Review Article

Hypersensitivity Pneumonitis: Challenges of a Complex Disease

Table 1

List of jobs with possible antigen exposure sources.

Occupation areaJobs with occupational exposuresPossible sources of antigensAntigen name

AgricultureFarmersDecaying vegetation (hay and grass) and soil (farms with animals, such as cattle and horses)Absidia corymbifera, Lichtheimia corymbifera, and Saccharopolyspora rectivirgula
Plant surfaces, fruit,
honeybee’s environment,
animal, or human feces (soil with organic fertilizer)
Pantoea agglomerans and Streptomyces albus
Moldy hay, straw, plant material, seeds (sunflower, wheat, rye, barley, maize, in-shell peanuts, pecans, and peas), beans (mung, soybeans, soy products, and green coffee beans); cereals (corn, rice, and wheat); dry substrates (straw and seeds); air in agricultural and human-associated environmentsThermophilic actinomycetes (Saccharopolyspora rectivirgula, Thermoactinomyces vulgaris, and Thermoactinomyces sacchari), Pantoea agglomerans Wallemia sebi, Wallemia mellicola, and Wallemia muriae
CompostStreptomyces thermohygroscopicus, Thermoactinomyces vulgaris, and Saccharomonospora viridis
Peat mossSaccharomonospora viridis (thermoactinomyces viridis) and Aspergillus spp. (e.g., A. fumigatus and A. niger)
Onion growersOnion peelsPenicillium spp., Aspergillus flavus, and Aureo pullulans
Bagasse workersBagasse, hay, straw, and moldy plantsAerobacter cloacae, Thermoactinomyces sacchari, and Thermoactinomyces vulgaris
Mushroom growersContaminated compost, edible mushroom manure, hay, and dusty soilStreptomyces albus and Streptomyces thermohygroscopicus

PoultryBird breeders (hen workers, pigeon breeders, turkey, duck, goose handlers, and feather pluckers)Parakeet, pigeon, chicken, turkey, goose, and duck proteinsBird droppings or feathers

Food industryCheese producersCheese processing and washingPenicillium notatum, Penicillium viridicutum, Penicillium roqeforti, Penicillium verrucosum, Penicillium casei, Aspergillus fumigatus, Aspergillus niger, and Aspergillus pullulans
BakersContaminated flour and aspergillus enzyme in baking agentsAspergillus fumigatus
Soy sauce brewersFermentation starter for soy sauceAspergillus oryzae
Salami factory workersDried sausage dust white coating on salamiPenicillium glabrum, Penicillium spp., and Aspergillus fumigatus
Wine growersMold on grapesBotrytis cinerea

ConstructionsPlasterers, insulators, and varnishersGlue, polyurethane foam, paint, plastic, resins, and varnishesIsocyanate acid anhydrides, toluene diisocyanate, methylene diphenyl, isocyanate, and hexamethylene diisocyanate
Woodworkers and wood trimmersOak, cedar, pine, spruce, mahogany dust, and contaminated wood trimmingsAlternaria spp, Bacillus subtilis Rhizopus spp, and Mucor spp

MiscellaneousWind instruments playersTrombone, trumpet, flute, saxophone, and clarinetMycobacteria chelonae or other mycobacteria species Fusarium spp and Phoma spp
Air conditioner/humidifier/swamp coolerContaminated waterThermoactinomyces spp., Aspergillus spp., Penicillium spp. Aureobasidium spp, Candida albicans, and Thermophilic actinomycetes
Dental techniciansDental productsMethyl acrylates
Lifeguards, pool workersContaminated water jets and spraysPseudomonas spp.
CPAP machine, nebulizersContaminated waterRhodotorula minuta and Candida spp
Sawmill workersMaple barkCryptostroma corticale