Hypersensitivity pneumonitis in children: pigeon breeder's disease

Hypersensitivity pneumonitis (HP), an extrinsic allergic alveolitis, is a group of immunologically mediated, diffuse inflammatory lung parenchymal diseases. Pigeon breeder's disease (PBD) is one of the most common clinical forms of HP. It is caused by inhalation of various pigeon-derived materials and can present in different clinical forms. The diagnosis is difficult and the best diagnostic tool is correlation of onset of symptoms with time of exposure. Precipitating antibodies against the avian proteins form the characteristic precipitin reactions. The most effective treatment is avoidance of the antigens. Steroids, either systemic or topical (inhalational), can be used to treat HP. We report five children with different clinical forms of PBD in whom the diagnosis was confirmed by positive serum precipitating antibodies to avian proteins. Although the disease is rarely seen in children, it should be considered in any child with recurrent or unexplained respiratory symptoms. Nebulising steroids might be a useful alternative treatment for allergic alveolitis.