The long-term outcome in acute, subacute, and chronic forms of pigeon breeder's disease hypersensitivity pneumonitis

Zacharisen, Michael C.; Schlueter, Donald P.; Kurup, Viswanath P.; Fink, Jordan N.

doi:10.1016/s1081-1206(10)61993-x

Cited by 71 publications

(35 citation statements)

References 24 publications

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“…The patient did not recover completely after cessation of exposure. This does not argue against the diagnosis of HP as it is known from the literature that the outcome of sub-acute or chronic forms of HP is poor [10,11]. Thus, there is virtually no doubt about a diagnosis of occupational HP, which was categorised as subacute due to the available information.…”

Section: Exposure Assessmentmentioning

confidence: 99%

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

Schreiber¹,

Knolle²,

Sennekamp³

et al. 2008

European Respiratory Journal

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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 reexposure. 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 mg?m -3 in front of one booth (corresponding to a total reactive isocyanate group concentration of 1 mg?m -3 ).The present authors conclude that concentrations of diisocyanates far below current exposure limits may induce hypersensitivity pneumonitis in susceptible subjects.

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Section: Exposure Assessmentmentioning

confidence: 99%

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

Schreiber¹,

Knolle²,

Sennekamp³

et al. 2008

European Respiratory Journal

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“…There may be no discernable history of acute or subacute symptoms (Yi, 2002;Zacharisen et al, 2002). The patient presents with progressive cough and/or shortness of breath and diminished exercise tolerance, anorexia, weight loss and rarely fever (Mohr, 2004).…”

Section: Hypersensitivity Pneumonitismentioning

confidence: 99%

Environmental, Inhaled and Ingested Causes of Pulmonary Fibrosis

et al. 2007

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Pulmonary fibrosis is a general term that refers to a collection of connective tissue around alveolar structures. There are over 200 disorders where the lungs may be involved in a fibrotic response. To determine the cause of pulmonary fibrosis requires an in depth understanding of the pathogenesis of pulmonary fibrosis and breadth of knowledge of the causative agents and associated disorders that may lead to pulmonary fibrosis. A comprehensive evaluation of the patient is absolutely essential, starting with detailed history that includes an occupational and environmental history because fibrogenic exposures can occur in many settings. Equally important is a history of ingestion of pharmaceutical or nonpharmaceutical substances. A physical examination and judicious investigations are always a part of any comprehensive clinical assessment but they are not commonly helpful in elucidating the cause of most pulmonary fibrotic disorders. Although, a chest film is invariably done, a logical and strongly recommended next step is a high-resolution computed tomography (HRCT). HRCT provides a better assessment of the radiological pattern, may suggest a diagnosis as well as direct the site, and type of lung biopsy. If the history and investigations do not lead to a diagnosis then a lung biopsy is required. Prevention or removal of the inciting agent is critical to the treatment of these disorders and in some instances corticosteroids may be of help.

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“…[1][2][3][4][5][6][7][8][9] Treatment is primarily aimed at identifying and avoiding the implicated antigen. 1,10,11 Identifying the off ending antigen, however, is achieved only in about 40% of cases. 1,12 Further, a subset of patients develop progressive fi brosis and have a high mortality risk.…”

Section: Discussionmentioning

confidence: 99%