Hypersensitivity Pneumonitis in Farmers: Improving Etiologic Diagnosis to Optimize Counselling

In a farmer, a diagnosis of hypersensitivity pneumonitis (HP) might cause drastic changes in life, and guidance concerning future prospects within farming requires a best possible etiological diagnosis. We aimed to assess (1) if immunological analyses based on material samples from the work environment could be used to improve the etiologic diagnosis in a farmer suffering from HP, and (2) if combining a longitudinal immunological investigation of workplace material with a realistic work place inhalation challenge could be used to optimize counselling with respect to further employment within farming. A realistic workplace inhalation challenge was performed to explore potential associations between exposure, symptoms and immune responses. Material samples were collected from various places on the farm, and enzyme-linked immunosorbent assay (ELISA) was performed to identify possible IgE and IgG antibodies in patient serum towards these material samples. Electrophoresis (SDS-PAGE) and immunoblot were used to detect the specific proteins in the material samples that were recognized by ELISA. The patient's symptoms were reproduced by the workplace challenge, and more severe symptoms were associated with increased serum levels of specific IgG antibodies towards material samples from the workplace. The immunoblot detected IgG binding proteins in agreement with known allergens of the fungi Alternaria and Pullularia. Combining realistic workplace challenge with immunological analyses of workplace material may improve the basis for counselling farmers with farmer´s lung concerning future work within farming.