…The only case report of HP with lovebird exposure presented in a female exposed to a total of eight birds (parrots, parakeets, one cockatoo, one conure and one lovebird), all of them provoked positive precipitins. It is unclear whether the lovebird was partially responsible for the disease in this case [16]. To the current authors' knowledge, there is no previous description of bird fancier's disease exclusively related to lovebird exposure, and they therefore report this new aetiology herein.…”

Section: Discussionmentioning

confidence: 77%

“…This interrogative detail is essential to establish the diagnosis, as exposure to an offending antigen predicts HP with a very high odds ratio [22]. Furthermore, identification of the possible offending antigen allows a search for specific precipitins using extracts from the patient's environment [22], which is probably more efficient than searching for precipitins against commercial antigens [16]. This dual procedure is very important in the diagnostic process of HP [22].…”

Section: Discussionmentioning

confidence: 99%

Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier's disease

Funke

2008

Eur Respir J

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Hypersensitivity pneumonitis (HP) is an immunologically mediated lung disease due to the repetitive inhalation of antigens. Most new cases arise from residential exposures, notably to birds, and are thus more difficult to recognise.The present authors report a 59-yr-old male who complained of dyspnoea and cough while being treated with amiodarone. Pulmonary function tests revealed restriction and obstruction with low diffusing lung capacity for carbon monoxide and partial pressure of oxygen. A high-resolution computed tomography chest scan and bronchoalveolar lavage showed diffuse bilateral groundglass attenuation and lymphocytic alveolitis, respectively.Initial diagnosis was amiodarone pulmonary toxicity, but because of a rapidly favourable evolution, this diagnosis was questioned. A careful environmental history revealed a close contact with lovebirds shortly before the onset of symptoms. Precipitins were strongly positive against lovebird droppings, but were negative against other avian antigens. The patient was diagnosed with hypersensitivity pneumonitis to lovebirds. Avoidance of lovebirds and steroid treatment led to rapid improvement.The present observation identifies a new causative agent for hypersensitivity pneumonitis and highlights the importance of a thorough environmental history and of searching for precipitins against antigens directly extracted from the patient's environment. These two procedures should allow a more precise classification of some cases of pneumonitis, and thus might avoid progression of active undiagnosed hypersensitivity pneumonitis to irreversible fibrosis or emphysema.

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Hypersensitivity pneumonitis: Problems in diagnosis†

Cited by 37 publications

References 4 publications

Interferon-gamma is necessary for the expression of hypersensitivity pneumonitis.

Interferon-gamma is necessary for the expression of hypersensitivity pneumonitis.

Diagnostic value of serum precipitins to mould antigens in active hypersensitivity pneumonitis

Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier's disease

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