Hypersensitivity Pneumonitis: Challenges in Diagnosis and Management, Avoiding Surgical Lung Biopsy.

@article{Morell2016HypersensitivityPC,
  title={Hypersensitivity Pneumonitis: Challenges in Diagnosis and Management, Avoiding Surgical Lung Biopsy.},
  author={Ferran Morell and Ana Villar and I{\~n}igo Ojanguren and Xavier Mu{\~n}oz and Mar{\'i}a Jes{\'u}s Cruz},
  journal={Seminars in respiratory and critical care medicine},
  year={2016},
  volume={37 3},
  pages={
          395-405
        }
}
This review presents an update of the currently available information related to hypersensitivity pneumonitis, with a particular focus on the contribution of several techniques in the diagnosis of this condition. The methods discussed include proper elaboration of a complete medical history, targeted auscultation, detection of specific immunoglobulin G antibodies against the most common antigens causing this disease, skin tests, antigen-specific lymphocyte activation assays, bronchoalveolar… Expand
Assessment and Management of Occupational Hypersensitivity Pneumonitis.
TLDR
This review provides an update of the recent literature regarding the different presentations of OHP and the diagnostic yield and value of the diagnostic tests currently available, which include occupational and medical history, laboratory tests (serum-specific immunoglobulins, environmental sampling), imaging, bronchoalveolar lavage, transbronchial biopsy, surgical lung biopsy and specific inhalation challenges. Expand
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TLDR
Combining realistic workplace challenge with immunological analyses of workplace material may improve the basis for counselling farmers with farmer´s lung concerning future work within farming. Expand
Hypersensitivity pneumonitis recognised in a single pulmonary unit, between 2005 and 2015 - comparison with recently proposed diagnostic criteria.
TLDR
HP diagnosis was confirmed according to current diagnostic criteria in 70% of patients diagnosed between 2005 and 2015, and the confirmation of HP with lung biopsy has been obtained in 36% of non-confident cases. Expand
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TLDR
The present report provides an overview of the role of antigen role in HP, highlighting its diversity, research methods, and prevention strategies, as well as the impact on disease prognosis following elimination of antigen. Expand
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TLDR
A systematic approach was developed to the diagnosis of hypersensitivity pneumonitis and the need for a thorough history and validated questionnaire to identify potential exposures was agreed on. Expand
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TLDR
AZA revealed to be effective in disease stabilisation in most patients, while ineffective for a subset, and BAL lymphocytosis appears as a potentially valuable strategy to identify AZA responders, although with limited accuracy. Expand
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TLDR
Pulmonologists treating patients with interstitial lung disease (ILD) know that hypersensitivity pneumonitis (HP) cannot be ruled out, but a meticulous case history must be obtained, looking for evidence of previous contact with birds, feathers (down comforters, etc.), or fungi (damp environments, aerosols with contaminated water, spas, steam iron, moldy walls, etc.). Expand
[Extrinsic allergic alveolitis: minimum for clinical practice].
TLDR
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The value of serum precipitins against specific antigens in patients diagnosed with hypersensitivity pneumonitis – retrospective study
TLDR
The results of the study indicate that ssIgG against birds’ allergens were the valuable diagnostic tool in HP patients and indicate that other microorganisms, most likely molds, could be responsible for the disease development. Expand
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TLDR
The objective was to identify diagnostic criteria and to develop a clinical prediction rule for hypersensitivity pneumonitis and it was found that the rule retained its accuracy when validated in a separate cohort of 261 patients. Expand
Hypersensitivity Pneumonitis: A Comprehensive Review.
TLDR
Hypersensitivity pneumonitis is a complex pulmonary syndrome mediated by the immune system and caused by inhalation of a wide variety of antigens to which the individual has been previously sensitized, and clinical presentation and natural history vary widely. Expand
Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the Subcommittee on Hypersensitivity Pneumonitis.
In general, a history of exposure to "moldy" hay, birds, or other incriminated occupational or environmental inhalants in a patient with clinical and radiologic features consistent with HSP shouldExpand
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TLDR
The present review analyzes the reasons for the test's limited use, assesses its diagnostic utility, and proposes a basis for its standardization. Expand
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TLDR
The current classification of HP in acute, subacute, and chronic phases is now challenged, and a set of clinical predictors has been proposed. Expand
Hypersensitivity pneumonitis
TLDR
Improved understanding of the complex inflammatory events involved in hypersensitivity pneumonitis means that the treatment and outcome of HP have not changed and oral corticosteroids remain the only effective drugs and contact withdrawal constitutes the ideal solution. Expand
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TLDR
Serum specific IgG antibody determinations and specific skin tests against Aspergillus fumigatus and suberin demonstrated the capacity of both these antigenic extracts to induce an immunologic response. Expand
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Hypersensitivity pneumonitis (HP) is a complex syndrome caused by the inhalation of environmental antigens. Chronic HP may mimic other fibrotic lung diseases, such as idiopathic pulmonary fibrosis.Expand
Diagnostic yield of specific inhalation challenge in hypersensitivity pneumonitis
TLDR
In hypersensitivity pneumonitis, positive SIC testing virtually confirms the diagnosis, whereas negative testing does not rule it out, especially when the antigenic sources are not birds or fungi. Expand
Histologic Diagnosis of Extrinsic Allergic Alveolitis
TLDR
Twenty-seven patients with open-lung biopsy findings consistent with extrinsic allergic alveolitis (hypersensitivity pneumonitis) were studied; all 10 patients in whom an exposure was found and 13 of 17 without causative exposure are alive without progressive lung disease. Expand
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