As organic dust is composed of a variety of respirable organic materials, it is not clear what specific entity is responsible for OTDS. Endotoxin has been suggested to be the primary cause of inflammation in ODTS. Inhalation of endotoxin can reproduce the symptoms of ODTS, and acute ODTS episodes occur in areas of high endotoxin levels. However, endotoxin-free grain extract also appears capable of inducing pulmonary inflammation. Others have suggested that other microbial sources, such as spores and glucan, are important in the pathogenesis (14,50,61-68).

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