Summary
Definition
History and exam
Key diagnostic factors
- exposure to avian protein antigen, especially excrement
- mould in work environment
- occupational exposure to chemicals
- dyspnoea
- non-productive cough
- productive cough
Other diagnostic factors
- fever/chills
- malaise
- weight loss/anorexia
- bibasilar rales
- diffuse rales
- clubbing
Risk factors
- smoking
- viral infection
- exposure to avian protein antigen
- exposure to mould antigen
- exposure to bacterial antigen
- exposure to diisocyanate (e.g., epoxy resin)
- exposure to acid anhydride antigen (e.g., paint refinisher)
- exposure to metal-working fluid
- nitrofurantoin, methotrexate, roxithromycin, and rituximab
- herbal supplements with ayurvedic medicine
Diagnostic investigations
1st investigations to order
- immunological response to causative antigen
- FBC
- erythrocyte sedimentation rate
- albumin
- CXR
- CT chest
- pulmonary function test
- diffusing lung capacity of carbon monoxide
Treatment algorithm
Contributors
Authors
Professor
Northwestern University Feinberg School of Medicine
Director
Ernest S. Bazley Asthma and Allergy Center
Clinic Practice Director
Allergy-Immunology
Northwestern Medical Faculty Foundation
Chicago
IL
Disclosures
LG declares that she has no competing interests.
Peer reviewers
Professor of Pediatrics
Allergy-Immunology Division
Medical College of Wisconsin
Milwaukee
WI
Disclosures
JF is an author of a number of references cited in this topic.
Professor of Family Medicine
Medical University of South Carolina
Charleston
SC
Disclosures
AC declares that he has no competing interests.
Consultant Respiratory Physician
Interstitial Lung Disease Unit
Royal Brompton Hospital
London
UK
Disclosures
TMM has received consultancy fees from GSK, Actelion, and Philips Respironics. He has received lecture fees from Astra Zeneca and holds an unrestricted industry-academic grant from GSK.
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