PT  - JOURNAL ARTICLE
AU  - R. C. van Heemst
AU  - I. Sander
AU  - J. Rooyackers
AU  - L. de Jong
AU  - R. S. Djamin
AU  - J. G. Aerts
AU  - H. N. A. Belderbos
TI  - Hypersensitivity pneumonitis caused by occupational exposure to phytase
AID  - 10.1183/09031936.00035408
DP  - 2009 Jun 01
TA  - European Respiratory Journal
PG  - 1507--1509
VI  - 33
IP  - 6
4099  - http://erj.ersjournals.com/content/33/6/1507.short
4100  - http://erj.ersjournals.com/content/33/6/1507.full
SO  - Eur Respir J2009 Jun 01; 33
AB  - 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.