Resumo
Definição
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
- use of certain drugs
- use of e-cigarettes
- ayurvedic medicine
Diagnostic tests
1st tests to order
- chest x-ray
- high-resolution CT chest
- serum antigen-specific IgG or IgA
- pulmonary function tests
- 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
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
Disclosures
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
Declarações
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.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
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.Texto completo Resumo
Quirce S, Vandenplas O, Campo P, et al. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79.Texto completo Resumo
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.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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