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Biogenics Research Institute
Other Respiratory Tract Disorders
Hypersensitivity Pneumonitis
Idiopathic Intersitial Lung Disease

Laboratory Findings

Blood and serological testing have been markedly under utilized and understated in evaluations of individual patients and in the published series in the recent past. Blood tests including white blood counts and differential, non-specific inflammatory markers including sedimentation rate, C-reactive protein, Rheumatoid factor, and antinuclear antibodies, serological tests of serum precipitins, serum immunoglobulins levels, and total serum IgE, and environmental tests of microscopic examination of swabs and air cultures have been objective data that has proven critical in the recognition of organic antigens as the cause of these disorders. These data also provide objective measurements that respond within a time frame that allows for avoidance-challenge procedures to become practical methods of diagnosis and evidence of the effectiveness of remediation.


WBC: The white blood count may be elevated, particularly in the acute presentations. This objective measurement may change within a 4 hour time period during environmental (natural) and specific challenges. An increase of >2,500 cells/cmm is considered a positive response during these challenge procedures.


Differential: The most significant cells of the differential include the eosinophils and neutrophils when elevated. Neutrophils may increase rapidly during challenge procedures. Eosinophils, likewise, may change rapidly, but are more reliable cellular markers for long-term monitoring of stability of the disorder after remediation.


Sedimentation Rate: This acute acute phase reactant is one of the more commonly elevated nonspecific inflammatory markers. Levels may be above 100 mm/hr by the Westergren method. This measurement may rise or fall dramatically within a one week period becoming a very sensitive tests during challenge procedures.


C-reactive Protein: This test is equally as important as an acute phase reactor as the sedimentation rate in these disorders. The C-reactive protein measured by a quantitative method may change by 20 fold during avoidance-challenge procedures.


Rheumatoid Factor: This test may be positive in patients with interstitial lung disease without an association with an autoimmune disorder. Quantitative measurements may also become a reliable monitoring marker over long-term follow-up as a slow phase reactor. It does not change in a time frame that allows for usefulness during challenge procedures.


Antinuclear Antibody: This test is positive in low titers in many patients without a clinical pattern suggestive of an autoimmune process. It may remain positive over months to years after remediation and is not useful in monitoring. High titers of this tests suggests an underlying autoimmune disorder and may require further testing for a definitive diagnosis.


Total IgE: In our series, this antibody was elevated more commonly than any other. Some were elevated to hyper-IgE levels of >5000 IU/ml. This antibody when elevated should be viewed as a slow-phase reactor that may chance over weeks to months. It may be useful in long-term monitoring of progression or non-progression of interstitial lung disease.


Total Serum Immunoglobulin levels: Some of these tests including IgG, IgM, and IgA may be elevated, particularly , in patients with positive serum precipitins. These tests may gradually fall and can be helpful in the long term monitoring of an interstitial lung disease.


Serum Precipitins: These tests measure specific reactivity through the antibody systems to high levels of inhaled microbes. These tests may be positive in individuals exposed but not yet exhibiting evidence of disease, thereby, creating a controversy as to their value in diagnosis of cause. Patients that have an interstitial lung disease with positive serum precipitins usually respond to a direct antigen challenge.


Microscopic Examination of Swabs: Swabs taken from any sources can be microscopically examined to determine if the specimen is simply amorphous dust or sheets of mold spores. If there is doubt, a culture may be needed to decide. These swabs are best utilized to culture and identify a mold. It has no usefulness in a quantitative fashion.


Gravity Air Cultures: This technique must be done under controlled conditions to have any validity. This measures the level of viable (living), aerosolized (airborne) microbes (mold and bacteria) that is in the air in the home at the time of the test. This test may also be utilized to identify specific types of mold in the home. This test can be done serially, after remediation, to monitor levels of microbes.