Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, School of Medicine and VA Northern California Health Care System, 4150 V Street, Sacramento, CA 95817, USA.
Clin Rev Allergy Immunol. 2012 Aug;43(1-2):69-83. doi: 10.1007/s12016-011-8282-y.
Bird fancier's lung (BFL) resulting from avian antigen exposure is a very common form of hypersensitivity pneumonitis. Its pathogenesis is modified by genetic polymorphisms located within the major histocompatibility complex, and also by smoking, which may decrease serum antibody response to inhaled antigen. Acute, subacute, and chronic presentations of BFL are recognized, but often overlap clinically. Continued antigen exposure in the chronic phase portends a worse prognosis. Chronic bronchitis symptoms may be part of the BFL clinical spectrum, and rhinitis may suggest an allergic component. The diagnosis of BFL is enhanced by a high index of suspicion of exposure to avian antigen, recurrent symptomatic episodes occurring 4-8 h after exposure, inspiratory "velcro" crackles on auscultation, weight loss, and positive IgG precipitins to the antigen. Characteristic findings on high-resolution computed tomography of the chest include centrilobular nodules, ground-glass opacification, and mosaicism due to air trapping. Bronchoalveolar lavage will classically show >25% lymphocytosis, a CD4/CD8 ratio of <1.0 and >1% mast cells in the acute phase. Lung biopsies, if obtained in the subacute phase of the disease, typically show loosely formed granulomas, giant cells, a lymphoplasmacytic interstitial infiltrate, and possibly some degree of fibrosis. In some patients, usual interstitial pneumonia or fibrotic non-specific interstitial pneumonia patterns may be seen on surgical biopsy. Skin testing, serological testing, and bronchial provocation tests for BFL frequently suffer from a lack of standardization. Effective treatment for BFL consists mainly of antigen avoidance, as corticosteroids likely do not alter long-term prognosis. Lung transplantation can be considered for progressive chronic disease refractory to medical measures.
养鸟者肺（BFL）是一种由禽类抗原暴露引起的非常常见的过敏性肺炎形式。其发病机制受主要组织相容性复合体中基因多态性的修饰，也受吸烟的影响，吸烟可能会降低血清对吸入性抗原的抗体反应。BFL 的急性、亚急性和慢性表现形式已被识别，但临床上常重叠。在慢性期持续暴露于抗原预示着预后更差。慢性支气管炎症状可能是 BFL 临床谱的一部分，而鼻炎可能提示过敏成分。通过高度怀疑暴露于禽抗原、暴露后 4-8 小时出现反复症状发作、听诊吸气时“嘎吱”声、体重减轻和对抗原的 IgG 沉淀素阳性，可增强对 BFL 的诊断。胸部高分辨率计算机断层扫描的特征性发现包括小叶中心结节、磨玻璃影和马赛克征，这是由于空气潴留引起的。支气管肺泡灌洗通常会显示出>25%的淋巴细胞增多、CD4/CD8 比值<1.0 和急性期中>1%的肥大细胞。如果在疾病的亚急性阶段获得肺活检，通常会显示出松散形成的肉芽肿、巨细胞、淋巴浆细胞间质浸润，以及可能存在一定程度的纤维化。在一些患者中，外科活检可能会看到普通间质性肺炎或纤维化非特异性间质性肺炎模式。养鸟者肺的皮肤测试、血清学测试和支气管激发试验常常缺乏标准化。BFL 的有效治疗主要包括抗原回避，因为皮质类固醇可能不会改变长期预后。对于对医疗措施无反应的进行性慢性疾病，可以考虑进行肺移植。
