Subpopulations of T cells in lung biopsies from patients with pigeon breeder's disease

Monoclonal antibodies were used to determine surface phenotypes of T cells in tissue obtained by open lung biopsies from patients with chronic hypersensitivity pneumonitis (pigeon breeder's disease). The results indicate that an increased number of suppressor/cytotoxic cells is present in these patients when compared with the number of helper/inducer cells. These findings, which were present within the interstitium, are consistent with those found in bronchoalveolar lavage of patients with this disease. In addition, in two-thirds of the patients there was a greater total number of helper and suppressor cells than the total count for Pan T cells. A possible interpretation of these findings might be the presence of both markers in the same cell.

Immunodetection by enzyme-linked immuno-filtration assay (ELIFA) of IgG, IgM, IgA and IgE antibodies in bird breeder's disease

The diagnosis of bird breeder's lung (BBL) depends upon a range of epidemiological, clinical, radiological and immunological arguments. The simple detection of antibodies cannot constitute a pathognomonic criterion of BBL. We applied the enzyme-linked immuno-filtration assay (ELIFA) to the study of 50 sera chosen from 2509 samples taken from subjects exposed to avian antigens. The arc-IgAp was detected in all sera samples (n = 27) taken from symptomatic subjects (n = 16), but was only demonstrated 3 times out of 2466 samples taken from exposed asymptomatic subjects. The ELIFA method revealed IgG, IgM, IgA and IgE precipitating antibodies only in the case of clinically ill subjects. Finally, this technique demonstrated a second functional antigenic component (arc-P2) which preferentially induced specific immunoglobulins of different classes. Compared immunological profiles (CIP), established by ELIFA, seem to be highly significant for BBL, and correlate well with pathological symptoms and their evolution.

Increase of HLA-DR7 in pigeon breeder's lung in a Mexican population

The phenotypes of the major histocompatibility complex, loci A, B, C, and DR, were studied in 48 patients with hypersensitivity pneumonitis induced by avian antigen (pigeon breeder's lung) and the results were compared to those obtained from 200 normal subjects of similar ethnic background. Furthermore, we analyzed the delta values of the observed and expected frequencies in the deduced haplotypes of the affected population. Our results showed a significant increase of the antigen HLA-DR7 (corrected P less than 0.001) in patients with pigeon breeder's lung and an equally important difference in the delta values of the haplotypes A1-B8, A25-B14, B35-DR4, and B4-DR5. In addition, the phenotypes of locus DQ were analyzed in 21 patients and 20 controls and no apparent differences were observed. These results suggest that a multifactorial genetic susceptibility associated at least in part with the major histocompatibility complex plays in important role in the development of this disease.

Immunoglobulin G4 in pigeon breeder's disease

Immunoglobulin G4 has previously been implicated in the pathogenesis of pigeon breeder's disease (PBD), a form of hypersensitivity pneumonitis associated with inhalation of pigeon antigens. We investigated the presence of IgG4 antibody to antigens in pigeon dropping extracts (PDE) in the lungs of pigeon breeders. Seven of these subjects had symptoms of PBD and eight others had no symptoms. IgG4 antibody to PDE was compared with IgG3 levels because both were relatively minor subclasses, but IgG3 is not considered reaginic whereas IgG4 is. An increase in IgG4 antibody relative to IgG3 would therefore be considered a selective increase and suggest a role for this subclass in the development of PBD. Our results, however, indicated that pigeon breeders without symptoms had significantly higher levels of serum IgG4 and that there were no significant differences with regard to the lavage fluid levels of IgG4, IgG3, or total IgG antibody in the two groups of subjects. A tendency of higher IgG4 antibody levels was found in lavage fluid from subjects without symptoms. These results do not support the hypothesis that IgG4 may act as a reaginic trigger in the development of PBD symptoms.

Antibodies against hen's egg proteins in pigeon breeder's disease

The serum of patients with pigeon breeder's lung (PBL) contains IgG-class antibodies against pigeon serum proteins. These antibodies cross-react strongly with the sera of other avian species. Cross-reactivity, as demonstrated by precipitation, complement fixation, haemagglutination and microELISA, is also exhibited with the water-soluble proteins in hen's egg yolk and egg white. The phenomenon appears to be due to the presence of hen serum proteins in the eggs, which occur particularly concentrated among the water-soluble proteins in the yolk ('livetins'). It is proposed that anti-egg antibodies may explain the frequent serological finding of 'false-positive' asymptomatic pigeon breeders.

Skin tests in bird breeder's disease

The diagnostic value of skin tests was assessed in 35 patients affected by bird breeder's disease by comparing the results with those obtained in a group of 27 symptomless breeders and 10 symptomless unexposed individuals. Sterilised and diluted serum and lyophilised extracts of faeces prepared from the breeder's own birds were injected intradermally. Skinprick tests using the same materials were carried out simultaneously. The intradermal test using serum showed a positive reaction in 18 out of 20 patients tested and in three out of 20 symptomless breeders (p less than 0.0005); later reactions occurred in eight of the patients and one of the symptomless breeders (p less than 0.01). A delayed reaction was seen in five of the patients and one of the symptomless breeders (p = 0.09). No positive reactions were recorded in symptomless unexposed individuals. Intradermal skin testing using extracts of faeces yielded an immediate reaction in 19 of 21 patients and in three of 11 symptomless breeders tested (p less than 0.001); a late reaction was seen in 18 of the patients and in five of the symptomless breeders (p less than 0.05). Delayed reactions occurred in 11 of the 21 patients tested, whereas no positive responses were seen in symptomless breeders (p less than 0.025). Skinprick tests gave negative results in all cases. Skin testing constitutes a simple, quick, and safe procedure that can assist the differential diagnosis between individuals with bird breeder's disease and symptomless breeders, the immediate reaction being similar in its sensitivity to testing for serum precipitins but possessing greater specificity.

Louis E. Siltzbach Memorial Lecture. Concepts of pathogenesis and lung reactivity in hypersensitivity pneumonitis

It is surprising that forms of hypersensitivity pneumonitis do not occur more frequently, given the variety of biologic dusts and airborne antigens that have been found to cause disease. Exposure is almost universal in some occupations that involve handling animals or feed products, and development of humoral immunity occurs in most; however, overt respiratory illness is relatively infrequent or not easily recognized by the subject. What differs between symptomatic and asymptomatic subjects is not certain, but unique host resistance or susceptibility, as the case may be, appears to be a factor. This may have a genetic basis, but this has not been investigated vigorously. With repeated airborne exposure to appropriate antigens, a humoral and a local respiratory antibody response occur but perhaps with little disease consequence, as most subjects so immunized remain clinically asymptomatic. So far as is known, there is no other route of antigenic exposure except through the respiratory tract, but contact with the antigens could occur on the skin or on mucosal surfaces such as the conjunctiva, or antigens could be ingested by swallowing nasopharyngeal secretions. Except for serum antibodies, however, there is little documentation that other systemic organs are affected, as may occur with sarcoidosis. Of course there is great variability in the age of the subjects and the dosage of antigen to which the subject is exposed, and the frequency and duration of exposure can vary considerably. All of these would seem to be easily tested, however, in an animal model where most of the variables could be independently controlled and varied at will. Even the genetic and aging factors, which are the most difficult parameters to control in humans, could be investigated. Yet, it has been very difficult and perplexing not to have created a more faithful model of hypersensitivity pneumonitis in the laboratory. It is virtually impossible to cause predictable lung disease without the use of an adjuvant that will induce some measure of delayed or cellular hyperreactivity. The acute lung disease caused by antigen-antibody reactions seems too explosive and severe, for its acute disease counterpart of hypersensitivity pneumonitis in humans and the persistence of histologic changes in lung tissue is brief and is usually resolved within 1-2 weeks. A chronic model producing granulomas and fibrosis has been difficult to construct, although the work reported by Fulmer and colleagues is very encouraging.(ABSTRACT TRUNCATED AT 400 WORDS)

Relationships between avian exposure, humoral immune response, and pigeon breeders' disease among Scottish pigeon fanciers

In a large scale clinical survey of Scottish pigeon fanciers, 277 people completed a detailed questionnaire and provided a venous blood sample. There were 29 (10.4%) who fulfilled the clinical criteria for pigeon breeders' disease used in the study and 84 (30.3%) who showed a significant serum IgG antibody response to pigeon gammaglobulin (4 micrograms/ml) and were considered to have been sensitised. Increasing exposure was associated with a progressive tendency towards sensitisation, but the intensity of the antibody response was related to the presence of symptoms and not the degree of exposure. Thirteen out of 15 subjects in the survey with a serum concentration of antipigeon IgG greater than 60 micrograms/ml fulfilled the clinical criteria for pigeon breeders' disease, and those affected within 10 years of starting the hobby had the highest mean antibody response. Accurate quantitation of antibody response is therefore helpful in the investigation of pigeon breeders' disease. The radioimmunoassay provides a quantitative method for determining antibody response that can be used in the routine screening of pigeon fanciers and in serial monitoring of their response.

[Exogenous allergic alveolitis in patients at secondary health facilities]

In order to avoid the transition into an irreversible pulmonary fibrosis a diagnosis of the exogenic allergic alveolitis as early as possible is necessary. On the basis of 8 own cases the importance of a correct interpretation of the in detail not specific clinical and radiological symptoms as well as of the with regard to possible inhalative allergen loads directed establishment of the anamnesis is described.

A component of pigeon dropping extract that reacts specifically with sera of individuals with pigeon breeder's disease

A component of pigeon droppings has been demonstrated to react with sera of individuals with pigeon breeder's disease, a form of hypersensitivity pneumonitis, by crossed isoelectric focusing. Similarly, exposed but asymptomatic pigeon breeders do not exhibit antibody to this component, even though they possess significant levels of antibody to other components of pigeon droppings. Purification of this disease-specific component of pigeon dropping was attempted by preparative isoelectric focusing, gel filtration, and affinity chromatography on an immunoadsorbent prepared with asymptomatic antibody. After repeated passage over the affinity column, complete purification could not be achieved. A rabbit antiserum made against the partially purified component revealed the presence of at least one other component that did not react with either symptomatic or asymptomatic sera. Despite these contaminants, the disease-specific component was characterized as a single polypeptide having a molecular weight of approximately 50,000 daltons and having an isoelectric point between 3.5 and 5.1.

Immunoglobulin E antibodies against budgerigar and canary feathers

In 212 sera from budgerigar and canary fanciers with symptoms of rhinitis and/or bronchial asthma, IgE antibodies against budgerigar feathers (Budf) or canary feathers (Canf) were determined. In 25 of 98 Canf-specific IgE antibody measurements, and in 28 of 154 Budf-specific IgE antibody measurements, a significant (6% or more binding of 125I-anti-IgE) level of specific IgE was found. In 3 sera with the highest levels of Canf- or Budf-specific IgE, IgE antibodies against sera from both birds were present. It is concluded that IgE antibodies against canary and/or budgerigar feathers are present in about 20% of canary and budgerigar fanciers with symptoms of atopic disease. Canary and budgerigar feathers contain IgE-binding antigens that are not present in the corresponding bird sera and droppings.

Immunoregulation in hypersensitivity pneumonitis: phenotypic and functional studies of bronchoalveolar lavage lymphocytes

We examined the immunologic phenotype and function of bronchoalveolar lymphocytes isolated from 4 pigeon breeders who developed symptoms of hypersensitivity pneumonitis on exposure to pigeons, and 6 asymptomatic but equally exposed individuals. Similar numbers of bronchoalveolar lymphocytes were found in symptomatic breeders compared with the asymptomatic, and the percent of T11, T4, and T8 bearing cells as well as the T4/T8 ratios were similar in both groups. Despite these similarities, the groups had significantly different functional activity. Bronchoalveolar lymphocytes from symptomatic breeders demonstrated a marked (p less than 0.001) increase in blastogenic activity to both phytohemagglutinin and pigeon serum stimulation when compared with asymptomatic breeders. In addition, enriched bronchoalveolar T-cells suppressed the response of autologous preincubated peripheral blood lymphocytes to both phytohemagglutinin and pigeon serum in the asymptomatic compared with the symptomatic breeders. These studies suggest a discrepancy between the phenotype and function of immunoregulatory T-cell subsets in bronchoalveolar lavage lymphocytes in pigeon breeder's disease, and support a role for functional immunoregulatory imbalances in the pathogenesis of hypersensitivity pneumonitis.