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. 2024 Aug 20;24(1):398.
doi: 10.1186/s12890-024-03098-3.

Effect of antigen removal in hypersensitivity pneumonitis

Mark J Robertshaw  1 , April Gorman  2 , Craig S Glazer  1 , Traci N Adams  3
Affiliations

Effect of antigen removal in hypersensitivity pneumonitis

Mark J Robertshaw et al. BMC Pulm Med. .

Abstract

Background: Antigen removal is a cornerstone of treatment of hypersensitivity pneumonitis (HP), but its association with transplant-free survival remains unclear. Further, HP guidelines conflict as to whether antigen removal is a recommended diagnostic test in patients with suspected HP.

Objective: The purpose of this study is to (1) evaluate the impact of antigen removal on transplant-free survival and (2) to describe the impact of antigen removal on pulmonary function testing and imaging in a retrospective cohort of patients with HP.

Methods: We retrospectively identified HP patients evaluated between 2011 and 2020. Demographic, physiologic, radiographic, and pathologic data were recorded.

Results: 212 patients were included in the cohort. Patients who identified and removed antigen had a better transplant-free survival than patients who did not identify antigen and patients who identified but did not remove antigen. Antigen removal was associated with improvement in FVC by 10% predicted in 16.9% of patients with fibrotic HP and 56.7% of patients with nonfibrotic HP.

Discussion: Our results suggest that over 50% of nonfibrotic HP patients and 16.9% of fibrotic HP patients improve with exposure removal. In addition, antigen removal, rather than antigen identification, is associated with transplant-free survival in HP.

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Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Flow chart for HP diagnosis in the cohort
Fig. 2
Fig. 2
Direct adjusted survivor functions comparing groups (1) antigen identified and removed; (2) antigen identified but not removed; and (3) antigen not identified
Fig. 3
Fig. 3
Direct adjusted survivor functions comparing groups based on known antigen removal: antigen identified but not removed or antigen not identified vs. antigen identified and removed
Fig. 4
Fig. 4
Proportion of patients with > 10% improvement in FVC following antigen removal based on degree of fibrosis on HRCT
See this image and copyright information in PMC

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