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Hypersensitivity pneumonitis caused by occupational exposure to phytase

¹ Dept of Respiratory Diseases, Amphia Hospital, Breda, ⁴ ARBO Union, Breda, ³ Netherlands Expertise Centre for Occupational Respiratory Disorders Utrecht, ⁵ Dept of Respiratory Diseases, Erasmus University MC Rotterdam, The Netherlands, and ² Research Institute of Occupational Medicine, German Social Accident Insurance (BGFA), Allergology/Immunology, Ruhr-University Bochum, Germany.

CORRESPONDENCE: H. Belderbos, Dept of Respiratory Diseases, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands. Fax: 31 765953121. E-mail: hbelderbos{at}amphia.nl

Keywords: Extrinsic allergic alveolitis, hypersensitivity pneumonitis, phytase

Received: March 7, 2008
Accepted January 5, 2009

A 43-yr-old male presented with a 6-month history of episodes of coughing, shortness of breath and fever. He suffered from dyspnoea on minor exertion. The patient worked in a cattle feed factory and noticed that he had more complaints after his working hours. His symptoms could be ascribed to hypersensitivity pneumonitis due to contact with phytase, an enzyme added to cattle feed to strengthen bone and diminish phosphorus excretion.

The diagnosis was supported by bibasal lung crackles on physical examination, restrictive ventilatory defect (with decreased diffusion capacity for carbon monoxide), typical radiographical findings, lymphocytosis in bronchoalveolar lavage fluid and a positive exposure test performed at the workplace. Blood examination showed high immunoglobulin G levels to phytase.

After treatment and cessation of phytase contact the patient became symptom free and lung function normalised. Phytase should be considered as a cause of occupational hypersensitivity pneumonitis in the animal feed industry.