[Improved IgG Antibody Diagnostics of Feather Duvet Lung by an Antibody Screening Test]. / Optimierte IgG-Antikörperdiagnostik der Bettfedern-Alveolitis mittels EAA-Suchtest.

The underdiagnosed feather duvet lung, an extrinsic allergic alveolitis (hypersensitivity pneumonitis) caused by duck and goose feathers, can be more frequently diagnosed, if duck and goose feather antibodies are included in the panel of the routinely applied IgG antibody screening test. This does not necessarily require extending the screening test to include duck and goose feather antigens. By analysing 100 sera with duck and goose antibodies we found that the commonly used pigeon and budgerigar antibodies can also screen for feather duvet antibodies. All examined sera lacking pigeon and budgerigar antibodies also lacked clear-cut duck and goose feather antibodies. The examined sera with strong pigeon or budgerigar antibodies always also contained feather duvet antibodies. However, sera with medium or low concentrated pigeon or budgerigar antibodies are not always associated with feather duvet antibodies. In the light of these observations, we find that 71% of the duck and goose antibody analyses would be dispensable without essential loss of quality, if the results of screening for pigeon and budgerigar antibodies were incorporated into the procedure of a step-by- step diagnostics.

[Farmer's lung antigens in Germany]. / Farmerlungen-Antigene in Deutschland.

Recent studies suggest that besides the long-known farmer's lung antigen sources Saccharopolyspora rectivirgula (Micropolyspora faeni), Thermoactinomyces vulgaris, and Aspergillus fumigatus, additionally the mold Absidia (Lichtheimia) corymbifera as well as the bacteria Erwinia herbicola (Pantoea agglomerans) and Streptomyces albus may cause farmer's lung in Germany. In this study the sera of 64 farmers with a suspicion of farmer's lung were examined for the following further antigens: Wallemia sebi, Cladosporium herbarum, Aspergillus versicolor, and Eurotium amstelodami. Our results indicate that these molds are not frequent causes of farmer's lung in Germany.

[Allergic alveolitis after influenza vaccination]. / Allergische Alveolitis nach Grippeschutzimpfung.

Allergic alveolitis as a side effect of vaccination is very rare. We report a life-threatening complication in a female patient after influenza vaccination. The causative antigen was the influenza virus itself. Our Patient has suffered from exogen-allergic alveolitis for 12 years. Because of the guidelines of regular administration of influenza vaccination in patients with chronic pulmonary disease further research in patients with known exogen-allergic alveolitis is vitally important for the pharmaceutical drug safety.

Consort hypersensitivity pneumonitis.

To date, there is little information in the literature that hypersensitivity pneumonitis due to birds may occur without direct contact to birds. A 62-yr-old pensioner developed mild flu-like symptoms, fatigue and polyuria several hours after each meeting with his new female partner, either in hotels or his apartment. After divorcing from her ex-husband, who was a canary fancier, the female had moved into a bungalow approximately 6 months earlier. When the couple met for the first time at the bungalow, the patient's symptoms worsened and he developed shortness of breath. The patient had never entered the bird house or the married couple's house. Hypersensitivity pneumonitis was demonstrated by chest radiography, computed tomography, a restrictive ventilatory defect, decreased diffusion capacity and hypoxaemia after physical exercise. Sensitisation to canaries was shown by immunoassays. Canary antigens were detected by a polyclonal immunoassay at different locations of the married couple's house and the female's bungalow, where no birds had ever been kept. In conclusion, hypersensitivity pneumonitis should be recognised as a further consort disease, i.e. a disease that can be transmitted by partners.

Sub-acute occupational hypersensitivity pneumonitis due to low-level exposure to diisocyanates in a secretary.

There is virtually no information in the literature about the exposure levels needed to induce hypersensitivity pneumonitis (HP) by diisocyanates. The present study reports a case of occupational HP due to diisocyanates after low-level exposure. A 53-yr-old female never-smoker developed progressive shortness of breath on exertion, cough, fatigue and flu-like symptoms shortly after she began work as a secretary of a car body repair shop. A diagnosis of HP was made 2 yrs later, based on a restrictive ventilatory defect, a reticulonodular and discrete ground-glass pattern on high-resolution computed tomography, lymphocytosis in bronchoalveolar lavage and specific immunoglobulin G antibodies to diisocyanate human serum albumin conjugates in the patient's serum. The diagnosis was confirmed by recovery after exposure cessation and deterioration after re-exposure. Ambient monitoring revealed air concentrations of different diisocyanate monomers below the detection limit in both the patient's work station and in front of the paint spray booths, with the exception of one measurement that showed 4,4-methylenediphenyl diisocyanate concentrations of 3 microg x m(-3) in front of one booth (corresponding to a total reactive isocyanate group concentration of 1 microg x m(-3)). The present authors conclude that concentrations of diisocyanates far below current exposure limits may induce hypersensitivity pneumonitis in susceptible subjects.

[Recent advances in extrinsic allergic alveolitis]. / Exogen-allergische Alveolitis--neue Erkenntnisse.

Extrinsic allergic alveolitis (hypersensitivity pneumonitis), especially humidifier lung, has been more frequently diagnosed over the last decades, whereas farmer's lung has decreased over the same time period. Today two types of the chronic course of extrinsic allergic alveolitis can be distinguished. The recurrent chronic course with a good prognosis may be differentiated from the insidious course with a poor prognosis by means of different histological patterns (UIP, NSIP, BOOP pattern). The characteristic neutrophilic infiltration of the lung in the insidious course cannot be detected by bronchoalveolar lavage (BAL) methods. Furthermore, lymphocytosis in the BAL can be absent or present at a low level. The CD4/CD8 ratio is not always decreased and may be normal or even increased in these insidious cases with a poor prognosis. Granulomas in the lung tissue, however, point to a good prognosis. In the diagnostic work-up of machine operator's and humidifier lung, it is advisable not only to look for serum antibodies against bacteria and molds but also for rapid growing mycobacteria in a sample of machine or humidifier water. IgM and IgG rheumatoid factors occur frequently in allergic alveolitis, especially in humidifier lung. The patients, however, do not suffer from arthritis. The IgM rheumatoid factor may simulate IgM antibodies against numerous infectious agents (e. g., Bordetella pertussis or Mycoplasma pneumoniae). Taking this phenomenon into account may improve the current differential diagnosis of allergic alveolitis.

[Swimming pool lung -- extrinsic allergic alveolitis or mycobacterial disease?]. / Schwimmbadlunge -- Exogen-allergische Alveolitis oder Mykobakteriose?

There have been several recent reports of pulmonary disease resulting from exposure to Mycobacterium avium complex in indoor hot tubs. The disease is thought to be due either to infection or extrinsic allergic alveolitis (EAA). In this report we describe the case of a patient who developed episodes of fever, dyspnea and cough 4-6 hours after cleaning his indoor swimming pool. A diagnosis of EAA was made on finding a restrictive lung function pattern with gas exchange abnormalities, a predominant lymphocytosis in the bronchoalveolar lavage, diffuse ground-glass opacities in the lower lobes on high-resolution computer tomography, and specific IgG antibody activity to the swimming pool water. There was no precipitin reaction or specific IgG antibody activity to microbes extracted from the water. Interestingly, the water contained Mycobacterium avium complex (MAC) in huge amounts and in this case the histopathological features of the lung biopsy specimens differed from those seen in typical EAA, but were similar to those described in "hot tub lung" caused by mycobacteria. Solely by avoidance of cleaning the swimming pool, without any pharmacological treatment, the patient recovered completely within three months. To the best of our knowledge, this is the first report of EAA possibly associated with MAC exposure in a swimming pool environment.

Extrinsic allergic alveolitis (hypersensitivity pneumonitis) caused by Sphingobacterium spiritivorum from the water reservoir of a steam iron.

A case of extrinsic allergic alveolitis (EAA) caused by Sphingobacterium spiritivorum is described. The symptoms were associated with the use of a steam iron. The water reservoir was heavily contaminated with S. spiritivorum (10(6) CFU ml(-1)). This is the first report of S. spiritivorum as a causative agent of EAA.

[Misting-fountain-alveolitis]. / Zimmerspringbrunnen-Alveolitis.

A 22-year-old woman developed recurrent episodes of fever, cough and dyspnea after repeated exposure to a misting fountain at home. A diagnosis of extrinsic allergic alveolitis (EAA) was made by detection of serum antibodies against the fountain water, by culture of Bacillus subtilis, Mucor racemosus, Mucor mucedo, and Saccharomyces cerevisiae from the water, and by detection of specific IgG antibodies against Bacillus subtilis and the Mucores. The diagnosis was confirmed by a restrictive lung function pattern, and a highly increased total cell count with a lymphocytosis of 39 % in the bronchoalveolar lavage. An inhalation challenge with the misting fountain resulted in a positive reaction. Because this humidifier system has recently become widespread at home, clinicians should be aware of this specific type of EAA which may be called "misting fountain alveolitis".

Extrinsic allergic alveolitis with IgA deficiency.

Up to now only 3 cases of extrinsic allergic alveolitis (hypersensitivity pneumonitis) with IgA deficiency have been published worldwide. We had the opportunity to detect two additional cases which will be presented here. Summarizing all cases IgA deficiency is a risk factor for a severe course of the disease and an increased susceptibility to acquire allergic alveolitis by low dose antigen exposure.

Allergy, total IgE and eosinophils in East and West -- serious effects of different degrees of helminthiasis and smoking.

Allergies are rarer in East Germany than in West Germany, although elevated IgE-levels and blood eosinophil counts can be found in the East. The aim of this study is to control the known results in Slowakia. The total-IgE and the blood eosinophil counts as well as stool samples of 311 plant-workers in Slovakia and 522 in West Germany were checked. In 1999/2000 21% of the plant workers examined in Slovakia suffered from an allergy compared with 32 % of the workers in West Germany. In contrast the total IgE in the East (Slovakia) was 166 IU/ml compared with 99 IU/ml in West Germany. Worms were detected in the stools in 7 % of those examined in the East and in only 1 % of those in the West. The percentage distribution of eosinophils in the blood was on average 7.5% in the East and 2.7% in the West. 39% of the workers in the East were smokers compared with 20% in the West. Nevertheless among non-smoking workers volunteers without parasites, the total IgE and eosinophil count were higher in those from the East than in those from the West. For Slowakia we can show for the first time that allergies are less frequent compared with West-Germany. The total IgE and the blood eosinophils are associated with higher smoking habits and more frequent helminthic diseases.

Workplace-related complaints due to exposure to contaminated humidifier water and the VDI guideline 6022

We describe a case report of one patient with hypersensitivity pneumonitis (humidifier lung) due to exposure to contaminated humidifier water and another four patients with related complaints. The setting was a building with photographic laboratories and corresponding office rooms that were supported with air by a humidification, ventilation, and air conditioning (HVAC) system. In the humidifier water, we found different fungi, particularly species of the genus Verticillium, as well as gramnegative bacteria, but no Legionella species. Colony counts were done according to the German Drinking Water Regulations and the VDI Guideline 6022 at 20 degrees C and 36 degrees C; the results exceeded the recommended level of 103 cfu/ml. The hygienic role of the isolated microorganisms and their products (e.g., antigens, endotoxins) is discussed. The case report emphasizes the importance of careful maintenance and control of HVAC systems. The new VDI guideline 6022 (issue July 1998) gives detailed information on this subject and pays special attention to qualifications and training of the HVAC operations staff.

Acute allergic reaction and demonstration of specific IgE antibodies against alpha-1-protease inhibitor.

A 44 yr-old female with severe pulmonary emphysema and reduced alpha-1-protease inhibitor (alpha1-PI) serum levels developed an acute anaphylactic reaction following the third intravenous infusion of human alpha1-PI which was administered to prevent the progression of pulmonary emphysema. Specific immunoglobulin E-antibodies against human alpha1-PI could be demonstrated in the patient's serum using an enzyme allergosorbent test. Because of the risk of further severe anaphylactic reaction, the replacement therapy with alpha1-PI was discontinued. Physicians should be aware of this rare complication.

[IgA antibodies in exogenous allergic alveolitis are more specific than IgG antibodies]. / IgA-Antikörper bei exogen allergischer Alveolitis sind spezifischer als IgG-Antikörper.

Nineteen sera from patients suffering from extrinsic allergic alveolitis (bird fancier's lung, farmer's lung) and 19 sera from asymptomatic persons demonstrating IgG-antibodies were examined for IgA-antibodies against pigeon serum, Micropolyspora faeni and Aspergillus fumigatus. The IgA-antibodies against pigeon serum and Micropolyspora faeni were less of ten false-positive than the corresponding IgG-antibodies. Hence the IgA-antibodies were more specific than the IgG-antibodies. However, the sensitivity of the IgA-antibodies was lower than that of the IgG-antibodies. On the other hand IgA-antibodies against Aspergillus fumigatus were scarcely more specific than the corresponding IgG-antibodies against pigeon and M. faeni. It would thus seem that IgA-antibodies can supplement the IgG-serodiagnosis of extrinsic allergic alveolitis.

Pigeon breeder's lung: association with HLA-DR 3.

52 symptomatic (SPB) and 64 asymptomatic (APB) pigeon breeders were investigated for the HLA-A, -B, -C, -DR; C2, C3, C4 and Bf systems, and C3, C4 and factor B serum concentrations. HLA-DR3 and Bf S frequencies were significantly higher in the SPB than the APB group. Mean factor B concentrations were lower in the SPB than in the APB group. A positive two-way association between HLA-DR3 and the disease was found. It is concluded that a gene or genes responsible for type III and IV allergic reactions leading to the disease is associated with HLA-DR3. The increase of Bf S allotype and low mean factor B concentrations, however, can be explained by the strong linkage disequilibrium between BfS and HLA-DR3.