, Volume 166, Issue 1, pp 113–124 | Cite as

Humidifier lung and humidifier fever

  • X. Baur
  • J. Behr
  • M. Dewair
  • W. Ehret
  • G. Fruhmann
  • C. Vogelmeier
  • W. Weiss
  • V. Zinkernagel


The aim of our study was to evaluate clinical diagnoses in symptomatic persons exposed to aerosols from humidifiers or air conditioners. In addition, we tried to identify the causative antigens. Results of clinical investigations, including inhalation challenge tests, demonstrated a typical hypersensitivity pneumonitis (humidifier lung) in 9 persons and isolated systemic symptoms without significant changes in lung function and chest x-rays (humidifier fever) in 3 persons. Microbiological studies revealed a variety of fungi and bacteria in the water supplies of humidifiers and air conditioners at patients’ workplaces. The detection of 4 members of the orderSphaeropsidales (Deuteromycotina), not previously associated with humidifier-induced diseases, is of special interest. By means of an improved polystyrene tube-immunoradiometric assay, high concentrations of IgG antibodies against extracts prepared from water of patients’ humidifier systems were found in all cases. In addition, patients demonstrated low concentrations of IgG antibodies against thermophilicActinomycetes, and usually also against various fungi, such asAlternaria tenuis, Aureobasidium pullulans, Penicillium notatum, Aspergilli, and fungi of the orderSphaeropsidales, which were isolated and cultured from humidifier water supplies. The much higher concentrations of antibodies against humidifier/air conditioner water extracts seem to result from sensitization to a variety of antigens from different fungi and bacteria. For in vivo and in vitro diagnostic tests in humidifier-induced lung diseases, we especially recommend using extracts from water systems installed at the corresponding workplaces.

Key words

Humidifier Lung Allergic Alveolitis Immunologic Reactions 


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  1. 1.
    Arnow PM, Fink JN, Schluter DP, Barboriak JJ, Mallison G, Said SI, Martin S, Unger FF, Scanlon GT, Kurup VP (1978) Early detection of hypersensitivity pneumonitis in office workers. Am J Med 64:236–242PubMedCrossRefGoogle Scholar
  2. 2.
    Banaszak E, Thiede W, Fink J (1970) Hypersensitivity pneumonitis due to contamination of an air conditioner. N Engl J Med 283:271–276PubMedCrossRefGoogle Scholar
  3. 3.
    Barret JM, LeMot B, Chow S (1975) Antibodies coupled to the inside of plastic test-tube and their use in a radioimmunoassay for serum thyroxine. Clin Chem 21:1011Google Scholar
  4. 4.
    Baur X, Fruhmann G, Prelicz H (1984) Die Befeuchterlunge—eine Berufskrankheit? Überlegungen anhand eines kasuistischen Beitrages Arbeit Sozial Prävent 19:35–38Google Scholar
  5. 5.
    Bernstein RS, Sorenson WG, Garabrant, D, Reaux C, Treitman RD (1983) Exposures to respirable, airborne Penicillium from a contaminated ventilation system: clinical, environmental and epidemiological aspects. Am Ind Hyg Assoc J 44:161–169PubMedGoogle Scholar
  6. 6.
    Bolt W, Brille D, Cara M, Coppee G, Houberechts A, Lavenne F, Sadoul P, Sartorelli, E, Zorn O (1971) Leitfaden für die Durchführung der Untersuchung der ventilatorischen Funktion durch die Spirographie. Schriftenr Arbeitshyg Arbeitsmed 11:77–113Google Scholar
  7. 7.
    Cotes JE (1975) Lung function assessment and application in medicine, 3rd ed. Blackwell, Scientific Publications, OxfordGoogle Scholar
  8. 8.
    Dewair M, Baur X (1984) Radioallergosorbent test (RAST) for measurement of IgG antibodies toAspergillus fumigatus in sera of patients with different lung diseases. J Immunol Methods 75:117–128PubMedCrossRefGoogle Scholar
  9. 9.
    Dewair M, Baur X (1987) Binding of IgG from patients with interstitial lung diseases to cellulose. Clin Chim Acta 163:87–95PubMedCrossRefGoogle Scholar
  10. 10.
    Edelstein PH, Snitzer JB, Feingold SM (1982) Isolation of Legionella pneumophila from hospital potable water specimen: comparison of direct plating with guinea pig inoculation. J Clin Microbiol 15, 1092–1096PubMedGoogle Scholar
  11. 11.
    Edwards JH (1980) Microbial and immunological investigations and remedial action after an outbreak of humidifier fever. Br J Ind Med 37:55–62PubMedGoogle Scholar
  12. 12.
    Fink J, Banaszak E, Thiede W, Barboriak J (1971) Interstitial pneumonitis due to hypersensitivity to an organism contaminating a heating system. Ann Int Med 74:80–83PubMedGoogle Scholar
  13. 13.
    Flaherty DK, Deck FH, Cooper J, Bishoff K, Winzenburger PA, Smith LR, Bynum L, Witmer WB (1984) Bacterial endotoxin isolated from a water spray air humidification system as a putative agent of occupation-related lung disease. Infect Immun 43:206–212PubMedGoogle Scholar
  14. 14.
    Flaherty DK, Deck FH, Hood MA, Liebert C, Singleton F, Winzenburger P, Bishop K, Smith LR, Bynum L, Witmer WB (1984) A cytophaga species endotoxin as a putative agent of occupation-related lung disease. Infect Immun 43:213–216PubMedGoogle Scholar
  15. 15.
    Ganier M, Lieberman P, Fink J, Lockwood DG (1980) Humidifier lung. An outbreak in office workers. Chest 77:183–187PubMedCrossRefGoogle Scholar
  16. 16.
    International Labour Office (ILO) (1980) Guidelines for the use of ILO international classification of radiographs of pneumoconioses. Occupational Safety and Health Series No. 22 (Rev. 80)Google Scholar
  17. 17.
    Keller H, Spengler H, Latscha U (1972) Befeuchterfieber. Schweiz Med Wochenschr 102:865–872PubMedGoogle Scholar
  18. 18.
    Marx JJ, Emanuel DA, Dovenbarger WV, Reinecke ME, Roberts RC, Treuhaft MW (1978) Farmer’s lung disease among farmers with precipitating antibodies to the thermophilic actinomycetes: a clinical and immunologic study. J Allergy Clin Immunol 62:185–189PubMedCrossRefGoogle Scholar
  19. 19.
    Muittari A, Kuusisto P, Virtanen P, Sovijärvi A, Grönroos P, Harmoinen A, Antila P, Kellomäki L (1980) An epidemic of extrinsic allergic alveolitis caused by tap water. Clin Allergy 10:77–90PubMedCrossRefGoogle Scholar
  20. 20.
    MCR-Symposium (1977) Humidifier fever. Thorax 32:653–663CrossRefGoogle Scholar
  21. 21.
    Patterson R, Fink JN, Roberts M, Kelly JF, Sommers HM (1978) Antibody activity in sera of patients with humidifier disease. Studies of the water supply as a source of antigens. J Allergy Clin Immunol 62:103–108PubMedCrossRefGoogle Scholar
  22. 22.
    Peterson GL (1977) A simplification of the protein assay method of Lowry et al. which is more generally applicable. Anal Biochem 83:346–356PubMedCrossRefGoogle Scholar
  23. 23.
    Pickering CAC, Moore WKS, Lacey J, Valerie C, Holford-Strevens, Pepys J (1976) Investigation of a respiratory disease associated with an air-conditioning system. Clin Allergy 6:109–118PubMedCrossRefGoogle Scholar
  24. 24.
    Reed CE, Lopez MC, Ford AM, Major J, Witmer WB, Valdes TB (1983) Measurement of IgG antibody and airborne antigen to control an industrial outbreak of hypersensitivity pneumonitis. J Occup Med 25:207–210PubMedCrossRefGoogle Scholar
  25. 25.
    Robertson AS, Burge PS, Wieland GA (1984) Extrinsic allergic alveolitis from a humidifier at 15 degrees C. Br Soc Allergy Clin Immunol Nov. 2, 1984Google Scholar
  26. 26.
    Rylander R, Haglind P, Lundholm W, Mattsby I, Stenqvist K (1978) Humidifier fever and endotoxin exposure. Clin Allergy 8:511–516PubMedCrossRefGoogle Scholar
  27. 27.
    Scherrer M, Imhof K, Weickhardt U, Lebek G (1978) Befeuchterfieber in einer Gießerei. Schweiz Rundschau Med (Praxis) 67:1855–1861Google Scholar
  28. 28.
    Ulmer WZ, Reichel G, Nolte D (1976) Die Lungenfunktion, Physiologie und Pathophysiologie. Georg Thieme Verlag, StuttgartGoogle Scholar
  29. 29.
    Van Assendelft A, Forsen KO, Keskinen H, Alanko K (1979) Humidifier-associated extrinsic allergic alveolitis. Scand J Work Environ Health 5:35–41PubMedGoogle Scholar
  30. 30.
    Vogelmeier C, Koenig G, Baur X, Dewair M, Dexheimer E (1986) Symptome und Befunde bei Patienten mit Farmerlunge unter besonderer Berücksichtigung der Antikörper gegen Heustaub-Antigene. Atemw Lungenkrkh 12/7:298–299Google Scholar

Copyright information

© Springer-Verlag New York, Inc 1988

Authors and Affiliations

  • X. Baur
    • 1
  • J. Behr
    • 1
  • M. Dewair
    • 1
  • W. Ehret
    • 2
  • G. Fruhmann
    • 1
  • C. Vogelmeier
    • 1
  • W. Weiss
    • 1
  • V. Zinkernagel
    • 3
  1. 1.Pneumologische Abteilung, Medizinische Klinikum GrosshadernUniversität MünchenFederal Republic of German
  2. 2.Max-von-Pettenkofer-InstitutUniversität MünchenFederal Republic of Germany
  3. 3.Lehrstuhl für PhytopathologieTechnische Universität MünchenWeihenstephanFederal Republic of Germany

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