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Review
. 2016 Sep 21:9:171-181.
doi: 10.2147/JAA.S81540. eCollection 2016.

Chronic hypersensitivity pneumonitis

Carlos Ac Pereira  1 , Andréa Gimenez  2 , Lilian Kuranishi  2 , Karin Storrer  2
Affiliations
Review

Chronic hypersensitivity pneumonitis

Carlos Ac Pereira et al. J Asthma Allergy. .

Abstract

Hypersensitivity pneumonitis (HSP) is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary.

Keywords: HRCT; diffuse lung disease; extrinsic allergic alveolitis; farmers lung; interstitial lung diseases; lung immune response.

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Figures

Figure 1
Figure 1
Chronic HSP caused by feather pillows. Notes: Male, 67 years of age, nonsmoker, asymptomatic, but with progressive ILD; on HRCT since 2009. Use of feather pillows for 8 years. FVC =3.02 L (70%), DLCO =12.3 mL/min/mmHg (74% of predicted). Videothoracoscopic biopsy from three lobes on the right side. Abbreviations: HSP, hypersensitivity pneumonitis; ILD, interstitial lung disease, HRCT, high-resolution computed tomography; FVC, forced vital capacity; DLACO, diffusing capacity for carbon monoxide.
Figure 2
Figure 2
Chronic nonfibrotic HSP. Notes: Female, 56 years of age, ex-smoker; dyspnea in the last 7 months. Exposure to molds in the bedroom. FVC =2.31 L (94%); FEV1/FVC =0.87; RV =1.98 L (145%). Inspiratory HRCT without abnormalities. (A) Expiratory images showing several areas of air trapping. (B) Surgical lung biopsy showing cellular bronchiolitis with ill-defined granulomas, (C) focal peribronchiolar lymphocytic interstitial pneumonia, and air trapping. Removed from exposure with reversion of dyspnea and return of residual volume to normal range. Abbreviations: HSP, hypersensitivity pneumonitis; HRCT, high-resolution computed tomography; FVC, forced vital capacity; RV, residual volume.
Figure 3
Figure 3
Chronic fibrosing HSP. Notes: Male, 64 years of age, ex-smoker. dyspnea and cough for 2 years. Exposure to molds at home. HRCT-reticular pattern predominant in upper lobes, with peribronchovascular distribution, peripheral reticular pattern with honeycombing, asymmetric in lower lobes (A) and (B). Surgical lung biopsy-centered airway fibrosis (C) with chronic inflammatory infiltrate (D) and organizing foci in airways (E). Abbreviations: HSP, hypersensitivity pneumonitis; HRCT, high-resolution computed tomography.
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