Hypersensitivity pneumonitis concomitant with acute airway obstruction after exposure to hay dust

The case of a non-atopic farmer who had developed severe respiratory as well as systemic symptoms upon exposure to hay dust during the past several years is presented. Inhalation challenge by his own hay induced an unusual association of peripheral and central airway obstruction beginning immediately, and hardly susceptible to therapeutic control, as well as the typical hypersensitivity pneumonitis reaction several hours later. By means of double immunodiffusion it was possible to demonstrate serum precipitins to antigenic components in this hay, which could be predominantly identified as antigens of several Aspergillus species. By means of the more sensitive crossed immunoelectrophoresis technique ten relevant antigens of Aspergillus terreus and four of Aspergillus fumigatus were demonstrable. Only minimal aspergillus-specific IgE antibodies were found in the patient's serum. This case demonstrates that hay dust can cause bronchial obstruction as well as hypersensitivity pneumonitis in the same individual, with symptoms beginning immediately and lasting up to 2 days.