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. 2022 Sep 1;17(9):e0273544.
doi: 10.1371/journal.pone.0273544. eCollection 2022.

Impact of number and type of identified antigen on transplant-free survival in hypersensitivity pneumonitis

Margaret Kypreos  1 , Kiran Batra  2 , Craig S Glazer  1 , Traci N Adams  1
Affiliations

Impact of number and type of identified antigen on transplant-free survival in hypersensitivity pneumonitis

Margaret Kypreos et al. PLoS One. .

Abstract

Background: Identification of inciting antigen can affect diagnostic confidence, quality of life, and prognosis in patients with HP. It is unknown whether the number and type of antigen affect results of diagnostic testing or prognosis, whether antigen identified by clinical history alone affects prognosis, and whether feather exposure is associated with outcomes similar to those of other antigens.

Methods: To evaluate whether the number or type of antigen identified by clinical history alone affects clinical outcomes, we evaluated a retrospective cohort of patients with a high or definite probability of HP based on recent guidelines.

Results: In our retrospective cohort, 136 patients met high or definite probability of HP and were included in the analysis. Median transplant-free survival was better in patients with antigen identified on clinical history alone than patients without identified antigen. Feather exposure was associated with improved TFS compared to patients without antigen identified; there was no difference in TFS between patients with feather exposure and either mold or live bird exposure. Mold antigen was associated with increased risk of fibrotic HP compared to avian antigen. Among patients with identified antigen, the number and type of antigen did not affect TFS.

Discussion: Our study suggests that clinical history is adequate for providing prognostic information to patients with HP and classifying the diagnostic probability of HP according to recent guidelines. Feather exposure should be considered an inciting antigen in patients with ILD.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan-Meier curve comparing transplant-free survival in years in patients with no antigen identified vs at least 1 antigen identified.
Fig 2
Fig 2. Kaplan-Meier curve comparing transplant-free survival in years in patients with no antigen identified, 1 antigen identified, or 2 or more antigens identified.
Fig 3
Fig 3. Kaplan-meier curve comparing transplant-free survival in years in patients with no antigen, feather, live bird, or mold.
See this image and copyright information in PMC

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