The value of family history in the diagnosis of hypersensitivity pneumonitis in children

Abstract

Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is an immunologically mediated disease resulting from the inhalation of organic substances that trigger an inflammatory response in the alveolar wall, bronchioles, and interstitium in susceptible individuals. Although HP is predominantly an occupational disease, seen in adulthood, cases in children have been described. The diagnosis of HP requires a high degree of suspicion. The treatment consists in avoiding contact with the antigen, and, in some cases, systemic corticosteroids might be necessary in order to prevent its progression to pulmonary fibrosis. We report the clinical cases of three children with a history of contact with birds and a family history of HP. All three patients presented with cough and dyspnea on exertion. The disease was diagnosed on the basis of the clinical history and ancillary diagnostic test results consistent with the diagnosis, including a predominance of lymphocytes (> 60%, CD8+ T lymphocytes in particular) in bronchoalveolar lavage fluid and a ground-glass pattern seen on HRCT of the chest. Early diagnosis is crucial in order to prevent HP from progressing to pulmonary fibrosis. Hereditary factors seem to influence the onset of the disease.

Pulmonary Function Abnormalities in Regard to Age at the Time of Diagnosis of Hypersensitivity Pneumonitis

“…Diagnosis is made on the basis of a high index of suspicion, clinical history, physical examination, laboratory test results, pulmonary function testing (PFT), and imaging studies (Cardoso and Carvalho 2014;Wells et al 2008). The recommendation of several Several diagnostic criteria for HP have been published (Terho 1986;Richerson et al 1989;Cormier and Lacasse 1996).…”

“…There is still a lot of confusions and propositions concerning a new HP classification (Lacasse et al 2012). Depending on the dynamic nature of the disease, it can be classified as acute progressive, acute intermittent non-progressive, or recurrent non-acute disease (Cardoso and Carvalho 2014;Girard et al 2009). …”

Update on diagnosis and treatment of idiopathic pulmonary fibrosis

“…( 1 ) Nevertheless, they underscore the importance of thoroughly investigating environmental exposure in patients with interstitial lung disease. ( 9 )…”

Respiratory Health

“…Diagnosis is made on the basis of a high index of suspicion, clinical history, physical examination, laboratory test results, pulmonary function testing (PFT), and imaging studies (Cardoso and Carvalho 2014;Wells et al 2008). The recommendations of several diagnostic criteria for HP have been published (Terho 1986;Richerson et al 1989;Cormier and Lacasse 1996).…”

“…Depending on the dynamic nature of the disease, it can be classified as acute progressive, acute intermittent non-progressive, or recurrent non-acute disease (Cardoso and Carvalho 2014;Girard et al 2009). Dyspnea, cough, flu-like syndrome, and weight loss are common, but not pathognomonic symptoms for HP.…”