title: Familial hypersensitivity pneumonitis.
abstract: Two families are described in which seven members of a total of 19 were found to have hypersensitivity pneumonitis due to exposure to avian antigens. Diagnosis was made on the basis of characteristic roentgenologic changes together with respiratory function and immunologic studies. The latter included screening for precipitins, macrophage migration inhibition (MMI) to specific antigens in avian serum and droppings, quantitation of immunoglobulin and alpha1 antitrypsin (AAT) levels and assessment of the complement system. Specific precipitins to pigeon and/or budgerigar serum were found in the serum of only four of the seven patients. Six of these seven patients, however, had a positive MMI. Thus, the MMI test, at least in this group of patients appeared to be a more sensitive indicator of active disease. The finding of seven members of two families with disease led to a search for predisposing factors, either genetic or environmental. Evidence for a genetic predisposition came from tissue typing studies. In the first family, both paternal haplotypes were associated with disease; the maternal haplotype HLA3,7 was not inherited by any child with disease. In the second family, the disease developed in three of four members with the haplotype HL-A2,W15, who were significantly exposed to avian antigen. In the light of recent studies showing an association between immune response (Ir) genes, histocompatibility antigens and disease susceptibility, these findings were interpreted as possible evidence for a subtle genetically linked immune defect in hypersensitivity pneumonitis. Evidence for an environmental predisposition was less clear cut, but it is interesting that members of both families used a gamma isomer of hexachlorobenzene (Nickoff) to eradicate mite infestations in their birds which might have damaged the bronchial mucosa or acted as an immunologic adjuvant in a person with underlying susceptibility to disease. The presence of subclinical respiratory disease in two family members is reported, and the importance of performing a range of investigations of respiratory function in order to detect disease and monitor its progress is emphasized.
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000941:Antigens; D002648:Child; D010856:Columbidae; D003165:Complement System Proteins / Q000032:analysis; D004781:Environmental Exposure; D005203:Farmer's Lung / Q000175:diagnosis / Q000235:genetics* / Q000276:immunology; D005260:Female; D005796:Genes; D006680:HLA Antigens; D006801:Humans; D007111:Immunity, Cellular; D007136:Immunoglobulins / Q000032:analysis; D008264:Macrophages / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D011234:Precipitins / Q000032:analysis; D012129:Respiratory Function Tests; D000515:alpha 1-Antitrypsin / Q000032:analysis
chemical_list: D000941:Antigens; D006680:HLA Antigens; D007136:Immunoglobulins; D011234:Precipitins; D000515:alpha 1-Antitrypsin; D003165:Complement System Proteins