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Hypersensitivity Pneumonitis: environmental exposure investigation.

Dr Kenneth Anderson Department of Respiratory Medicine University Hospital Crosshouse Kilmarnock Scotland

President Elect Scottish Thoracic Society 25 years E&O lectures University of Glasgow

Disclosures None

Dr Kenneth Anderson, Consultant Physician

March 2016

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Gravimetric determination of dust and antigen exposure in pigeon breeders. G Morris, K Anderson, et al. Annals of Occup Hygiene 1994; 38(sup 1): 919-22

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Anderson K, et al Thorax. 1988;43:798-800

K Anderson et al Thorax 1988; 43: 798-800

— Case : 29yrs male non smoker athlete — 6 months short of breath — Cough initially dry then productive — Fever; muscle ache; backache — weight loss 15 kg — end of working day bad, good on hols — some crackles over lung fields

K Anderson et al Thorax 1985;40:312-3

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Serial Pulmonary Function

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Hypersensitivity Pneumonitis ??

Survey symptoms Factory 1 n=40 Factory 2 n=17 chest tightness 15/250 13/22 headache 24/250 4/22 chills 17 -- 3 -- breathlessness 15 -- 1-- wheeze 11 -- 0 -- poor appetite 10 -- 0 -- weight loss 6 -- 0 -- fever 8 -- 13 -- tiredness 26 -- 0 –

K Anderson MD thesis Univ Glasgow 1989

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Thanks to Dr J Edwards, Cardiff

Inhalational Fevers

— Humidifier fever

— Byssinosis

— Metal fume fever

— Grain workers

— Polymer fumes (smokers)

— Endotoxin

— Lake water fever

— Pulmonary mycotoxicosis

— Sump-bay fever

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Sump-bay fever: inhalational fever associated with a biologically-contaminated water aerosol. K Anderson, et al Occup and Env Medicine 1996; 53:106-111.

Sump-Bay Fever — shivers — ‘flu’ — muscle aches, tiredness — chest tightness — shortness of breath, wheeze, cough — headache — well following day — late afternoon evening

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Sump-Bay Fever : endotoxin

— Glasgow tap water 23.90

— dump sump 1055

— main sump 1055

— large pump drain funnel 938.4

— small pump dead leg valve 29000

— large pump oil sump dead area 57030

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43 yr old male cheeseworker

— Short of breath walking upstairs — Never smoked — Blue cheese maker, Penicillium roqueforti — Better off work, symptoms when back — DLCO 45%, FVC 95%, FEV 92% — Rarely reported syndrome. First case in UK. — 5K artisan cheeseries in the UK. Environmental assessment of hypersensitivity pneumonitis in a Scottish cheesery.A Hamilton, MD Richardson, K Anderson. Scottish Thoracic Society. 2015

Aspergillosis in immunocompromised paediatric patients: associations with building hygiene, design and indoor air. K Anderson, et al Thorax 1996; 51: 256-61.

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Pulmonary infiltration after home-renovation dust exposure : histopathology and microanalysis. K.Anderson, et al Thorax 1996; 51: 654-655.

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Thanks to

— Charlie McSharry

— Ruth Adamson

— Phil Lynch

— Gavin Boyd

— Malcolm Richardson

and about forty others.

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