Screening and diagnosis of acute and chronic bird-related hypersensitivity pneumonitis by serum IgG and IgA antibodies to bird antigens with ImmunoCAP®

Shirai, Tsuyoshi; Tanino, Yoshinori; Nikaido, Takefumi; Takaku, Yotaro; Hashimoto, Seishu; Terada, Yoshio; Baba, Tomohisa; Ogura, Takashi; Kataoka, Kensuke; Nakayama, Masayuki; Yamada, Yoshihito; Matsushima, Sayomi; Nakayama, Satoshi; Miyazaki, Yasunari

doi:10.1016/j.alit.2020.09.003

Cited by 23 publications

(16 citation statements)

References 12 publications

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“…In patients with fibrotic bird-related HP, the accuracy of the IgG testing varies between chronic HP with acute episodes and chronic HP without acute episodes. The sensitivity and specificity of the two groups combined for acute bird-associated HP and bird-related chronic HP with acute episodes were 70% and 86%, respectively, while for chronic HP both with and without acute episodes, the sensitivity and specificity were 33% and 86%, respectively [7]. Furthermore, the sensitivity and specificity differed according to the type of inciting antigens.…”

Section: Discussionmentioning

confidence: 92%

“…In these studies, the accuracy of IgG testing between HP and healthy controls was very high; however, HP was not divided into nonfibrotic and fibrotic HP. Shirai et al discovered that both acute HP and chronic HP with acute episodes have higher IgG titers than control using commercialized fluorescence enzyme immunoassay (FEIA) [7]. Therefore, the usefulness of IgG testing by FEIA method in fibrotic HP without acute episodes remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Serum Immunoglobulin G Testing against Pigeon Egg in Stable Fibrotic Hypersensitivity Pneumonitis

Okuda¹,

Takemura²,

Baba³

et al. 2023

Int Arch Allergy Immunol

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Introduction: The accuracy of serum immunoglobulin (Ig) G testing for diagnosis of stable bird-related fibrotic hypersensitivity pneumonitis (HP) is controversial. Furthermore, avian serum, extracts, or feathers were employed as antigens in bird-related HP; however, the usage of egg whites has not been reported. We investigated the utility of IgG testing against pigeon egg whites in patients with stable bird-related fibrotic HP. Methods: Patients having a positive inhalation test for pigeon antigen and a histological investigation with diagnostic confidence of fibrotic HP greater than moderate confidence were included. The control group consisted of patients with interstitial lung diseases (ILDs) other than HP. To select patients in the stable phase, patients with fibrotic HP were excluded if they were clinically considered to be in the acute exacerbation or acute phase. The IgG testing against pigeon egg whites by enzyme-linked immunosorbent assay and the commercialized anti-pigeon IgG testing by fluorescence enzyme immunoassay were investigated. Results: In this study, 37 patients with stable bird-related fibrotic HP and 32 patients with ILDs other than HP participated. Serum IgG testing for pigeon egg whites revealed that the control group’s optical density was 0.147 and the group with bird-related fibrotic HP had a mean value of 0.207 (p = 0.011). IgG testing in bronchial alveolar lavage fluid was not significantly higher in the bird-related fibrotic HP group than in controls (p = 0.42). No significant difference in area under the curve between an IgG testing against pigeon egg whites and a commercialized anti-pigeon IgG testing was observed (p = 0.24). Test accuracy for stable bird-related fibrotic HP ranged from 62% to 76% sensitivity and 59–66% specificity. Conclusion: IgG testing to identify the inciting antigen in patients with stable bird-related fibrotic HP had relatively low accuracy.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Serum Immunoglobulin G Testing against Pigeon Egg in Stable Fibrotic Hypersensitivity Pneumonitis

Okuda¹,

Takemura²,

Baba³

et al. 2023

Int Arch Allergy Immunol

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“…However, we and other researchers failed to detect precipitating antibody to P. digitatum in the serum of the patients with citrus farmer's OHP, suggesting that 1) other pathogens had caused the disease; 2) this type of OHP is dominantly caused by different pathogenic mechanisms, such as Type IV hypersensitivity reactions (18); or 3) the tests using crude fungal extracts lacked sufficient sensitivity for the diagnosis of chronic HP. In fact, the sensitivity of serum IgG and IgA for recurrent and insidious types of chronic bird-related HP was only 48%-61%, in contrast to 85%-91% in cases of acute or recurrent-type disease (19). Further analyses are necessary to identify the causal antigen for tangerine worker's OHP.…”

Section: Discussionmentioning

confidence: 97%

Occupational Hypersensitivity Pneumonitis in a Japanese Citrus Farmer

et al. 2021

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Hypersensitivity pneumonitis (HP) sometimes develops in people working in specific environments. We herein report a case of occupation-related HP in a citrus farmer in Japan. A 66-year-old man developed a fever, dyspnea, and general malaise in March after working near a trash dump filled with moldy tangerines. He presented with leukocytosis, bilateral lung opacities on chest radiographs, and intra-alveolar and interstitial lymphocytic inflammation with fibrotic change on a lung biopsy. His symptoms disappeared after admission and recurred on a revisit to the workplace. Fungal culture and a mycobiome analysis using next-generation sequencing suggested an association with exposure to Penicillium digitatum.

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“…It remains unclear whether serum precipitin levels are higher during active antigen exposure with acute disease compared to lower or waning titers with antigen avoidance or directed treatment [ 29 , 30 ]. In one study assessing serum IgG or IgA to several bird-related proteins, measured serum precipitin levels were notably higher in those with newly diagnosed acute disease and those with recurrent flares or progressive clinical symptoms compared to controls [ 31 ]. The combination of several avian antigen species in this study also improved the sensitivity and specificity of serologic testing for HP diagnosis.…”

Section: Diagnosis: Where the Whole Is Greater Than The Sum Of Its Partsmentioning

confidence: 99%

Challenges in the Diagnosis and Management of Fibrotic Hypersensitivity Pneumonitis: A Practical Review of Current Approaches

Moua

Petnak

Charokopos

et al. 2022

JCM

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Recent advances in fibrotic hypersensitivity pneumonitis include improved diagnostic guidance, systematic assessments of immunosuppressive therapy, and the recent availability of antifibrotic therapy (nintedanib) for those with progressive disease. A standardized approach to diagnosis may lead to better inclusion criteria for future therapeutic protocols and delineation of disease or treatment response predictors for real-world management. This review will highlight current diagnostic and treatment challenges and remaining knowledge gaps or areas of uncertainty, with a practical overview of supporting evidence and its clinical implications. Exposure history, serologic testing for antigen sensitivity, bronchoalveolar lavage lymphocytosis, histopathology, and radiologic findings will be covered in the diagnosis section, with immunosuppression, antifibrotic therapy, lung transplantation, and disease prognosis in the treatment and management section.

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Screening and diagnosis of acute and chronic bird-related hypersensitivity pneumonitis by serum IgG and IgA antibodies to bird antigens with ImmunoCAP®

Cited by 23 publications

References 12 publications

Serum Immunoglobulin G Testing against Pigeon Egg in Stable Fibrotic Hypersensitivity Pneumonitis

Serum Immunoglobulin G Testing against Pigeon Egg in Stable Fibrotic Hypersensitivity Pneumonitis

Occupational Hypersensitivity Pneumonitis in a Japanese Citrus Farmer

Challenges in the Diagnosis and Management of Fibrotic Hypersensitivity Pneumonitis: A Practical Review of Current Approaches

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