小结
定义
病史和体格检查
关键诊断因素
- exposure to avian protein antigen, especially excrement
- mold in work environment
- occupational exposure to chemicals
- dyspnea
- cough
其他诊断因素
- fever/chills
- malaise
- weight loss/anorexia
- bibasilar rales
- diffuse rales
- clubbing
危险因素
- 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
- use of certain drugs
- use of e-cigarettes
- ayurvedic medicine
诊断性检查
首要检查
- chest x-ray
- high-resolution CT chest
- serum antigen-specific IgG or IgA
- pulmonary function tests
- diffusing lung capacity of carbon monoxide
需考虑的检查
- bronchoalveolar lavage
- lung biopsy
治疗流程
all patients
撰稿人
作者
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
利益声明
LG declares that she has no competing interests.
同行评议者
Maximiliano Tamae-Kakazu, MD, FCCP
Associate Professor of Medicine
Program Director, Pulmonary and Critical Care Medicine Fellowship
Research Director, Pulmonary and Critical Care Medicine
Corewell Health West - Michigan State University College of Human Medicine
East Lansing
MI
利益声明
MTK received fees from InflaRx as a consultant to participate in a COVID-19 pneumonia Advisory Board. MTK received fees from Pfizer as a consultant to participate in a healthcare disparities in primary immunodeficiencies advisory board. MTK received fees from Regeneron as consultant on the pathophysiology of asthma and need of education in fellowship programs advisory board in January 2022. All the honoraria have been donated to the Corewell Health Foundation.
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
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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