Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Clin Exp Allergy. 2020 Dec;50(12):1381-1390. doi: 10.1111/cea.13752. Epub 2020 Oct 18.
Chronic hypersensitivity pneumonitis (CHP) remains a diagnostic challenge. The process of collecting and extracting serum and droppings from causative animals for the inhalation challenge test is complicated and the risk of inducing disease progression exists.
To investigate the utility and safety of an inhalation challenge test using pigeon eggs.
Pigeon eggs were pasteurized and mixed with a saline solution to produce an inhalation fluid. An inhalation challenge test was conducted on 19 patients with bird-related CHP and 17 patients with interstitial lung disease other than bird-related CHP. To identify antigens in pigeon eggs, the antigen-antibody responses of the pigeon eggs and serum from patients were evaluated using Western blotting.
The mean changes in C-reactive protein, alveolar-arterial oxygen difference, erythrocyte sedimentation rate, and lactate dehydrogenase significantly increased by 0.32 mg/dL (P = .014), 7.8 Torr (P = .002), 1.4 mm/h (P = .012), and 5.4 U/mL (P = .0019), respectively, in bird-related CHP group compared to the control 24 hours after the inhalation challenge test. Furthermore, within 24 hours of the inhalation test, the mean forced vital capacity decreased by 2.3% in the bird-related CHP group compared with a decline of 0.05% in the control group (P = .035). Serum collected from seven bird-related CHP patients who underwent the inhalation challenge test and reacted to antigens with molecular weights of 37-75 KDa, and these molecular weights were consistent with egg albumin and globulin.
Since a mild response was observed after the inhalation challenge test using pigeon eggs, this test was an obvious candidate for diagnosing bird-related CHP.
慢性过敏性肺炎（CHP）仍然是一个诊断挑战。收集和提取致病动物的血清和粪便进行吸入性挑战测试的过程很复杂，并且存在诱导疾病进展的风险。
研究使用鸽蛋进行吸入性挑战测试的实用性和安全性。
将鸽蛋巴氏消毒并与生理盐水混合制成吸入液。对 19 例与鸟类相关的 CHP 患者和 17 例非与鸟类相关的间质性肺疾病患者进行了吸入性挑战测试。为了鉴定鸽蛋中的抗原，使用 Western blot 评估了鸽蛋和患者血清中的抗原-抗体反应。
与对照组相比，吸入性挑战测试后 24 小时，与鸟类相关的 CHP 组的 C 反应蛋白、肺泡-动脉氧差、红细胞沉降率和乳酸脱氢酶的平均变化分别显著增加 0.32mg/dL（P=0.014）、7.8 托（P=0.002）、1.4mm/h（P=0.012）和 5.4U/mL（P=0.0019）。此外，在吸入试验后 24 小时内，与对照组相比，与鸟类相关的 CHP 组的用力肺活量平均下降 2.3%，而对照组下降 0.05%（P=0.035）。在接受吸入性挑战测试并对分子量为 37-75 kDa 的抗原产生反应的 7 例与鸟类相关的 CHP 患者的血清中检测到这些分子量与卵白蛋白和球蛋白一致。
由于使用鸽蛋进行吸入性挑战测试后观察到轻度反应，因此该测试是诊断与鸟类相关的 CHP 的明显候选方法。
