Sequential Evaluation of Clinical and Immunological Findings in Hypersensitivity Pneumonitis: Serial Subclass Distribution of Antibodies

doi:10.1006/clin.1994.1206

Clinical Immunology and Immunopathology

Volume 73, Issue 3, December 1994, Pages 330-337

Clinical Immunology ...

https://doi.org/10.1006/clin.1994.1206 Get rights and content

Abstract

The long-term outcome of hypersensitivity pneumonitis (HP) is variable depending upon the individual. To evaluate the mechanisms involved in the progression or regression of HP, the longitudinal changes in pulmonary function test results, bronchoalveolar lavage (BAL) cells and the subclass distribution of IgA and IgG antibodies were investigated in 14 patients with HP, including 5 cases with bird fancier's lung (BFL). The present study has shown that: (1) All patients with bird fancier's lung (BFL) demonstrated either a restrictive pattern or a reduced diffusing capacity for carbon monoxide (DLco), or both; one BFL patient showed deterioration in %VC and %DLco after avoidance of direct exposure. (2) All three patients with summer type HP who demonstrated reduced VC and DLco at the initial test improved, (3) T cells, especially CD8 cells, were predominant in the BAL fluids of the summer type HP patients, whereas either CD8 or CD4 cells were less common, but showed an increase in the BAL fluids of the BFL patients, depending upon individuals, (4) The number of CD8 cells in the summer type HP patients decreased gradually, but at a slower rate than in the BFL patients; (5) Antibody activities of IgG1, G2, G3, G4, and A1 subclasses in the sera and BAL fluids were detected during the 5-year observation period; (6) IgA2 subclass was abundant in the BAL fluids of both BFL and summer type HP patients, in contrast to very minute amounts in sera; (7) The level of IgG2 antibody in the BAL fluids of the summer type HP patients was low (0.15 ± 0.05) as compared to that in BFL (0.82 ± 0.29); (8) The level of IgG3 antibody in the BAL fluids of summer type HP patients was lower (0.18 ± 0.05) than in BFL (1.01 ± 0.1); and (9) The antibody activities in most immunoglobulin subclasses fluctuated, but declined gradually in the BAL fluids, although they were well beyond the normal ranges. We were unable to predict the progression or the disappearance of hypersensitivity pneumonitis based merely upon the results of the present study.

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Cited by (18)

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2003, Journal of Immunological Methods
Background and objective: The practical value of immunological diagnosis of bird-breeder's disease (BBD) is controversial, because of difficulties in distinguishing active disease patients from simple contact subjects. The aim of this study was to determine the diagnostic and prognostic value of (a) presumed disease-associated antibodies precipitating pigeon antigens (immunoglobulin A (IgAp) and P2 component), (b) characterization of specific isotypes (IgG, IgM, and IgA), and (c) antibody kinetics after antigen eradication. Methods: 405 subjects (775 sera) in contact with birds were studied [by means of co-immunoelectrodiffusion (Co-IED) and enzyme-linked immunofiltration (ELIFA)] with soluble extracts of pigeon droppings and squab crop milk. These patients were divided into two groups based on the final clinical evaluation of the patients' physicians, which was taken as the gold standard (positive in 90 and negative in 315 cases). Results: On the basis of this gold standard, the detection of presumed disease-associated precipitating antibodies by Co-IED had a specificity of 95.5%, a sensitivity of 98.7%, an accuracy of 98%, and positive and negative predictive values of 95.5% and 98.7%, respectively. Most of the patients with a final positive diagnosis of BBD had specific IgG, IgM, and IgA antibodies by ELIFA. After antigen eradication, anti IgAp and/or P2 antibodies disappeared more rapidly than other precipitating systems. Conclusion: Identification by Co-IED of precipitating immune complexes IgAp and/or P2 significantly reinforces the intrinsic credibility of immunological diagnosis of BBD. Compared to these presumed disease-associated precipitating antibodies, detection and time course of specific IgM, IgA antibodies, provided no additional diagnostic value or prognostic arguments to judge disease activity after antigen eradication.
The long-term outcome in acute, subacute, and chronic forms of pigeon breeder's disease hypersensitivity pneumonitis
2002, Annals of Allergy, Asthma and Immunology
Pigeon breeder's disease (PBD) is an avian-induced hypersensitivity pneumonitis. The limited data that exist on the long-term outcome for the disease are conflicting.
We sought to determine the long-term outcome of patients with PBD to evaluate the course of the disease.
Review a case series of 18 pigeon breeders that were followed from 4 to 26 years after initial diagnosis.
Fourteen breeders reduced their bird contact significantly; four kept their birds. In eight patients with the acute form of the disease, pulmonary function either did not change from normal or improved to normal. Of five patients with subacute disease, four had persistent symptoms. All had mildly abnormal spirometry with either restrictive or obstructive changes which persisted. Five patients with chronic disease exhibited daily dyspnea. They had severe abnormalities of lung function at diagnosis. Of these patients, three improved and two deteriorated. Chest radiographs were of little value in predicting outcome.
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Inhalation provocation tests in chronic bird fanciers lung
2000, Chest
Citation Excerpt :
The partially purified fraction was extensivelydialyzed against distilled water and lyophilized. Preliminaryexperiments demonstrated cross antigenicity between PDE andBDE.1314 Before inhalation challenge test, 10 mg of freeze-dried PDE orBDE was stirred with 1 mL of distilled water and was centrifuged threetimes at 12,000 revolutions/min for 30 min.
Patients with chronic bird fancier's lung(BFL) can be classified into two types. One group of patients developschronic disease with fluctuating acute episodes, including low-gradefever, mild exertional dyspnea, and cough (fluctuating chronic BFL;formerly termed recurrent and relapsing chronic BFL). The other groupof patients shows no history of acute episodes (insidious chronic BFL).The diagnosis of chronic BFL is difficult, since the onset of chronicBFL may be insidious, with few if any symptoms during the early stagesof the disease process.
To attempt todiagnose the conditions of these patients more precisely, inhalationprovocation tests were conducted using avian dropping extracts.
Retrospective chart review.
The Tokyo Medical and Dental University Hospitalin Japan.
Eleven patients with chronic BFL(6 with fluctuating chronic BFL and 5 with insidious chronic BFL) and 6control subjects (4 asymptomatic bird owners and 2 idiopathic pulmonaryfibrosis patients) were evaluated.
Inhalation provocation tests using avian droppingextracts were conducted. All BFL patients were evaluated as positive orprobable by inhalation challenge, whereas control subjects wereevaluated as negative. A peripheral leukocytosis, an increase ofalveolar-arterial oxygen pressure difference, an increase of bodytemperature, and the development of respiratory symptoms includingcough and dyspnea were more frequently observed in chronic BFL patientsthan in control subjects. All the BFL patients had an increase inneutrophils in BAL fluids following inhalation challenge.
We validated the utility of inhalationchallenge for the diagnosis of chronic BFL, including fluctuating andinsidious BFL. We also demonstrated that neutrophilia in BAL fluidsfollowing inhalation challenge could be added to the diagnosticcriteria for chronic BFL.
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Bird fancier's lung: A series of 86 patients
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Regular ArticleSequential Evaluation of Clinical and Immunological Findings in Hypersensitivity Pneumonitis: Serial Subclass Distribution of Antibodies

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Regular Article
Sequential Evaluation of Clinical and Immunological Findings in Hypersensitivity Pneumonitis: Serial Subclass Distribution of Antibodies