Hypersensitivity Lung Disease Research Articles

Antibodies of different immunoglobulin classes against antigens causing farmer's lung.

A solid phase radioimmunoassay technique was used to demonstrate antibodies of various immunoglobulin classes in sera against farmer's lung antigens. IgG, IgA, and IgM antibody activity in normal patients and in patients with farmer's lung were detected against Micropolyspora faeni. Only the IgG and IgA antibody activity was different in farmers and in control subjects. An asymptomatic subject could not be differentiated from symptomatic farmers by IgG antibody activity. No IgE antibody activity was detected. The radioimmunoassay technique can be used to show antibody activity against carbohydrate antigens and as a method of evaluation of antigens by inhibition analysis. Certain types of hypersensitivity lung disease can be discriminated by in vitro analysis of serum antibody of various immunoglobulin classes. This is apparent for IgE and possibly true for IgM.

Hyperimmunoglobulinemia E in a child with allergic bronchopulmonary aspergillosis and bronchiectasis

A 12-year-old boy was hospitalized for resection of a bronchiectatic lesion. Investigation of an elevated cencentration of serum IgE led to a diagnosis of allergic bronchopulmonary aspergillosis. ABPA has rarely been described in the pediatric age group. This hypersensitivity lung disease is characterized by intermittent wheezing, fever, recurrent pulmonary infiltrates, eosinophilia, hyperimmunoglobulinemia E, and Type I (allergic) skin reactivity to aspergillus extract. Hyphae of aspergillus may also be found in expectorated brown mucus plugs. Type III (Arthus) skin test response and presence of precipitating antibody to this fungus may be demonstrated. Central bronchiectasis or pulmonary fibrosis may result from uncontrolled progression of this disease.

The prevalence of farmer's lung in an agricultural population.

Four hundred seventy-one persons associated with farming or dairy production were surveyed by means of a questionnaire for evidence of hypersensitivity lung disease due to inhalation of moldy hay or grain (farmer's lung). Of these, 172 were evaluated with spirometry, serologic studies, and chest roentgenographs. A history typical of the farmer's lung syndrome was given by 14 of the 471 subjects (3.9 per cent). Precipitating antibodies to Micropolyspora faeni were identified in sera from 2 of these 14 subjects (14 per cent), and spirograms were abnormal in 4 (28 per cent). The prevalence of farmer's lung in this community (i.e., 3 per cent) is comparable to that found in epidemiologic studies in Britain and Scotland. Farmer's lung disease may be an important occupational illness of dairy and cattlemen in this country, but the diagnosis may be overlooked frequently because of the lack of patient and/or physician awareness.

Hypersensitivity lung disease in the turkey raising industry.

Two hundred five subjects involved in raising or processing turkeys were surveyed for clinical and laboratory evidence of hypersensitivity lung disease. One hundred forty· two (69 per cent) described respiratory symptoms occuring within I hour after working with the birds. Thirteen workers (6 per cent) also reported dyspnea, cough, myalgia, and fever occurring 4 to 8 hours after exposure to turkeys. Sera from II per cent of the study population contained precipitating anti­ bodies against turkey serum, whereas 18 per cent of subjects had positive skin tests to turkey antigens. When compared with the group of 63 subjects without complaints, the symptomatic group had a significantly higher prevalence of precipitating antibodies to turkey serum, positive skin tests to both turkey and environmental antigens, elevated IgE levels, and atopic histories. Many of the immediate onset respiratory symptoms were considered to represent type I im­ munologic reactions, whereas delayed symptoms were thought .to represent type III reactions. This study showed that hypersensitivity pulmonary disease may occur in persons working with turkeys and that the delayed reactions closely resembled the same syndrome reported in pigeon and parakeet breeders.

Immunologic mechanisms in hypersensitivity pneumonitis: I. Evidence for cell-mediated immunity and complement fixation in pigeon breeders' disease

Immunologic studies were performed on 5 patients with pigeon breeders' disease. Intradermal injection of pigeon serum produced an immediate wheal-and-flare reaction within 15 minutes and a secondary Arthus-type reaction within 4 to 8 hours. Immunofluorescent studies of the secondary reaction site showed IgG, C3, and C4 in 2 patients. Patients' sera produced multiple precipitin bands with pigeon serum when reacted by double diffusion in gel. IgG antibody isolated from each of the patients' serum formed precipitating immune complexes that fixed large amounts of complement (C4) when added to fresh human serum. Peripheral blood lymphocytes from 4 of the 5 patients produced macrophage migration inhibitory factor (MIF) when challenged with dilute pigeon serum. These studies are the first to show complement fixing antibodies and macrophage MIF production by lymphocytes from patients with hypersensitivity lung disease and suggest that both humoral and cellular immunity may be important in the pathogenesis of these disorders.

Extremes of Clinical Presentation in Parakeet-Fancier's Lung

Lung disease due to parakeet dander J was first reported by Pearsall et al in 1960.¹They demonstrated precipitating antibody and both immediate and delayed skin reactions. Hargreave et al, in 1966,²reported allergic alveolitis caused by the budgerigar (love bird) which is a small parrot in the same general group as parakeets. The budgerigar fancier is usually closely exposed to only one or two birds, tends to develop disease insidiously, and may present with irreversible lung damage and roentgenographic evidence of pulmonary fibrosis. Other workers noted similarities to farmer's lung and described the same entity in pigeon breeders.^3-5In pigeon breeder's disease intermittent exposure to large amounts of dust from pigeon droppings is followed several hours later by an acute, febrile respiratory illness.⁶ The present report illustrates both the acute and chronic varieties of parakeet-related hypersensitivity lung disease. Since the parakeet is such a common