Current methodology is not sensitive enough to monitor effectiveness of avoidance measures

Editor—The final sentence of Bourke and Boyd's editorial on pigeon fancier's lung states that sequential measurement of circulating antibody to pigeon related antigen is important in patient management.1 Experience within the United Kingdom National External Quality Assessment Scheme (UKNEQAS) performance testing programme for antibodies in extrinsic allergic alveolitis suggests that this is far from being a practical proposition at the present time. The quality assessment scheme for antibody to fungal and related antigens currently has 57 participating laboratories, 12 of which are outside the United Kingdom. Two serum samples are distributed every eight weeks, and the participating laboratories are required to test one of the samples for antibody to pigeon, budgerigar, or antigens associated with farmer's lung and to submit both qualitative and quantitative results. The methods used to detect antibody to pigeon related antigens are: double diffusion (35 laboratories), counterimmunoelectrophoresis (20), enzyme linked immunosorbent assay (ELISA) …