Physicians are reporting a case of an exaggerated allergic reaction to feather bedding in a 43-year-old patient and say doctors should be alert to “feather-duvet lung” (FDL), an immunologically mediated form of hypersensitivity pneumonitis.
The patient was referred to respiratory specialists with a three-month history of malaise, fatigue and breathlessness. At this time, he reported having recently acquired a duvet and pillows containing feathers. The patient was initially advised to remove this bedding, treat some mould he reported from his bathroom and check his loft for nesting birds. He was also prescribed oral prednisolone 40 mg once daily for one month, reducing every two weeks (30, 20 and 15 mg) until reaching a maintenance dose of 10 mg once daily.
Blood tests revealed antibodies to bird feather dust, and radiology suggested possible hypersensitivity pneumonitis.
The patient’s symptoms improved rapidly within the first month, even before commencing oral corticosteroids, and by six months, he felt completely well.
Writing in BMJ Case Reports, the authors said the case reinforces the importance of taking a meticulous exposure history and asking about domestic bedding in patients with unexplained breathlessness. "Prompt recognition and cessation of antigen exposure may prevent the development of irreversible lung fibrosis,” they added.