Positive "alveolar" responses to antigen inhalation provocation tests: their validity and recognition.

Chacinero’s lung – hypersensitivity pneumonitis due to dry sausage dust

“…It is likely, however, that Penicillium frequentans has an important role, since in one patient, it was the only fungus testing positive in the skin prick test, specific IgG determination, and SIC. In addition to being the reference standard for the diagnosis of HP, (10,(21)(22), SIC also enables identification of the causative agent. With the use of this test, it has been established that in certain types of HP, various agents can be the cause in different individuals, and, although it is less common, different agents can be implicated in the same patient (20).…”

“…The test was considered positive when any of the following post-inhalation responses was elicited: (i) FVC decrease >15% or DLCO decrease >20% as compared with baseline values; (ii) 10-15% FVC decrease plus the at least one of the following criteria related to clinical status and baseline analytical values (21)(22): (a) white blood cell increase ≥20%, (b) 3% decrease in O 2 saturation; (c) significant radiologic changes; (d) rise in body temperature >0.5 ºC; or (e) evident clinical symptoms (eg, cough, dyspnea); or (iii) FVC decrease <10%, but with evidence of ≥3 of the previously-mentioned clinical and analytical criteria (10,20).…”

Cardiopulmonary exercise testing following hay exposure challenge in farmer's lung

“…At present, there are no generally accepted criteria that define a positive "alveolar" response induced by exposure [17]. The characteristic findings that may be expected in association with positive alveolar reactions are a restrictive ventilatory defect and a decreased transfer factor, but both ventilation and transfer factor may remain apparently unchanged [15,[18][19][20]. In the study by HENDRICK et al [20], measurement of minute ventilation during exercise proved to be the most useful parameter, having a sensitivity of 85%.…”

“…Hay exposure tests were standardized, and were performed as published previously [1,3,4,11]. In short, the study participants tossed a mixture of mouldy hay specimens obtained from patients with farmer's lung disease in a designated chamber for 1 h. An observation period of 6 h followed.…”

“…The diagnosis of farmer's lung is based mainly on clinical history, radiological evaluation, pulmonary function testing and serum antibodies [4]. However, up to now, little has been known about gas exchange and exercise capacity during the acute phase of hypersensitivity pneumonitis [5,6].…”