{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T16:42:45Z","timestamp":1757781765760,"version":"3.40.5"},"reference-count":61,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T00:00:00Z","timestamp":1594252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the diagnostic accuracy of inhalation challenge tests for bird fancier's lung and related adverse reactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We performed a systematic review and meta\u2010analysis for the diagnostic test accuracy of inhalation challenge tests and a systematic review for adverse events of the tests. We evaluated the risk of bias and applicability of the included articles for diagnostic test accuracy with the modified Quality Assessment of Diagnostic Accuracy Studies\u20102 tool. We used hierarchical summary receiver operating characteristic (HSROC) curve analysis to evaluate the sensitivity and specificity of challenge tests and assessed subjective adverse reactions and steroid treatment use. Sensitivity was calculated by fixing specificity at 99% from the HSROC curve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>We searched for articles evaluating the diagnostic accuracy of inhalation challenge tests or describing adverse reactions in Medline, Embase, the Cochrane Library, the International Clinical Trials Registry Platform, and Web of Science.<\/jats:p><\/jats:sec><jats:sec><jats:title>Eligibility criteria for selecting studies<\/jats:title><jats:p>We included randomized control trials, prospective or retrospective cohort studies, or case\u2010control studies assessing the diagnostic test accuracy of inhalation challenge tests for bird fancier's lung. For adverse effects review, we included the same articles, and case series or case reports reporting adverse reactions of inhalation challenge tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In our review of 12 articles, the diagnostic accuracy of inhalation challenge tests was substantially high. Point estimate of sensitivity when calculated with a fixed specificity of 99% was 99%. Among 873 patients, 6 needed steroid treatment for adverse reactions; however, no death occurred due to acute exacerbation following a challenge test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Inhalation challenges for bird fancier's lung could be accurate and safe diagnostic procedures and may be considered both as rule\u2010in and rule\u2010out tests in tertiary care centres. However, caution is required regarding overestimation of diagnostic yield due to risk of bias.<\/jats:p><jats:p>Systematic review registration: University hospital Medical Information Network Clinical Trials Registry (UMIN000038799).<\/jats:p><\/jats:sec>","DOI":"10.1111\/cea.13685","type":"journal-article","created":{"date-parts":[[2020,6,17]],"date-time":"2020-06-17T21:43:39Z","timestamp":1592430219000},"page":"1007-1016","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Diagnostic accuracy and safety of inhalation challenge tests for bird fancier\u2019s lung\u2014Systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0262-459X","authenticated-orcid":false,"given":"Akihiro","family":"Shiroshita","sequence":"first","affiliation":[{"name":"Department of Pulmonology Kameda Medical Center Kamogawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhuan","family":"Jin","sequence":"additional","affiliation":[{"name":"Post Graduate Education Center Kameda Medical Center Kamogawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Pulmonology Kameda Medical Center Kamogawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Kataoka","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan"},{"name":"Department of Hospital Care Research Unit Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2011.12.004"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.4065\/82.7.812"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/148.1.49"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACI.0b013e32835e033b"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201608-1675PP"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.19163"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-8-201110180-00009"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1325163"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201607-1484OC"},{"key":"e_1_2_8_11_1","first-page":"114s","article-title":"Comparison of registries of interstitial lung diseases in three European countries","volume":"32","author":"Thomeer MJ","year":"2001","journal-title":"Eur Respir J Suppl"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.2012.04322.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2003.12.019"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.942"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.6130.81"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.35.6.415"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02713892"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.88.4.563"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.158.3.9710036"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.118.5.1382"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e31816d1dda"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-011-9292-5"},{"key":"e_1_2_8_23_1","first-page":"A4685","article-title":"Inhalation provocation tests in bird\u2010related hypersensitivity pneumonitis [abstract]","volume":"185","author":"Miyazaki Y","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00060714"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201408-350OC"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alit.2018.12.010"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0091-6749(72)90047-4"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.1991.tb05810.x"},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1183\/09031936.93.06040467","article-title":"Inhalation challenge in pigeon breeder's disease: BAL fluid changes after 6 hours","volume":"6","author":"Reynolds SP","year":"1993","journal-title":"Eur Respir J"},{"issue":"60","key":"e_1_2_8_30_1","first-page":"665","article-title":"Chronic bird fancier's lung: histopathological and clinical correlation. 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