Changes in PH in exhaled breath condensate after specific bronchial challenge test in patients with chronic hypersensitivity pneumonitis: a prospective study.

BACKGROUND: The aim of this study was to investigate the influence of the specific inhalation challenge (SIC) on changes of pH values in exhaled breath condensate (EBC) in patients with hypersensitivity pneumonitis (HP). METHODS: A prospective study of 85 patients with suspected HP, of whom 63 were diagnosed with HP due to exposure to avian or fungal antigens. In all cases, EBC samples were collected before and after completion of the SIC and pH values were determined. RESULTS: Taken as a whole, patients with HP did not present changes in EBC pH after SIC. However, considering only patients with exposure to molds, those diagnosed with HP had a significantly more acid pH post-SIC than those with another diagnosis (p = 0.011). This fact is not observed in patients exposed to bird's antigens. A ROC curve showed that a reduction in EBC pH of 0.3 units or more after SIC in patients diagnosed with HP due to exposure to molds had a sensitivity of 30 % (CI: 12.8 to 54.3 %) and a specificity of 100 % (CI: 65.5 to 100 %). CONCLUSION: EBC pH may be useful in interpreting SIC results in patients with HP, especially in those patients exposed to molds. Further studies are now required to test the validity of these proposals.

Progressive dyspnea in a 46-year-old woman.

BACKGROUND: Hypersensitivity pneumonitis (HP) is an inflammatory lung disease that requires a high index of suspicion and evaluation for potential causative antigens in the patient's environment. OBJECTIVE: To describe a patient referred for allergic rhinitis who was found to have progressive dyspnea and was ultimately diagnosed as having HP. METHODS: The history of progressive dyspnea with findings of diffuse pulmonary crackles on physical examination and restrictive pulmonary function testing prompted further radiologic, pathologic, laboratory, and home environment evaluations. RESULTS: The constellation of findings from these studies led to the diagnosis of HP secondary to parakeet antigens. Elimination of further antigen exposure and corticosteroid therapy led to resolution of the patient's symptoms. CONCLUSION: Prompt diagnosis and removal of the antigen source are of paramount importance in the management of HP.

Hybridization increases measures of innate and cell-mediated immunity in an endangered bird species.

1. Given the increasing threat of 'emerging infectious diseases' (EIDs), and the vulnerability of small inbred populations to such novel challenges (at least partly through compromised immunity), a degree of interspecific hybridization may improve the viability of endangered species by enriching depauperate gene pools. 2. To investigate this hypothesis, we quantified indicators of the strength of both innate and cell-mediated immunity in wild populations of hybridizing parakeets on the Chatham Islands, New Zealand. 3. We show that both measures of immune function are markedly higher in the cosmopolitan red-crowned parakeet Cyanoramphus novaezelandiae than in the island endemic Forbes' parakeet C. forbesi, as is to be expected when comparing relatively outbred vs. relatively inbred species. 4. In addition, we show that both measures of immune function are higher in Forbes'x red-crowned parakeet hybrids than in the Forbes' parakeet. Even those individuals with few red-crowned characteristics, suggesting they are the products of matings between hybrids and Forbes' parakeets, have significantly higher measures of immune function. 5. As at least one of the immune indicators measured correlates directly with both survivorship and the viability of small bird populations, this study reveals a potential management option for hybridizing species of conservation concern, where an increase in resilience to novel disease challenges could outweigh some loss of genetic integrity.

[A case of acute hypersensitivity pneumonitis caused by contact with budgerigars (bird-breeder's lung)].

A 58-year-old woman was admitted to our hospital for repeated episodes of dry cough, low-grade fever, and gradual development of dyspnea on exertion. Chest computed tomography showed diffuse ground-glass opacities in both lung fields. Bronchoalveolar lavage fluid (BALF) showed an increased number of lymphocytes, and transbronchial lung biopsy revealed alveolitis and epithelioid cell granuloma. The acute onset and the patient's living environment suggested summer-type hypersensitivity pneumonitis. However, anti-Trichosporon antibody was negative and a definitive diagnosis could not be made. The patient's condition improved with corticosteroid treatment and, after discharge from the hospital, she moved to a new home. The following year, however, her symptoms returned, and she was readmitted to our hospital. Recurrence of the disease despite the change in environment ruled out summer-type hypersensitivity pneumonitis. Given the patient's history of budgerigar breeding five years earlier, bird breeder's lung was suspected. Anti-bird excreta antibody found in the patient's serum and BALF, along with a positive lymphocyte stimulation test against pigeon serum, strongly suggested an acute onset of bird breeder's lung. We report a rare case of acute bird breeder's lung with radiologic findings of ground-glass opacities, a one-year disease-free period and an acute relapse.

Exposure to parakeets and bronchiolitis obliterans.

Case report of a 64-year-old woman with increasing dyspnea and cough. She cared at home for 8 parakeets (Melopsittacus undulatus). Subsequent studies revealed a restrictive pulmonary defect and transbronchial biopsy, a histological bronchiolitis obliterans (BO). No significant elevated anti-avian IgG could be detected, probably because of a transient hypogammaglobulinaemia. The implication of antigenic exposure to avian antigens in the pathogenesis of BO is discussed.

Nasal allergy to avian antigens.

This study describes the case of a patient who developed symptoms of rhinoconjunctivitis on exposure to budgerigars and parrots. An IgE-mediated allergy to budgerigar, parrot and pigeon antigens was demonstrated using both in-vivo challenge tests (skin and nasal provocation tests) and in-vitro investigations (radio-allergo-sorbent test, histamine release test). The study shows that the development of nasal disease can be associated with allergy to avian antigens.

Precipitins to different avaian serum antigens in bird fancier's lung and coeliac disease.

Precipitins to avian serum antigens have been found in the sera of bird fanciers and, until now, they have been considered strong supporting evidence for a clinical diagnosis of bird fancier's lung (BFL). We now report that 35% of patients with coeliac disease, none of whom had recently kept a bird, had precipitins against an avian serum antigen common to all the avian species tested, but which was distinct from the antigens usually associated with BFL. This antigen was a component of hen egg yolk but not of bird droppings. In patients with BFL the antibody response results from inhaled antigens in the bird droppings, whereas the antibody response in patients with coeliac disease probably results from eating uncooked or soft-boiled eggs.

Hypersensitive lung disease due to avian antigens.

Five patients, three exposed to budgerigars (parakeets) and two to chickens, had immunological lung reactions. A Type III hypersensitivity response likely accounts for the pulmonary alteration. The inflammatory exudate accumulates within the alveolar walls and adjacent lobular septa. Radiologically, this is manifested as reticular linear densities and/or multiple small nodules, the interstitial pattern. With spillage into the distal air spaces, an acinar pattern emerges. As this disease is reversible in its early stages, increased awareness and proper management may lead to a reduction in the number of patients who are subsequently diagnosed as having "idiopathic pulmonary fibrosis".