Hypersensitivity pneumonitis and antigen identification--An alternate approach.

OBJECTIVES: Identification of the causal antigen for patients with hypersensitivity pneumonitis (HP) is challenging in a standard clinical setting. The purpose of this pilot study was to determine whether it was possible to evaluate the home/workplace of patients, and identify the causal antigen. METHODS: Using a case-control study design we compared the presence of antibody to antigen collected in the environment of individuals with HP and controls consisting of family members/co-workers. Based on patient interviews, homes/workplaces were evaluated and suspected sources of antigen collected for use in immunoassays. RESULTS: Nineteen individuals with HP participated with 15 classified as having fibrotic disease. Up to 54 bulk samples were collected from each patient's environment, with multiple isolates (antigens) cultured from each. Of the seven individuals who tested positive to one or more environmental samples, three had a positive response to more than 1 antigen from the environmental sample (range 1-9). Twelve individuals tested positive to antigen(s) on a standard panel, with only one overlapping with the antigen from the home/workplace sample. A significant association existed between results of interviews/site evaluations, and ability to collect antigen eliciting a positive response (p < 0.001). CONCLUSION: Antigen identification was successful for patients with 'active' disease. Antigens for which patients test positive on standard panels may not be present in their environment. One benefit to patient-centered testing is the ability to develop recommendations specific to their environment. As most individuals tested positive for >1 antigen, further investigation is warranted to determine the actual antigen responsible for disease.

Airborne particulates (PM10) and tracheal mucus: A case-control study at an American Thoroughbred racetrack.

REASONS FOR PERFORMING STUDY: Particle mapping within stalls has demonstrated a relationship between particulate concentrations and visible accumulations of tracheal mucus. However, measurement of breathing zone particulate concentrations, which is the most accurate way to measure exposure, has not been performed to determine the relationship between exposures and accumulations of tracheal mucus sufficient to affect performance. OBJECTIVES: To compare breathing zone particulate exposures between horses with tracheal mucus scores (MS) previously demonstrated to affect performance (MS≥2) and those without (MS = 0) visible tracheal mucus. STUDY DESIGN: Case-control study. METHODS: We endoscopically examined 649 Thoroughbred racehorses over 7 months and selected 113 age-matched cases and controls based on the presence (MS≥2) or absence (MS = 0) of tracheal mucus, respectively. Inflammatory cell numbers in tracheal lavage were also determined. Breathing zone monitors recorded particulate exposure during 3 time periods (mid-day, evening and overnight). Total recording time averaged 17.5 h/horse. RESULTS: The overall prevalence of MS≥2 in the observed stables was 23%. Breathing zone particular matter (PM10) concentrations were very similar to previously reported ambient concentrations. During the evening and overnight, cases had significantly higher breathing zone PM10 concentrations and neutrophil counts than controls. Inflammatory cell counts were associated with average PM10 concentrations throughout the day. CONCLUSIONS: Breathing zone particulate concentrations are associated with MS≥2 and inflammatory cell numbers. If breathing zone particulate exposures are predominantly influenced by ambient PM concentrations, racing stable management practices to reduce particle exposures should greatly reduce the prevalence of tracheal mucus.

Local airborne particulate concentration is associated with visible tracheal mucus in Thoroughbred racehorses.

REASON FOR PERFORMING STUDY: Accumulations of tracheal mucus assessed by endoscopic examination are associated with poor performance in racehorses. The air quality in horses' stalls may contribute to this visible tracheal mucus. OBJECTIVES: To determine whether the concentration and number of airborne particulates in stalls are associated with visible accumulations of tracheal mucus and with the number of inflammatory cells in tracheal aspirates. METHODS: We studied 107 racehorses from 3 stables, in 3 different months, and measured airborne particulate matter 3 times daily in each of the stalls. On each monthly visit, horse airways were examined endoscopically and assigned a mucus score, and tracheal lavage was performed. Bivariate procedures, general estimating equations and linear mixed models were applied to estimate the association between PM and the presence of accumulations of mucus and number of inflammatory cells. RESULTS: Stable, stall, month and PM were all significantly associated with the presence of accumulations of tracheal mucus, which had an overall prevalence of 67%. The odds of horses having visible accumulation of mucus were increased when horses occupied enclosed stables or stalls with higher particulate concentrations, and when concentrations of larger particles (≤ 10 µm in diameter) were elevated. Sixty-eight percent of tracheal wash samples contained more than 20% neutrophils. Increased numbers of neutrophils were associated with the concentration of smaller particles (≤ 2.5 µm in diameter). POTENTIAL RELEVANCE: Careful consideration of stable construction and management practices focused on maintaining the lowest possible dust concentrations throughout the day should reduce the prevalence of visible accumulations of tracheal mucus, potentially improving racing performance.

Particle mapping in stables at an American Thoroughbred racetrack.

REASONS FOR PERFORMING STUDY: Airway inflammation and mucus in the trachea are common in racehorses. Fine airborne particles can initiate and coarse particles can worsen airway inflammation in man and in animal models of airway disease. The regional and seasonal distribution of particles of different sizes has never been investigated in American racing stables. OBJECTIVES: To determine the regional and seasonal concentration and number of airborne particles of different sizes in racing stables. METHODS: Direct reading instruments were used to determine the mass concentration and numbers of particles 3 times daily (early morning, midday and late afternoon) in July, September and November, in 3 different racing stables. RESULTS: Average particle concentrations were lowest in July and highest in September and November. Early morning concentrations were significantly higher than those measured throughout the rest of the day. The completely enclosed stable with little natural ventilation, had significantly higher particulate concentrations than the open-sided stable. With regard to numbers of particles, those 2-5 µm were greatest in July and least in November; those 0.5-1.0 µm were greatest in September and least in November. Location of stall within stable also affected concentrations and numbers. CONCLUSIONS: The concentration and number of particles in sizes known to reach the lower airways varies with stable design/management, time of day, season of year and location of the stall within the stable. POTENTIAL RELEVANCE: Particle mapping is a useful tool in the identification of stables, season, and location of stalls within stables where horses may be at greater risk of exposure to offending particulates.