herican Journal of Industrial Medicine 10281-282 (1986)

Sensitization, Clinical Symptoms, and Lung Function Disturbances Among Poultry Farm Workers in the German Democratic Republic

Stefan Muller, MD, K.-Ch Bergmann, H. Kramer, and H. Wuthe

Key words: poultry, allergic alveolitis, sensitization, cliical symptoms, and lung function, antibodies

Three hundred thirty-nine poultry farmers (234 females, 105 males) were investigated by immunological methods, lung function tests, systematic interviewing (questionnaires), and registration of respiratory symptoms. Serum antibodies against organic dusts of fowls (hen serum,-HS; hen total extract,-HTE; hen droppings,-HD) were detected by means of counterimmunoelectrophoresis.

Of all workers, 22% had precipitating antibodies: nine persons (3%) had a strong sensitization with at least two antibodies against HS or HTE, 39 persons (11 %) had at least one antibody against HS or HTE, and 28 persons (8%) had a weak sensitization with one antibody against HD. The number of persons with antibodies and respiratory symptoms was significantly higher in the departments with especially high dust concentrations (breeding and keeping of adult animals). A correlation was established between the duration of exposure and the frequency of antibody formation.

The intracutaneous testing with 1: 10 and 1: 100 diluted sterilized HS was per- formed on 42 seropositive and 17 seronegativae workers. The observed immediate reactions (20 min) after antigen application in both groups (81 % and 88 % , respec- tively) were interpreted as nonspecific irritant-toxic reactions. In the group of sensi- tized persons, we observed an Arthus reaction in 28.6% and a positive reaction after 24 hr in 26.2% of the persons tested. In the seronegative group, no case of Arthus or late reaction was detected.

About 20% of workers complained of cough, dyspnea, expectoration, and shortness of breath; of these, 5 % had suspect signs of allergic alveolitis (AA). The frequency of upper airway symptoms (eg; nasal itching, rhinorrhea, and sneezing) was the same in the seropositive and seronegative groups.

Ventilation, arterial oxygen tension (pOza), residual volume (RV) , slope index (SI), and closing volume (CV) were measured in a mobile laboratory. In general, there were no significant differences in the investigated lung function values between

Department of Clinical Immunology, Research Institute of Lung Diseases and Tuberculosis, Berlin- Buch, German Democratic Republic Address reprint requests to Stefan Miiller, Department of Clinical Immunology, Research Institute of Lung Diseases and Tuberculosis, Karower Strasse 11, 1115 Berlin-Buch, German Democratic Republic. Accepted for publication January 16, 1986.

0 1986 Alan R. Liss. Inc.

282 Miiller et a1

workers with and without sensitization. However, in the group of strongly sensitized workers, pathological findings, including lowered FEVl/FVC and peak expiratory flow (PEF), which are signs of obstruction and WPV (slope index/predicted value), which are signs of inequalities of ventilation, and lowered p02=, signs either of distribution disturbances or hypoxaemia, were three to four times more frequent than in nonsensitized workers.

By chest X-ray examination and additional lung function tests (compliance, diffusion capacity), we could diagnose one case of AA in the group of workers with antibodies. Another case in the same group was diagnosed by the bronchial provoca- tion test with a 1: 10 diluted hen serum.

To investigate possible changes in humoral and cellular immunity and in the lung function parameters during continuous sensitization and exposure, we performed a longitudinal study over 5 years in a group of 25 poultry farm workers. By means of three independent methods for detecting disturbances of ventilatory function, it could be established that, after 5 years, changes in the small airways were an early indication of impaired pulmonary function. A reduction in arterial oxygen tension after 5 years indicated a disturbance in ventilation/perfusion.

The signs of small airways changes suggest that workers with antibodies are persons at risk and should be regularly investigated by clinical, lung function, and immunological methods.