Out of 500 patients with asthma at the allergy clinic of Tokyo Kyosai Hospital there were 5 patients with pulmonary infiltration with eosinophilia (PIE syndrome) in whom a specific diagnosis was established. The diagnosis was chronic eosinophilic pneumonia, allergic bronchopulmonary candidiasis, allergic granulomatous angitis (one case each), and chronic bronchitis (two cases). Common symptoms were asthma, fever, weight loss, leucocytosis, large volume of sputum and productive cough. Skin tests to common inhalant antigens were principally negative except for molds. Precipitins to Candida albicans were positive in the patient with allergic broncho-pulmonary candidiasis in whom late asthmatic reactions were provoked by inhalation of Candida albicans extract. Sputum cultures from the patients with chronic bronchitis repeatedly yielded heavy growth of pseudomonas aeruginosa. Serum IgE levels were generally low, ranging from 40 to 700ng/ml. The clinical manifestations, the skin test reactivity and the presence of precipitating antibodies to molds, pseudomonas etc. were suggestive of combined reaginic and Arthus type hypersensitivity in these cases. Their clinical features were similar to those of infectious type asthma. Therefore the possibility that Arthus type and/or cell-mediated sensitivity might be playing a part in some of the respiratory symptoms observed ininfectious asthma was suggested.
