» Articles » PMID: 35140104

Diagnosis, Course and Management of Hypersensitivity Pneumonitis

Overview
Journal Eur Respir Rev
Specialty Pulmonary Medicine
Date 2022 Feb 10
PMID 35140104
Authors
Affiliations
Soon will be listed here.
Abstract

Hypersensitivity pneumonitis (HP) is a complex and heterogeneous interstitial lung disease (ILD) that occurs when susceptible individuals develop an exaggerated immune response to an inhaled antigen. In this review, we discuss the latest guidelines for the diagnostic evaluation of patients with suspected HP, the importance of identifying patients with fibrotic and progressive disease, and the evidence supporting the drugs commonly used in the treatment of HP. Differential diagnosis of HP can be challenging and requires a thorough exposure history, multidisciplinary discussion of clinical and radiologic data, and, in some cases, assessment of bronchoalveolar lavage lymphocytosis and histopathologic findings. Patients with HP may be categorised as having non-fibrotic or fibrotic HP. The presence of fibrosis is associated with worse outcomes. A proportion of patients with fibrotic HP develop a progressive phenotype, characterised by worsening fibrosis, decline in lung function and early mortality. There are no established guidelines for the treatment of HP. Antigen avoidance should be implemented wherever possible. Immunosuppressants are commonly used in patients with HP but have not been shown to slow the worsening of fibrotic disease. Nintedanib, a tyrosine kinase inhibitor, has been approved by the US Food and Drug Administration for slowing the progression of chronic fibrosing ILDs with a progressive phenotype, including progressive fibrotic HP. Non-pharmacological interventions, such as oxygen therapy, pulmonary rehabilitation and supportive care, may be important components of the overall care of patients with progressive HP.

Citing Articles

Respiratory Diseases with High Occupational Fraction in Italy: Results from the Italian Hospital Discharge Registry (2010-2021).

Ferrante P Healthcare (Basel). 2025; 12(24.

PMID: 39765992 PMC: 11675411. DOI: 10.3390/healthcare12242565.


Potential of phosphodiesterase 4B inhibition in the treatment of progressive pulmonary fibrosis.

Keith R, Nambiar A Ther Adv Respir Dis. 2025; 19:17534666241309795.

PMID: 39745090 PMC: 11694302. DOI: 10.1177/17534666241309795.


Clinical predictors of physiologic change after treatment with immunosuppression in hypersensitivity pneumonitis.

Kypreos M, de Boer E, Ellington G, Fujioka G, Liu J, Glazer C PLoS One. 2024; 19(11):e0313540.

PMID: 39585828 PMC: 11588199. DOI: 10.1371/journal.pone.0313540.


Patient perspectives on knowledge gaps in hypersensitivity pneumonitis.

Varadarajan J, Edgar A, OBeirne R, Paul T, Krishnan J, Kaner R BMJ Open Respir Res. 2024; 11(1).

PMID: 39438082 PMC: 11499782. DOI: 10.1136/bmjresp-2024-002487.


Diagnosis of pulmonary sarcoidosis comorbid with non-specific interstitial pneumonia: a case report.

Xu R, Wang K, Li W, Liu D BMC Pulm Med. 2024; 24(1):497.

PMID: 39385123 PMC: 11462828. DOI: 10.1186/s12890-024-03316-y.


References
1.
Wang P, Jones K, Urisman A, Elicker B, Urbania T, Johannson K . Pathologic Findings and Prognosis in a Large Prospective Cohort of Chronic Hypersensitivity Pneumonitis. Chest. 2017; 152(3):502-509. DOI: 10.1016/j.chest.2017.02.011. View

2.
Flaherty K, Wells A, Cottin V, Devaraj A, Inoue Y, Richeldi L . Nintedanib in progressive interstitial lung diseases: data from the whole INBUILD trial. Eur Respir J. 2021; 59(3). PMC: 8927709. DOI: 10.1183/13993003.04538-2020. View

3.
Faverio P, Piluso M, De Giacomi F, Della Zoppa M, Cassandro R, Harari S . Progressive Fibrosing Interstitial Lung Diseases: Prevalence and Characterization in Two Italian Referral Centers. Respiration. 2020; 99(10):838-845. DOI: 10.1159/000509556. View

4.
Ferreira M, Borie R, Crestani B, Rigaud P, Wemeau L, Israel-Biet D . Efficacy and safety of rituximab in patients with chronic hypersensitivity pneumonitis (cHP): A retrospective, multicentric, observational study. Respir Med. 2020; 172:106146. DOI: 10.1016/j.rmed.2020.106146. View

5.
Holland A, Dowman L, Hill C . Principles of rehabilitation and reactivation: interstitial lung disease, sarcoidosis and rheumatoid disease with respiratory involvement. Respiration. 2015; 89(2):89-99. DOI: 10.1159/000370126. View