Hypersensitivity Pneumonitis in a Hairdresser

Abstract

To the Editor: We read with interest the paper by Weiss and Baur on hypersensitivity pneumonitis caused by powdered pearl-oyster shell (Chest 1987; 91:146-49) and remembered the importance of occupational lung disease. In Japan, summer-type hypersensitivity pneumonitis is the most prevalent type of hypersensitivity pneumonitis,1Kawai T Tamura M Murao M Summer-type hypersensitivity pneumonitis. A unique disease in Japan..Chest. 1984; 85: 311-317Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar and occupational hypersensitivity pneumonitis such as farmer's lung is rare. Recently, Shirnazu etal2Shimazu K Ando M Sakata T Yoshida K Araki S. Hypersensitivity pneumonitis induced by Trichosporon cutaneum..Am Rev Respir Dis. 1984; 130: 407-411PubMed Google Scholar reported that Trichosporon cutaneum, an arthrospore-forming yeast, was a likely etiologic agent of summertype hypersensitivity pneumonitis. T cutaneum is well known as the cause ofwhite piedra, an asymptornatic fungal infection ofthe hair shaft. Hairdressers may be exposed to this organism more frequently than others. We wish to report a case of hypersensitivity pneumonitis occurring in a hairdresser. In August, 1985 (and again in 1986), a 53-year-old female hairdresser experienced sore throat, cough, fever, and dyspnea. Her symptoms improved with hospitalization and therapy, but recrudescence occurred several hours after she returned home in early October. She had no symptoms when she was discharged from the hospital in November. From her typical history and the laboratory data (including inhalation challenge test and transbronchial lung biopsy), hypersensitivity pneumonitis was diagnosed. Hairdressers are occupationally exposed to hair sprays. Disease attributed to hair sprays has been variously described as diffuse interstitial fibrosis, and hair sprays containing shellac (insect proteins) could provoke extrinsic allergic alveolitis.3Parkes WR Hair lacquer sprays. In: Occupationalhung disorders. Butterworth & Co Ltd,, London1974: 486-487Google Scholar However, it cannot concluded that hair sprays are an established cause oflung disease hairdressers. The precipitating antibody was observed against T cutaneum in our patient Bronchial challenge test with T cutaneum antigen was done with a positive result. An environmental provocation test with hairsprayswhich ourpatient usually usedwas alsoperformed, witha negative result. These indicate that T cutaneum is a likely etiologic agent ofhypersensitivity pneumonitis reported here. It is possible thathairanddandruffmightcontain nutrients forthe growth factor of cutaneum, since this organism infects hair, beard, mustache, and skin. T cutaneum could grow in house dust in a beauty parlor and barbershop We conducted a detailed environmental survey of our patient's house (most hairdressers and barbers in Japan work at their own house), but failed to isolate T cutaneum from house dust at various locations. This might be attributed to the season-the survey was done in November. As it would be moist and warm in summer, the fungus could easily grow in house dust containing hair and dandrufi and successful isolation of T cutaneum would be expected. There have been several other case reports of hypersensitivity pneumonitis occurred in hairdressers and barbers mnJapan, but they did not findetiologic agents. Trichosporon cutaneum mightbe one of the familiar fungal antigens in hypersensitivity pneumonitis in a hairdresser. Further study is needed to investigate the relationship between respiratory symptoms in hairdressers and T cutaneum, not only in Japan but also in other warm countries. We wish to thank Drs. M. Ando and Soda (Kumamoto University Medical School) for their assistance flingal studies.