[Severe subglottic edema caused by bird breeder's disease?]

A 44-year old female farmer and pigeon-breeder presented with paroxysmal attacks of dyspnoea caused by recurrent subglottic laryngeal oedema. The symptoms disappeared under corticosteroid therapy but returned after discharge from hospital. The avian origin of the disease, suggested by a strongly positive search for avian precipitins, was confirmed when the attacks ceased after antigen exclusion. A realistic inhalation challenge test performed on two occasions with pigeon's feathers and droppings as antigens resulted, within 15 minutes, in a 4-hour long attack of paroxysmal laryngeal dyspnoea. The dyspnoea was caused by subglottic laryngeal oedema visualized, 15 minutes after the inhalation, by pharyngeal and bronchial fibroscopy. Nasal manifestations have been reported in patients with hypersensitivity of the lung, but it seems that no case of subglottic oedema in pigeon-breeder's disease has yet been published.