Domestic hypersensitivity pneumonitis caused by inadvertent exposure to feathers

Case series of patients with domestic hypersensitivity pneumonitis, focusing on hidden avian exposures or other non-suspected antigens (feather comforters and pillows).

Seven female patients diagnosed with non-occupational HP were evaluated using clinical records from La Paz University Hospital (2014-2022). Data collected included exposure history, HRCT findings, IgG antibodies, BAL, biopsies, and treatment outcomes.

Patients had a median age of 53.5 years (range: 15-75), with varied exposure to birds or indirect sources like feather duvets. Diagnosis was made based on HRCT, BAL, and biopsy findings. Five patients removed the antigen source, resulting in symptom improvement and pulmonary function in non-fibrotic cases. Corticosteroid treatment was given to all, with one patient requiring oxygen therapy. The median FEV1 improvement was 50 ml, and three patients with a non-fibrotic pattern showed improved DLCO after treatment.

Early diagnosis and antigen avoidance are key to managing hypersensitivity pneumonitis (HP), especially in cases of hidden bird-related exposures. A multidisciplinary approach improved outcomes, particularly in non-fibrotic cases. Larger studies and broader antigen testing are needed to validate these findings and enhance diagnostic accuracy.