Hypersensitivity pneumonitis from ordinary residential exposures: University of Rochester School of Medicine and Wayne State University College of Pharmacy and Allied Health Professions - Grand Rounds in Environmental Medicine

Environmental Health Perspectives, Sept, 2001 by Michael J. Apostolakos, Harold Rossmoore, William S. Beckett

Conclusions

Hypersensitivity pneumonitis (extrinsic allergic alveolitis) has now been associated with over 50 inhaled environmental substances (11). Most are biological materials such as fungi, bacteria, and animal proteins, while a few industrial chemicals have been found to cause this immunologic lung disease. Since the first clinical description in 1932, the largest number of case series have been described in dairy farmers exposed to microorganisms growing in hay and in pigeon breeders as well as other bird fanciers.

Case reports, case series, and descriptions of occupational outbreaks in North America and Europe have described disease in specific vocations or avocations, but only occasionally with exposures in the home. In North America, such cases from domestic exposure have been associated with an unusual source of a microbial aerosol, such as a humidifier or air-conditioning device. For this patient, moving to a new residence was the difficult but ultimately successful intervention in preventing the recurrence of disease and allowing the discontinuation of corticosteroid medication.

Table 1. Laboratory data.

Date          FE[V.sub.1]      FVC       DLCO

15 Nov 1999   2.73 (95)     3.31 (87)     ND
29 Nov 1999   2.38 (82)     2.76 (73)     45
6 Dec 1999    3.27 (113)    3.87 (102)    71
3 Jan 2000    3.30 (114)    4.09 (108)    ND
17 Jan 2000   3.19 (111)    3.89 (103)    ND
18 Feb 2000   3.10 (108)    3.63 (96)     ND
6 Mar 2000    3.19 (111)    3.70 (98)     64
3 Apr 2000    2.94 (102)    3.62 (96)     63
22 May 2000   3.14 (109)    3.67 (97)     ND
10 Jul 2000   2.87 (101)    3.48 (92)     60
25 Sep 2000   2.89 (101)    3.50 (93)     60
7 Nov 2000    3.05 (107)    3.61 (96)     64
24 Jan 2001   3.09 (108)    3.60 (96)     62

                 [O.sub.2]
               Saturation (%)

Date          Rest   Exercise   Comments

15 Nov 1999    95       85      Initial pulmonary evaluation
29 Nov 1999    ND       ND      Prednisone started
6 Dec 1999     ND       ND      Prednisone taper begins
3 Jan 2000     ND       ND      Prednisone 10 mg bid
17 Jan 2000    95       92      asymptomatic off prednisone
18 Feb 2000    95       87      Symptoms return; prednisone restarted
6 Mar 2000     97       91      Symptoms improved; prednisone tapered
3 Apr 2000     ND       ND      Prednisone 10mg/day
22 May 2000    ND       ND      Asymptomatic: prednisone 10 mg/day
10 Jul 2000    95       92      Asymptomatic
25 Sep 2000    ND       ND      Asymptomatic
7 Nov 2000     ND       ND      Asymptomatic
24 Jan 2001    95       92      Asymptomatic

Abbreviations: DLCO, diffusing capacity for carbon monoxide
(percent predicted); [FEV.sub.1], forced expiratory volume in
1 sec in liters (percent predicted); FVC, forced vital capacity
in liters (percent predicted); ND, Not done.

REFERENCES AND NOTES

(1.) Richerson H, Bernstein I, Fink J, Hunninghake J, Novey H, Reed C, Salvaggio J, Schuyler M, Schwartz H, Stechschulete D. Guidelines for the clinical diagnosis of hypersensitivity pneumonitis. Report of the subcommittee on hypersensitivity pneumonitis. J Allergy Clin Immunol 84:839-844 (1989).