Summary
Definition
History and exam
Key diagnostic factors
- exposure to avian protein antigen, especially excrement
- mold in work environment
- occupational exposure to chemicals
- dyspnea
- 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 mold antigen
- exposure to bacterial antigen
- exposure to diisocyanate (e.g., epoxy resin)
- exposure to acid anhydride antigen (e.g., paint refinisher)
- exposure to metalworking fluid
- nitrofurantoin, methotrexate, roxithromycin, and rituximab
- e-cigarettes
- sertraline
- ayurvedic medicine
Diagnostic tests
1st tests to order
- chest x-ray
- CT chest
- serum antigen-specific IgG or IgA
- pulmonary function test
- diffusing lung capacity of carbon monoxide
Tests to consider
- bronchoalveolar lavage
- lung biopsy
Treatment algorithm
all patients
Contributors
Authors
Leslie Grammer, MD
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
Jordan Fink, MD
Professor of Pediatrics
Allergy-Immunology Division
Medical College of Wisconsin
Milwaukee
WI
利益声明
JF is an author of a number of references cited in this topic.
Alec Chessman, MD
Professor of Family Medicine
Medical University of South Carolina
Charleston
SC
利益声明
AC declares that he has no competing interests.
Toby M. Maher, MB, MSc, PhD, MRCP
Consultant Respiratory Physician
Interstitial Lung Disease Unit
Royal Brompton Hospital
London
UK
利益声明
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.
参考文献
关键文献
Raghu G, Remy-Jardin M, Ryerson CJ, et al. Diagnosis of hypersensitivity pneumonitis in adults. An Official ATS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2020 Aug 1;202(3):e36-69.全文 摘要
Quirce S, Vandenplas O, Campo P, et al. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79.全文 摘要
Fernández Pérez ER, Travis WD, Lynch DA, et al. Diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report. Chest. 2021 Aug;160(2):e97-156.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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