Orriols R, Aliaga J L, Antó J M, Ferrer A, Hernandez A, Rodrigo M J, Morell F
Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Eur Respir J. 1997 Apr;10(4):780-6.
Following the discovery of hypersensitivity pneumonitis caused by the inhalation of mollusc shell dust in two workers from a nacre-button factory, the health status of 26 workers employed in sawing mollusc shells was investigated. The evaluation included the administration of two questionnaires and radiological, functional and immunological assessments of all workers at the outset and 1 year later, when hygienic and therapeutic measures had been taken. Six workers, in whom specific inhalation challenge test was positive, were diagnosed with mollusc shell hypersensitivity pneumonitis, thus yielding a prevalence of 23%. Evidence of diffuse lung disease and systemic symptoms was found in these patients. Nonspecific bronchial hyperreactivity was also found more frequently in patients with mollusc shell hypersensitivity pneumonitis. Specific immunoglobulin G (IgG) level and specific skin testing failed to differentiate patients with mollusc shell hypersensitivity pneumonitis from other exposed workers; whereas, nonspecific skin testing, which was impaired in the patients, did differentiate. Bronchoalveolar lavage and transbronchial biopsy performed in patients with mollusc shell hypersensitivity pneumonitis were consistent with the disease. Removal from an environment containing mollusc shell dust was followed by regression of clinical, radiological and functional changes. The clinical picture of the 20 workers who did not present mollusc shell hypersensitivity pneumonitis remained unchanged, but functional decline was observed despite improvement in the environmental conditions of the factory. This report describes the first series of patients with mollusc shell hypersensitivity pneumonitis studied, and underlines the importance of careful follow-up of workers occupationally-exposed to mollusc shell dust.
在一家珍珠母纽扣厂的两名工人中发现因吸入软体动物贝壳粉尘导致过敏性肺炎后，对26名从事软体动物贝壳锯切工作的工人的健康状况进行了调查。评估包括在开始时以及采取卫生和治疗措施1年后对所有工人进行两份问卷调查以及放射学、功能和免疫学评估。6名特异性吸入激发试验呈阳性的工人被诊断为软体动物贝壳过敏性肺炎，患病率为23%。在这些患者中发现了弥漫性肺部疾病和全身症状的证据。软体动物贝壳过敏性肺炎患者中也更频繁地发现非特异性支气管高反应性。特异性免疫球蛋白G（IgG）水平和特异性皮肤试验未能将软体动物贝壳过敏性肺炎患者与其他暴露工人区分开来；而患者受损的非特异性皮肤试验则可以区分。对软体动物贝壳过敏性肺炎患者进行的支气管肺泡灌洗和经支气管活检与该病相符。脱离含有软体动物贝壳粉尘的环境后，临床、放射学和功能变化有所缓解。20名未出现软体动物贝壳过敏性肺炎的工人的临床症状保持不变，但尽管工厂环境条件有所改善，仍观察到功能下降。本报告描述了首批研究的软体动物贝壳过敏性肺炎患者系列，并强调了对职业性接触软体动物贝壳粉尘的工人进行仔细随访的重要性。
