Abstract
Three workers developed classical extrinsic allergic alveolitis while working in a printing works that had a contaminated cold water humidifier. All had nodular shadows on their chest radiographs, reduced gas transfer measurements, and lung biopsy specimens that showed an alveolitis with giant cells and cholesterol clefts. In two subjects bronchoalveolar lavage was performed and the lavage fluid contained more than 70% lymphocytes in each case. Bronchial provocation tests with the humidifier antigen in these two workers reproduced their symptoms. Unlike previously reported cases, where exposure was to humidifiers working at generally higher temperatures, challenge with thermophilic actinomycetes in our two patients produced no reaction. Tests for precipitins to the humidifier antigen gave strongly positive reactions in the three workers but no single organism isolated from the humidifier produced a significantly positive reaction.
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Selected References
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- Anderson K., McSharry C. P., Boyd G. Radiographic changes in humidifier fever. Thorax. 1985 Apr;40(4):312–313. doi: 10.1136/thx.40.4.312. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Arnow P. M., Fink J. N., Schlueter D. P., Barboriak J. J., Mallison G., Said S. I., Martin S., Unger G. F., Scanlon G. T., Kurup V. P. Early detection of hypersensitivity pneumonitis in office workers. Am J Med. 1978 Feb;64(2):236–242. doi: 10.1016/0002-9343(78)90051-7. [DOI] [PubMed] [Google Scholar]
- Banaszak E. F., Thiede W. H., Fink J. N. Hypersensitivity pneumonitis due to contamination of an air conditioner. N Engl J Med. 1970 Aug 6;283(6):271–276. doi: 10.1056/NEJM197008062830601. [DOI] [PubMed] [Google Scholar]
- Burge P. S., Finnegan M., Horsfield N., Emery D., Austwick P., Davies P. S., Pickering C. A. Occupational asthma in a factory with a contaminated humidifier. Thorax. 1985 Apr;40(4):248–254. doi: 10.1136/thx.40.4.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burke G. W., Carrington C. B., Strauss R., Fink J. N., Gaensler E. A. Allergic alveolitis caused by home humidifiers. Unusual clinical features and electron microscopic findings. JAMA. 1977 Dec 19;238(25):2705–2708. [PubMed] [Google Scholar]
- Cavagna G., Foà V., Vigliani E. C. Effects in man and rabbits of inhalation of cotton dust or extracts and purified endotoxins. Br J Ind Med. 1969 Oct;26(4):314–321. doi: 10.1136/oem.26.4.314. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Edwards J. H., Cockcroft A. Inhalation challenge in humidifier fever. Clin Allergy. 1981 May;11(3):227–235. doi: 10.1111/j.1365-2222.1981.tb01588.x. [DOI] [PubMed] [Google Scholar]
- Edwards J. H., Davies B. H. Inhalation challenge and skin testing in farmer's lung. J Allergy Clin Immunol. 1981 Jul;68(1):58–64. doi: 10.1016/0091-6749(81)90124-x. [DOI] [PubMed] [Google Scholar]
- Fink J. N., Banaszak E. F., Barboriak J. J., Hensley G. T., Kurup V. P., Scanlon G. T., Schlueter D. P., Sosman A. J., Thiede W. H., Unger G. F. Interstital lung disease due to contamination of forced air systems. Ann Intern Med. 1976 Apr;84(4):406–413. doi: 10.7326/0003-4819-84-4-406. [DOI] [PubMed] [Google Scholar]
- Fink J. N., Banaszak E. F., Thiede W. H., Barboriak J. J. Interstitial pneumonitis due to hypersensitivity to an organism contaminating a heating system. Ann Intern Med. 1971 Jan;74(1):80–83. doi: 10.7326/0003-4819-74-1-80. [DOI] [PubMed] [Google Scholar]
- Finnegan M. J., Pickering C. A., Davies P. S., Austwick P. K. Factors affecting the development of precipitating antibodies in workers exposed to contaminated humidifiers. Clin Allergy. 1985 May;15(3):281–292. doi: 10.1111/j.1365-2222.1985.tb02286.x. [DOI] [PubMed] [Google Scholar]
- Friend J. A., Gaddie J., Palmer K. N., Pickering C. A., Pepys J. Extrinsic allergic alveolitis and contaminated cooling-water in a factory machine. Lancet. 1977 Feb 5;1(8006):297–300. doi: 10.1016/s0140-6736(77)91839-6. [DOI] [PubMed] [Google Scholar]
- Hendrick D. J., Marshall R., Faux J. A., Krall J. M. Positive "alveolar" responses to antigen inhalation provocation tests: their validity and recognition. Thorax. 1980 Jun;35(6):415–427. doi: 10.1136/thx.35.6.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hodges G. R., Fink J. N., Schlueter D. P. Hypersensitivity pneumonitis caused by a contaminated cool-mist vaporizer. Ann Intern Med. 1974 Apr;80(4):501–504. doi: 10.7326/0003-4819-80-4-501. [DOI] [PubMed] [Google Scholar]
- Jamison J. P., Lowry R. C. Branchial challenge of normal subjects with the endotoxin of Enterobacter agglomerans isolated from cotton dust. Br J Ind Med. 1986 May;43(5):327–331. doi: 10.1136/oem.43.5.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Keller H., Spengler H., Latscha U. Befeuchterfieber. Schweiz Med Wochenschr. 1972 Jun 24;102(25):865–872. [PubMed] [Google Scholar]
- Liebert C. A., Hood M. A., Deck F. H., Bishop K., Flaherty D. K. Isolation and characterization of a new Cytophaga species implicated in a work-related lung disease. Appl Environ Microbiol. 1984 Nov;48(5):936–943. doi: 10.1128/aem.48.5.936-943.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marinkovich V. A., Hill A. Hypersensitivity alveolitis. JAMA. 1975 Mar 3;231(9):944–947. [PubMed] [Google Scholar]
- Miller M. M., Patterson R., Fink J. N., Roberts M. Chronic hypersensitivity lung disease with recurrent episodes of hypersensitivity pneumonitis due to a contaminated central humidifer. Clin Allergy. 1976 Sep;6(5):451–462. doi: 10.1111/j.1365-2222.1976.tb01929.x. [DOI] [PubMed] [Google Scholar]
- PESTALOZZI C. [Febrile group diseases in a carpentry shop caused by inhalation of moisture from air humidifiers contaminated with molds]. Schweiz Med Wochenschr. 1959 Jul 4;89:710–713. [PubMed] [Google Scholar]
- Pickering C. A., Moore W. K., Lacey J., Holford-Strevens V., Pepys J. Investigation of a respiratory disease associated with an air-conditioning system. Clin Allergy. 1976 Mar;6(2):109–118. doi: 10.1111/j.1365-2222.1976.tb01888.x. [DOI] [PubMed] [Google Scholar]
- Reynolds H. Y., Fulmer J. D., Kazmierowski J. A., Roberts W. C., Frank M. M., Crystal R. G. Analysis of cellular and protein content of broncho-alveolar lavage fluid from patients with idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonitis. J Clin Invest. 1977 Jan;59(1):165–175. doi: 10.1172/JCI108615. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rylander R., Haglind P. Airborne endotoxins and humidifier disease. Clin Allergy. 1984 Jan;14(1):109–112. doi: 10.1111/j.1365-2222.1984.tb02197.x. [DOI] [PubMed] [Google Scholar]
- Salvaggio J., Phanuphak P., Stanford R., Bice D., Claman H. Experimental production of granulomatous pneumonitis. Comparison of immunological and morphological sequelae with particulate and soluble antigens administered via the respiratory route. J Allergy Clin Immunol. 1975 Nov;56(5):364–380. doi: 10.1016/0091-6749(75)90130-x. [DOI] [PubMed] [Google Scholar]
- Shimazu K., Ando M., Sakata T., Yoshida K., Araki S. Hypersensitivity pneumonitis induced by Trichosporon cutaneum. Am Rev Respir Dis. 1984 Sep;130(3):407–411. doi: 10.1164/arrd.1984.130.3.407. [DOI] [PubMed] [Google Scholar]
- Tourville D. R., Weiss W. I., Wertlake P. T., Leudemann G. M. Hypersensitivity pneumonitis due to contamination of home humidifier. J Allergy Clin Immunol. 1972 Apr;49(4):245–251. doi: 10.1016/0091-6749(72)90087-5. [DOI] [PubMed] [Google Scholar]
- Weinberger S. E., Kelman J. A., Elson N. A., Young R. C., Jr, Reynolds H. Y., Fulmer J. D., Crystal R. G. Bronchoalveolar lavage in interstitial lung disease. Ann Intern Med. 1978 Oct;89(4):459–466. doi: 10.7326/0003-4819-89-4-459. [DOI] [PubMed] [Google Scholar]
- van Assendelft A., Forsén K. O., Keskinen H., Alanko K. Humidifier-associated extrinsic allergic alveolitis. Scand J Work Environ Health. 1979 Mar;5(1):35–41. doi: 10.5271/sjweh.2673. [DOI] [PubMed] [Google Scholar]