TY - JOUR
T1 - Diagnostic implications of positive avian serology in suspected hypersensitivity pneumonitis
AU - Woge, Matthew J.
AU - Ryu, Jay H.
AU - Moua, Teng
N1 - Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/8
Y1 - 2017/8
N2 - Background The diagnostic evaluation of patients with interstitial lung disease (ILD) often involves serologic assessment for identifiable causes such as hypersensitivity pneumonitis (HP). While not on its own defining of HP, precipitin serologies are often obtained to support clinical suspicion if other findings are inconclusive. We studied the clinical relevance of positive avian serology in patients undergoing ILD evaluation. Material and methods We identified individuals with positive avian serology (>53.3 mg/L) and undifferentiated ILD seen at our institution over a three-year period. Clinical, laboratory, pathologic, and radiologic findings were evaluated for consensus HP diagnosis by two expert pulmonologists, blinded to presenting serology levels. Results Ninety-one ILD subjects with positive avian serology were identified; mean age was 62.7 ± 15.3 years with a slight male predominance (56%). Forty-nine (54%) received a consensus HP diagnosis. Those with HP had higher mean avian serology titer (95.0 ± 38.7 mg/L vs. 68.3 ± 16.7, (P < 0.0001). Never-smokers also had higher titers compared to prior or active smokers (P = 0.0008). Positive avian protein exposure (P < 0.0001, OR 21.3 (6.4–87)), DLCO% (P = 0.04, unit OR 0.96 (0.92–0.99)), and increasing serology titer (P < 0.015, unit OR 1.03 [1.01–1.06]) were independent predictors of HP diagnosis. Conclusion Among patients with positive avian serology, those with higher titers were more likely to have HP diagnosis. Nonsmokers also manifested higher titers compared to those with smoking history. These results may guide the usage and interpretation of avian serology screening in the initial assessment of suspected HP.
AB - Background The diagnostic evaluation of patients with interstitial lung disease (ILD) often involves serologic assessment for identifiable causes such as hypersensitivity pneumonitis (HP). While not on its own defining of HP, precipitin serologies are often obtained to support clinical suspicion if other findings are inconclusive. We studied the clinical relevance of positive avian serology in patients undergoing ILD evaluation. Material and methods We identified individuals with positive avian serology (>53.3 mg/L) and undifferentiated ILD seen at our institution over a three-year period. Clinical, laboratory, pathologic, and radiologic findings were evaluated for consensus HP diagnosis by two expert pulmonologists, blinded to presenting serology levels. Results Ninety-one ILD subjects with positive avian serology were identified; mean age was 62.7 ± 15.3 years with a slight male predominance (56%). Forty-nine (54%) received a consensus HP diagnosis. Those with HP had higher mean avian serology titer (95.0 ± 38.7 mg/L vs. 68.3 ± 16.7, (P < 0.0001). Never-smokers also had higher titers compared to prior or active smokers (P = 0.0008). Positive avian protein exposure (P < 0.0001, OR 21.3 (6.4–87)), DLCO% (P = 0.04, unit OR 0.96 (0.92–0.99)), and increasing serology titer (P < 0.015, unit OR 1.03 [1.01–1.06]) were independent predictors of HP diagnosis. Conclusion Among patients with positive avian serology, those with higher titers were more likely to have HP diagnosis. Nonsmokers also manifested higher titers compared to those with smoking history. These results may guide the usage and interpretation of avian serology screening in the initial assessment of suspected HP.
KW - Avian serology
KW - Bird-fancier's disease
KW - Hypersensitivity pneumonitis
KW - Interstitial lung disease
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U2 - 10.1016/j.rmed.2017.06.019
DO - 10.1016/j.rmed.2017.06.019
M3 - Article
C2 - 28732828
AN - SCOPUS:85021449111
SN - 0954-6111
VL - 129
SP - 173
EP - 178
JO - Respiratory Medicine
JF - Respiratory Medicine
ER -