Table 2.
Sources of Antigens Known to Cause HP
| Matter | Typical Sources | HP “Disease” |
|---|---|---|
| Organic particulate matter |
|
|
| I. Microbes |
|
|
| Fungi/molds |
|
|
| Aspergillus spp. | Contaminated plant material | Farmer’s lung |
| Alternaria alternata, Aureobasidium spp. | Contaminated water | Humidifier lung |
| Botrytis cinerea | Contaminated houses (flooded) | Malt worker’s lung |
| Cephalosporium spp. | Upholstered furniture | Woodworker’s lung |
| Cladosporium spp. | Contaminated stucco | Indoor-air alveolitis (domestic HP) |
| Cryptococcus spp. | Contaminated raw materials in food-processing industry | Compost lung |
| Fusarium spp. | Organic wastes | Mushroom grower’s lung |
| Graphium spp. | Contaminated sawdust | Malt worker’s lung |
| Mucor spp. | Moldy wood | Stucco worker’s lung |
| Penicillium spp. | Aspergillus enzyme in baking agents | Suberosis |
| Rhizopus spp. | Contaminated domestic ventilation and cooling systems | Baker’s lung |
| Trichoderma spp. | Potted flowers, greenhouses | Waste sorter’s lung |
| Phytase (enzyme from Aspergillus or Trichoderma) | Mold on grapes | Sauna taker’s lung |
| Contaminated wind instruments | Wine grower’s lung | |
| Contaminated soil | Wind-instrument alveolitis | |
| Peat | Sequoiosis | |
| Peat worker’s lung | ||
| Cheese washer’s lung | ||
| Salami producer’s lung | ||
| Phytase alveolitis | ||
| Yeasts | ||
| Candida spp. | Contaminated misting fountains and humidifiers | Humidifier lung |
| Geotrichum candidum | Moldy hay, compost, mushrooms | Farmer’s lung |
| Saccharomyces cerevisiae | Contaminated swimming pools | Footcare alveolitis |
| Saccharomonospora viridis | Contaminated wind instruments | Candida alveolitis |
| Saccharopolysporarectivirgula | Human intestine, fingernails, and skin | Indoor-air alveolitis |
| Torulopsis glabrata | Milk mold | Yeast-powder alveolitis |
| Trichosporon cutaneum | Baker’s yeast, brewer’s yeast, wine yeasts | Thatched-roof lung |
| Contaminated houses | Mushroom worker’s lung | |
| Dried grasses, leaves | Summer-type HP | |
| Compost | Wind-instrument lung | |
| Mushrooms | ||
| Edible mushrooms | ||
| Mushrooms (shiitake, bunashimeji, Pleurotus, Pholiota, Lyophyllum, Agaricus) | Mushrooms growing in indoor environments | Mushroom grower’s lung |
| Bacteria | ||
| Acinetobacter spp. | Contaminated water, whirlpools | Machine operator’s lung |
| Bacillus spp. | Contaminated machine fluid | Humidifier lung |
| Klebsiella spp. | Sewage treatment plants | Woodworker’s lung |
| Nontuberculous mycobacteria | Sawdust | Detergent worker’s alveolitis |
| Phoma spp. | Moist wood | Summer-type HP |
| Pseudomonas spp. | Detergents | Farmer’s lung |
| Stenotrophomonas spp. | Biological cleaning agents | Hot-tub lung |
| Staphylococcus spp. | Washing powders | Whirlpool alveolitis |
| Streptomyces spp. | Contaminated houses | Wind-instrument alveolitis |
| Thermoactinomyces spp. | Moldy plants | Indoor-air alveolitis |
| Endotoxin from pool-water sprays and fountains | Contaminated wind instruments | Steam-iron alveolitis |
| Bacillus subtilis enzymes (subtilisin) | Moldy shower curtains | Mushroom grower’s lung |
| Compost | Thatched-roof disease | |
| Edible mushroom manure | Bagassosis | |
| Contaminated soil | Compost lung | |
| Moldy thatched roofs | ||
| Protozoa | ||
| Amoebae | Contaminated humidifiers and air-conditioning systems | Humidifier lung |
| Nematodes | ||
| Nematodes | Contaminated humidifiers and air-conditioning systems | Humidifier lung |
| Mite | ||
| Acarus siro | Contaminated cheese | — |
| II. Proteins/enzymes | ||
| Animal proteins | ||
| Animal fur dust | Animal pelts | Furrier’s lung |
| Avian droppings, serum, and feathers | Parakeets, canaries, budgerigars, pigeons, parrots, chicken, turkeys, geese, ducks, wild birds, pheasants | Bird fancier’s disease, bird breeder’s disease, pigeon breeder’s lung, chicken breeder’s lung |
| Avian feathers | Feather beds, pillows, duvets | Feather-duvet lung |
| Bats | Contact with bats | — |
| Carmine (from Coccus cacti) | Food and cosmetics | Carmine alveolitis, dyer’s lung |
| Cow milk | Cow milk | Heiner syndrome |
| Fish feed | Daphnia, meat, mosquito larvae | Fish-feed alveolitis |
| Fish meal | Animal feed | Fish-meal alveolitis |
| Shell protein (oyster, sea snail, mussels) | Oyster-shell powder | Shellfish alveolitis, oyster-shell HP, mollusk-shell HP |
| Pig pancreas | Animal extracts | — |
| Pituitary proteins | Pituitary powder | Pituitary snuff-taker’s lung |
| Rat and desert mouse (gerbil) urine, serum, pelts | Rats, gerbils | Alveolitis due to rat and mouse proteins |
| Silkworm proteins | Dust from silkworm larvae and cocoon | Silkworm rearer’s lung |
| Weevils (corn, wheat) (Sitophilus spp.) | Contaminated grain or flour | Corn (wheat)–weevil lung |
| Plant proteins | ||
| Alginate | Seaweed | — |
| Argan cake | Cosmetics, unsaturated fatty acids, phytosterol | — |
| Catechin | Green-tea powder | — |
| Esparto dust | Esparto grass | Esparto lung, plasterer’s lung |
| Grain flour (wheat, rye, oats, maize) | Flour dust | Flour-dust alveolitis |
| Malt | Food-processing industry | — |
| Legumes (soy) | Legumes (soya) flour dust | Soya-dust alveolitis |
| Paprika | Paprika dust | Paprika splitter’s lung |
| Pyrethrum | Plant-based insecticide | — |
| Spinach | Spinach powder | — |
| Tiger nut | Horchata (drink) | Tiger-nut alveolitis |
| Wood (cabreuva, cedar, mahogany, pine, ramin, umbrella pine) | Wood particles | Wood fiber alveolitis |
| Inorganic particulate matter | ||
| I. Chemicals | ||
| Acid anhydrides (pyromellitic and trimellitic anhydrides) | Polyurethane foams, spray paints, elastomers, glues, adhesives, mattresses, car parts, shoes, imitation leather, rubber products, chipboards, elastic synthetic fibers, electrical insulations | Acid anhydride alveolitis |
| Acrylate compounds (methyl methacrylate) | Dental materials, lacquer, resin, glues | Methacrylate alveolitis |
| Copper sulfate | Copper-sulfate Bordeaux mixture | Vineyard sprayer’s lung |
| Chloroethylene (trichlorethylene) | Degreasing agents, cleaning agents, extraction agents | Chemical alveolitis |
| Dimethyl phthalate and styrene | Industrial solvents, plasticizers | — |
| HFC-134a | Coolant fluid in laser hair-removal devices | Hair-remover lung |
| Isocyanates (toluene diisocyanate, methylene diphenyl diisocyanate, hexamethylene diisocyanate, MIC, NDI, polyisocyanate) | As in acid anhydrides | Isocyanate alveolitis |
| Tetrachlorophthalic and hexahydrophthalic acid | Hardener for epoxy resin | Acid anhydride alveolitis |
| Sodium diazobenzene sulfate | Laboratory reagent, chromatography | Chemical alveolitis |
| Triglycidyl isocyanurate | Polyester powder (powder paints) | Painter’s lung |
| | ||
| II. Pharmaceutical agents | ||
| Penicillins, cephalosporins | Antibiotics | Drug-induced HP |
| Methotrexate | Immunosuppressive agents | |
| α-IFN | Immunomodulatory agents | |
| Lenalidomide | Hypolipidemics | |
| Pravastatin | Antidepressants | |
| Venlafaxine | Alkylating agents | |
| Temozolomide | ||
| III. Metals | ||
| Cobalt | Hard metals, alloys | Giant cell pneumonitis |
| Zinc (tungsten and alloys) | Zinc fumes | Zinc-fumes alveolitis |
| Zirconium | Zircon | Zirconium alveolitis |
| Beryllium | Batteries, computers, neons | Beryllium HP |
| TMI | Organometallic compound for semiconductors used in industry | — |
Definition of abbreviations: HFC-134a = hydrofluorocarbon 134a; HP = hypersensitivity pneumonitis; MIC = methylisocyanate; NDI = naphtylene-1,5-diisocyanate; TMI = trimethylindium.
Adapted from Reference 11.