Clinical features of recurrent and insidious chronic bird fancier's lung

doi:10.1016/S1081-1206(10)61863-7

Annals of Allergy, Asthma & Immunology

Volume 90, Issue 6, June 2003, Pages 604-610

https://doi.org/10.1016/S1081-1206(10)61863-7 Get rights and content

Background

Chronic bird fancier's lung (BFL) can be subgrouped into two types. One subgroup of patients develops interstitial pulmonary fibrosis after recurrent acute episodes (recurrent BFL), and the other subgroup of patients has no history of acute episodes but has slowly progressive chronic respiratory disease (insidious BFL).

Objective

To define the clinical characteristics of both types of BFL and to provide clues for diagnosis.

Methods

We performed a retrospective review of the medical records of patients with chronic BFL who were evaluated between October 1992 and March 2001 at the Tokyo Medical and Dental University Hospital in Japan. Patients were evaluated for their clinical characteristics, including history, laboratory, and immunologic findings; imaging; bronchoalveolar lavage; and histologic findings.

Results

Thirty-two patients with chronic BFL were included in this study; 15 patients had recurrent BFL and 17 had insidious BFL. The patients with recurrent BFL tended to breed dozens of pigeons in a loft, whereas the patients with insidious BFL were likely to be exposed to smaller birds kept indoors. Specific antibodies against pigeon dropping extracts or budgerigar dropping extracts were positive in 87% of the recurrent BFL cases and 35% of the insidious BFL cases. Antigen-induced lymphocyte proliferation was positive in more than 90% of both groups. The upper lung field was frequently involved in both groups as demonstrated by chest radiographic findings. In all of the patients with insidious BFL, the diagnosis was confirmed by positive laboratory-controlled inhalation test results.

Conclusions

Insidious BFL may be misdiagnosed as idiopathic pulmonary fibrosis if a careful history is not taken and antigen-induced lymphocyte proliferation, careful imaging evaluation, and laboratory-controlled inhalation challenge testing are not conducted. In contrast, the clinical findings of recurrent BFL are consistent with hypersensitivity pneumonitis induced by other antigens.

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Citation Excerpt :
On the other hand, there was no significance in any results for the chronic insidious bird-related HP group compared to the control disease group. For chronic insidious bird-related HP, our previous report revealed that the positive rate of sIgG against bird antigens was only 35% (6 of 17 cases),1 and in this study, the positive rates of sIgG were relatively low at 21% for pigeon, 45% for parrot and 28% for budgerigar. This result may be explained by the involvement of the immune response in HP without specific antibodies, i.e., the role of cellular immunity in the pathophysiology.
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: This work was supported by the Research Committee of the Japanese Ministry of Health and Welfare on Diffuse Pulmonary Diseases, Grant-in-Aid for Scientific Research 12670552 from the Japanese Ministry of Education, the Research on Health Sciences focusing on Drug Innovation, the Charitable Trust of Okamoto Satoshi Fund for Fibrotic Lung Disorders, and the Smoking Research Foundation.

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ORIGINAL ARTICLESClinical features of recurrent and insidious chronic bird fancier's lung

Background

Objective

Methods

Results

Conclusions

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Respir Med

J Allergy Clin Immunol

Am J Med

Am J Med

Ann Allergy Asthma Immunol

Hypersensitivity pneumonitis

J Allergy Clin Immunol

Immunopathogenesis of hypersensitivity pneumonitis

Am Rev Respir Dis

Hypersensitivity pneumonitis

West J Med

A current view of pigeon fancier's lung: a model for pulmonary extrinsic allergic alveolitis

Clin Allergy

Mortality in Mexican patients with chronic pigeon breeder's lung compared with those with usual interstitial pneumonia

Am Rev Respir Dis

Antigens in pigeon breeder's disease: isolation of a homogeneous antigen from pigeon dropping extract and its relationship to pigeon serum antigens

J Reticuloendoth Soc

Human antibodies against antigens of the sparrow, blackbird, weaver finch, canary, budgerigar, pigeon and hen using the indirect immunofluorescent technique

Clin Allergy

ORIGINAL ARTICLES
Clinical features of recurrent and insidious chronic bird fancier's lung