Revista Portuguesa de Pneumología ISSN: 0873-2159 [email protected] Sociedade Portuguesa de Pneumologia Portugal Sterclova, M.; Vasakova, M.; Metlicka, M. Significance of specific IgG against sensitizing antigens in extrinsic allergic alveolitis: Serological methods in EAA Revista Portuguesa de Pneumología, vol. 17, núm. 6, noviembre-diciembre, 2011, pp. 253-259 Sociedade Portuguesa de Pneumologia Lisboa, Portugal Available in: http://www.redalyc.org/articulo.oa?id=169722769004 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Documento descarregado de http://www.elsevier.pt el 21/05/2012. Cópia para uso pessoal, está totalmente proibida a transmissão deste documento por qualquer meio ou forma. Rev Port Pneumol. 2011;17(6):253---259 www.revportpneumol.org ORIGINAL ARTICLE Significance of specific IgG against sensitizing antigens in extrinsic allergic alveolitis: Serological methods in EAA M. Sterclova a,∗, M. Vasakova b, M. Metlicka b a Department of Respiratory Diseases, Thomayer’s University Hospital, Videnska, Prague, Czech Republic b Department of Immunology, Thomayer’s University Hospital, Videnska, Prague, Czech Republic Received 23 December 2010; accepted 20 June 2011 Available online 16 September 2011 KEYWORDS Abstract The aim of our study is to find differences in IgG in sera of potentially exposed and Aeroallergen; nonexposed individuals and to detect differences in concentrations of specific serum IgG among Hypersensitivity subjects with and without EAA. pneumonitis; Seventy-two patients being followed for suspected interstitial lung disease were included. Immunoglobulins; Specific IgG in sera were established by ImmunoCAP. Indoor environment Serum concentrations of Aspergillus fumigatus, Candida albicans IgG and mixture of moulds IgG were higher in subjects with exposure to relevant inhalation antigens (p < 0.05). Patients exposed to parrot and mammal hair mixture had higher serum concentration of specific IgG (p < 0.05). Subjects without exposure to mites had lower serum IgG to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Dermatophagoides microceras and Glycophagus domesticus (p < 0.05). Higher concentration of serum specific IgG may show previous exposure to this antigen. Even though mite specific IgG are not commonly tested in EAA patients, we suggest their immunomodulatory activity may influence susceptibility to other inhalation antigens. © 2010 Published by Elsevier España, S.L. on behalf of Sociedade Portuguesa de Pneumologia. PALAVRAS-CHAVE A importância da IgG específica contra antigénios sensibilizantes na alveolite alérgica Aeroalergénio; extrínseca: Métodos serológicos na AAE Pneumonite de hipersensibilidade; Resumo O objetivo do nosso estudo é descobrir diferenc¸as da IgG no soro de possíveis indi- Imunoglobulinas; víduos expostos e não-expostos, bem como detetar diferenc¸as de concentrac¸ões da IgG sérica Ambiente interior específico entre indivíduos com e sem AAE. Foram incluídos setenta e dois pacientes com suspeita de doenc¸a pulmonar intersticial. A IgG sérica específica foi definida pelo ImmunoCAP. ∗ Corresponding author. E-mail address: [email protected] (M. Sterclova). 0873-2159/$ – see front matter © 2010 Published by Elsevier España, S.L. on behalf of Sociedade Portuguesa de Pneumologia. doi:10.1016/j.rppneu.2011.07.001 Documento descarregado de http://www.elsevier.pt el 21/05/2012. Cópia para uso pessoal, está totalmente proibida a transmissão deste documento por qualquer meio ou forma. 254 M. Sterclova et al. As concentrac¸ões séricas de IgG para o Aspergillus fumigatus, Candida albicans e mistura de fungos foram superiores em sujeitos expostos a inalac¸ão de antigénios relevantes (p < 0,05). Os pacientes expostos a uma mistura de penas de papagaio e pelos de mamíferos apresentaram uma maior concentrac¸ão sérica da IgG específica (p < 0,05). Os indivíduos sem exposic¸ão a ácaros apresentaram menor IgG sérica para Dermatophagoides pteronyssinus, D. farinae, D. microceras e Glycophagus domesticus (p < 0,05). Uma elevada concentrac¸ão de IgG sérica específica pode indicar uma exposic¸ão prévia a este antigénio. Embora a IgG específica para os ácaros não seja normalmente testada em pacientes com AAE, referimos que a sua atividade imunomoduladora pode influenciar a suscetibilidade de outras inalac¸ões de antigénios. © 2010 Publicado por Elsevier España, S.L. em nome da Sociedade Portuguesa de Pneumologia. Introduction Table 1 Diagnostic criteria for EAA used at the Department of Respiratory Diseases, Thomayer’s University Hospital, Extrinsic allergic alveolitis (EAA) is an interstitial lung Prague. disease which develops in susceptible individuals after repeated exposure to inhalation antigens. Many antigens are Subacute Chronic capable of provoking EAA. The best studied forms of EAA History + + include farmer’s lung, summer-type pneumonitis and pigeon breeder’s disease. Recent reports suggest that the household Symptoms Dyspnoea on Dyspnoea on environment is a potent source of antigens.1 EAA follow- exertion exertion ing exposure to feather duvets, steam iron, or cat fur has Worsening after Worsening after been documented.2 --- 4 The spectrum of antigens varies not contact with contact with only with environment but also with different geographical antigen antigen 5 locations. The immune response to inhalation antigens can PFT Restriction, ↓ DLCO Restriction, ↓ DLCO be detected by production of serum specific immunoglobu- BAL ↑ Ly, ↓ CD4/CD8 Ly may be normal, lin G (IgG).6 The diagnostic value of specific serum IgG in CD4/CD8 may be EAA patients is controversial. No physiological ranges for normal or ↑ specific IgG against possible causative antigens have been HRCT GGO Centrilobular established for the Czech population. The aim of our study is and peribronchial to discover whether there are any differences in specific IgG nodules in sera of potentially repeatedly exposed and nonexposed Small nodules Reticulonodulation, individuals and above all to detect possible differences in to 5 mm honeycombing concentrations of specific serum IgG among subjects with Air-trapping, subacute EAA, chronic EAA and subjects without EAA. emphysema Mosaic perfusion Biopsy Alveolitis with Poorly defined Materials and methods intraalv. exsudate granulomas Non-necrot. poorly Interalveolar septa Study population defined granul. thickening Bronchiolitis NSIP pattern UIP pattern Seventy-two patients being followed at the Department of Respiratory Diseases for suspected interstitial lung dis- BAL, bronchoalveolar lavage; DLCO, diffusing capacity; Ly, lym- ease (between 2008 and 2010) were included in the study. phocytes; GGO, ground glass opacity; HRCT, high resolution The research process consisted of a detailed history of computed tomography; NSIP, nonspecific interstitial pneu- exposure, clinical investigation, laboratory tests including monitis; PFT, pulmonary function tests; UIP, usual interstitial pneumonitis. assessment of specific serum IgG and concentration of total serum IgG, lung function tests, bronchoscopy with bron- choalveolar lavage, cytology and flow cytometry of the recovered fluid (BALF), transbronchial biopsy and high reso- as chronic EAA and the other 37 patients formed a control lution tomography of the chest (HRCT). There are no widely group. accepted diagnostic criteria for subacute and chronic EAA. The control group consisted of 6 patients with nonspe- The diagnostic criteria used at our Department are outlined cific interstitial pneumonia, 10 with idiopathic pulmonary in Table 1. fibrosis, 4 had organising pneumonia, 7 chronic form of After completing the diagnostic programme, 15 subjects sarcoidosis, 3 carcinomatous lymfangitis and 7 were diag- matched a diagnosis of subacute EAA, 20 were diagnosed nosed with interstitial pneumonia. Serum concentrations of Documento descarregado de http://www.elsevier.pt el 21/05/2012. Cópia para uso pessoal, está totalmente proibida a transmissão deste documento por qualquer meio ou forma. Serological methods in EAA 255 Table 2 Demographic data of the study group. Table 4 Spectrum of investigated specific serum IgG. Subacute Chronic Control Mites Dermatophagoides pteronyssinus d1 Number 15 20 37 Dermatophagoides farinae d2 Age 51.2 ± 15.9 59.2 ± 14.5 58.2 ± 14.8 Dermatophagoides microceras d3 Gender 4/11 7/13 27/10 Acarus siro d70 M/W Lepidoglyphus destructor d71 Smoking 1/10/4 4/11/6 9/15/13 Tyrophagus putrescentiae d72 (smoker/ Glycophagus domesticus d73 nonsmoker/ Euroglyphus maynei d74 stopped) Moulds Moulds 1: Penicillium notatum, Cladosporium mx1 herbatum, Aspergillus fumigatus, Alternalia specific IgG were not used either for confirmation or for alternata rejection of definite diagnosis. Moulds 2: Penicillium notatum, Cladosporium mx2 Demographic data of the study group are included in herbatum, Aspergillus fumigatus, Alternalia Table 2. BAL and pulmonary function tests data are sum- alternata, Setomelanomma rostrata marized in Table 3. Cladosporium herbatum m2 Aspergillus fumigatus m3 Exposure history Candida albicans m5 Alternaria alternata m6 Exposure history was taken for each investigated group of Micropolyspora faeni Rm212 antigens (mites, moulds, mammals and birds). Subjects were Thermoactinomyces vulgaris Rm213 divided into exposed and nonexposed individuals according Mammals to the their clinical history. Hair