Hypersensitivity Pneumonitis With and Without Autoimmune Features: A Clinical Comparative Analysis

Kalra, Saminder; Jaber, J.; Alzghoul, Bashar; Jansen, Brandon; Innabi, Ayoub; Tran, Amy B; Fu, Katherine; Reddy, Raju; Manjarres, D.C. Gomez; Patel, Divya

doi:10.1007/s00408-022-00577-4

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…Since antigen identification and avoidance is associated with improved survival in patients with HP [4,5], correct diagnosis is important for early and proper intervention. HP has a wide heterogeneity in presentation and findings, with no widely accepted goldstandard diagnostic test or algorithm [6][7][8]. Four main factors should be considered in the diagnostic workup of HP: history of antigen exposure, HRCT, bronchoalveolar lavage Diagnostics 2023, 13, 2335 2 of 11 (BAL), and lung biopsy [5,[9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Real-Life Diagnostic Performance of the Hypersensitivity Pneumonitis Guidelines: A Multicenter Cohort Study

et al. 2023

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Hypersensitivity pneumonitis (HP) is a heterogeneous interstitial lung disease (ILD) that may be difficult to confidently diagnose. Recently, the 2020 ATS/JRS/ALAT HP diagnostic guidelines were published, yet data validating their performance in real-life settings are scarce. We aimed to assess the diagnostic performance of the HP guidelines compared to the gold-standard multidisciplinary discussion (MDD). For this purpose, we included consecutive ILD patients that underwent diagnostic bronchoscopy between 2017 and 2020 in three large medical centers. Four diagnostic factors (antigen exposure history, chest computed tomography pattern, bronchoalveolar lavage lymphocyte count, and histology results) were used to assign guidelines-based HP diagnostic confidence levels for each patient. A sensitivity analysis was performed, with MDD diagnosis as the reference standard. Overall, 213 ILD patients were included, 45 (21%) with an MDD diagnosis of HP. The guidelines’ moderate (≥70%) confidence threshold produced optimal performance with 73% sensitivity for HP, 89% specificity, and a J-index of 0.62. The area under the receiver operating characteristic curve (AUC) for a correct guidelines-based diagnosis was 0.86. The guidelines had better performance for non-fibrotic than fibrotic HP (AUC 0.92 vs. 0.82). All diagnostic factors, except bronchoalveolar lavage lymphocyte count, were independent predictors for MDD diagnosis of HP in a multivariate analysis. In conclusion, the HP guidelines exhibited a good diagnostic performance compared to MDD diagnosis in real-life setting.

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Section: Introductionmentioning

confidence: 99%

Real-Life Diagnostic Performance of the Hypersensitivity Pneumonitis Guidelines: A Multicenter Cohort Study

et al. 2023

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“…Finally, clinical data, including mortality data, show that populations of HP, CTD-ILD, and IPAF can be similar [ 7 – 10 ]. In fact, autoimmunity in patients with HP can portend a poor prognosis [ 11 , 12 ]. Whether the reverse is true, that identification of antigen in patients with autoimmune-related ILD will impact survival, has not been previously evaluated.…”

Section: Introductionmentioning

confidence: 99%

Impact of antigen identification on transplant free survival in interstitial lung disease

Kypreos,

Batra,

Glazer

et al. 2023

BMC Pulm Med

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Introduction Antigen identification impacts diagnosis as well as prognosis in patients with hypersensitivity pneumonitis. An antigen may also be present in other etiologies of interstitial lung disease, however it is unknown whether identification impacts survival. Methods We evaluated a retrospective cohort in order to determine if antigen identification affects transplant free survival in patients with hypersensitivity pneumonitis, idiopathic pulmonary fibrosis, connective tissue disease interstitial lung disease, and interstitial pneumonia with autoimmune features. Only patients with definite or high probability of hypersensitivity pneumonitis by American Thoracic Society guidelines were included in the analysis. Results Transplant free survival was improved with antigen identification in patients with hypersensitivity pneumonitis but not in patients with idiopathic pulmonary fibrosis, connective tissue disease interstitial lung disease, and interstitial pneumonia with autoimmune features. Conclusion Our study suggests that removal of identified antigen in interstitial lung diseases other than hypersensitivity pneumonitis may not be impactful. Additionally, it further suggests that definitive diagnosis of hypersensitivity pneumonitis with bronchoalveolar lavage and transbronchial biopsy may be beneficial prior to recommending antigen removal.

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“…Studies of IPF investigated potential mechanisms [ 41 ], animal models of induced fibrosis [ 42 ], potential biomarkers [ 43 ] and clinical outcomes [ 44 ]. Contributions on the subject of ILD included evaluation of potential biomarkers [ 45 ], diagnostic cryobiopsy [ 24 ], pediatric ILD [ 46 ], ILD outcomes [ 47 ], as well as investigations of hypersensitivity pneumonitis [ 48 ] and bronchiectasis [ 49 , 50 ].…”

mentioning

confidence: 99%

LUNG Year in Review: 2022

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2023

Lung

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Hypersensitivity Pneumonitis With and Without Autoimmune Features: A Clinical Comparative Analysis

Cited by 4 publications

References 30 publications

Real-Life Diagnostic Performance of the Hypersensitivity Pneumonitis Guidelines: A Multicenter Cohort Study

Real-Life Diagnostic Performance of the Hypersensitivity Pneumonitis Guidelines: A Multicenter Cohort Study

Impact of antigen identification on transplant free survival in interstitial lung disease

LUNG Year in Review: 2022

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