In a farmer, a diagnosis of hypersensitivity pneumonitis (HP) might cause drastic changes in life, and guidance concerning future prospects within farming requires a best possible etiological diagnosis. We aimed to assess (1) if immunological analyses based on material samples from the work environment could be used to improve the etiologic diagnosis in a farmer suffering from HP, and (2) if combining a longitudinal immunological investigation of workplace material with a realistic work place inhalation challenge could be used to optimize counselling with respect to further employment within farming. A realistic workplace inhalation challenge was performed to explore potential associations between exposure, symptoms and immune responses. Material samples were collected from various places on the farm, and enzyme-linked immunosorbent assay (ELISA) was performed to identify possible IgE and IgG antibodies in patient serum towards these material samples. Electrophoresis (SDS-PAGE) and immunoblot were used to detect the specific proteins in the material samples that were recognized by ELISA. The patient's symptoms were reproduced by the workplace challenge, and more severe symptoms were associated with increased serum levels of specific IgG antibodies towards material samples from the workplace. The immunoblot detected IgG binding proteins in agreement with known allergens of the fungi Alternaria and Pullularia. Combining realistic workplace challenge with immunological analyses of workplace material may improve the basis for counselling farmers with farmer´s lung concerning future work within farming.

中文翻译：

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农民超敏性肺炎：改善病因诊断以优化咨询。

在农民中，对超敏性肺炎（HP）的诊断可能会导致生活发生巨大变化，有关农业未来前景的指南要求尽可能进行病因学诊断。我们旨在评估（1）是否可以基于工作环境中的材料样本进行免疫学分析来改善患有HP的农民的病因诊断，以及（2）是否将工作场所材料的纵向免疫学调查与实际工作结合起来场所吸入挑战可用于优化有关在农业中进一步就业的咨询。进行了现实的工作场所吸入挑战，以探索暴露，症状和免疫反应之间的潜在关联。从农场的各个地方收集了材料样本，并进行了酶联免疫吸附试验（ELISA），以鉴定患者血清中针对这些物质样品的可能的IgE和IgG抗体。电泳（SDS-PAGE）和免疫印迹用于检测ELISA识别的材料样品中的特定蛋白质。患者的症状通过工作场所的挑战再现，更严重的症状与针对来自工作场所的材料样本的特异性IgG抗体的血清水平升高相关。免疫印迹检测到的IgG结合蛋白与真菌链格孢和白痢病的已知过敏原一致。将现实的工作场所挑战与工作场所材料的免疫学分析相结合，可以为向农民提供关于肺部未来工作的农民肺咨询的基础。