Classification of Hypersensitivity Pneumonitis

Lacasse, Yves; Selman, Moisés; Costabel, Ulrich; Dalphin, Jean Charles; Morell, Ferrán; Erkinjuntti-Pekkanen, Riitta; Mueller, Nestor L.; Colby, Thomas V.; Schuyler, Mark; Jomphe, Valérie; Cormier, Yvon

doi:10.1159/000189200

Cited by 157 publications

(100 citation statements)

References 35 publications

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“…Although there was environmental exposure in these cases, inhalation of the antigens was not as massive as in the other patients. It is reasonable that high-intensity exposure to the causative antigen would trigger acute forms (25), whereas low-grade, prolonged exposure would be associated with a subacute or chronic presentation. In this line, it is worthy of note that in cases 4 and 5 the latency period between the start of exposure and the development of symptoms was long, whereas in patients 1 and 2, it was a matter of days.…”

Section: Discussionmentioning

confidence: 99%

Chacinero’s lung – hypersensitivity pneumonitis due to dry sausage dust

Morell¹,

Cruz²,

Gómez³

et al. 2011

Scand J Work Environ Health

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Section: Discussionmentioning

confidence: 99%

Chacinero’s lung – hypersensitivity pneumonitis due to dry sausage dust

Morell¹,

Cruz²,

Gómez³

et al. 2011

Scand J Work Environ Health

Self Cite

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“…ÔacuteÕ, ÔsubacuteÕ or ÔchronicÕ) truly reflects categories of patients with distinct clinical features (34). Data were used to divide a cohort of patients with HP into a limited number of categories (ÔclustersÕ) with maximally differing clinical patterns, without prejudgement.…”

Section: Classification Of Hpmentioning

confidence: 99%

Hypersensitivity pneumonitis

Girard

and

Cormier

2009

Allergy

114

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The first few cases of hypersensitivity pneumonitis (HP) were described in the early 20th century in farmers exposed to moldy hay or straw. As then, HP has been ascribed to multiple inhaled antigens found in a large variety of environmental settings. Hypersensitivity pneumonitis results from an exaggerated immune response, which gives rise to acute infection‐like symptoms or to progressive, sometimes irreversible lung damage. The diagnosis is based on a combination of clinical characteristics of the disease. Clinical diagnostic criteria have recently been published. The immune mechanisms leading to HP are still incompletely understood. Initially, believed to be a classes III and IV immune response, we now have a clearer understanding of the complex inflammatory events involved. These include the release of pro inflammatory cytokines and a decrease in the immune control mechanisms via surfactant, dendritic and T‐regulatory cells. Despite the improved understanding, the treatment and outcome of HP have not changed. Oral corticosteroids remain the only effective drugs and contact withdrawal constitutes the ideal solution. If unchecked, HP can lead to irreversible lung damage in the form of fibrosis or emphysema, respiratory insufficiency and even death.

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“…HP is classified as acute or chronic 2, 3. According to a national survey in Japan, avian antigen is the cause of chronic HP in 61% of cases 4.…”

Section: Introductionmentioning

confidence: 99%

Environmental levels of avian antigen are relevant to the progression of chronic hypersensitivity pneumonitis during antigen avoidance

Sema

Miyazaki²,

Tsutsui³

et al. 2017

Immunity Inflam & Disease

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BackgroundIn chronic hypersensitivity pneumonitis (chronic HP), antigen avoidance is critical for disease management; however, complete avoidance is difficult because of unrecognized exposure to antigens. Recently, we revealed that the amount of avian antigen (AAA) in household dust at the time of diagnosis predicted the progression of chronic bird‐related HP. The purpose of this study is to evaluate the relationship between the prognosis of chronic bird‐related HP and the AAA that remained in the environment during antigen avoidance.MethodsFirst, we measured the AAA in household dust of 28 consecutive patients (22 with chronic bird‐related HP and 6 with acute bird‐related HP) and 12 healthy volunteers. Second, we measured the AAA and collected questionnaires on the environmental conditions of the homes of 53 patients with various lung diseases, including bird‐related HP, to investigate the environmental parameters related to a higher AAA. Finally, we prospectively recruited 14 consecutive patients with chronic bird‐related HP, measured the AAA periodically, and collected clinical data.ResultsThe AAA was higher in patients with chronic bird‐related HP at the time of diagnosis compared to healthy volunteers and was highest in patients with acute bird‐related HP. Logistic regression analysis showed that birds frequenting a residence was the only significant factor for a higher AAA (odds ratio, 5.686; 95%CI, 1.263–25.59; P = 0.024). There was a correlation between the mean AAA and decline of vital capacity for 1 year (r = −0.55; 95%CI −0.84 to −0.01; P = 0.043).ConclusionMeasurements of the AAA after diagnosis predict the progression of chronic bird‐related HP. Avian antigen can exist in the indoor environment regardless of antigen avoidance. The presence of avian antigen in the indoor environment can be attributed to wild birds found outdoors.

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Classification of Hypersensitivity Pneumonitis

Cited by 157 publications

References 35 publications

Chacinero’s lung – hypersensitivity pneumonitis due to dry sausage dust

Chacinero’s lung – hypersensitivity pneumonitis due to dry sausage dust

Hypersensitivity pneumonitis

Environmental levels of avian antigen are relevant to the progression of chronic hypersensitivity pneumonitis during antigen avoidance

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