Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Hypersensitivity Pneumonitis

  • Chapter
Allergy Frontiers: Diagnosis and Health Economics

Part of the book series: Allergy Frontiers ((ALLERGY,volume 4))

  • 657 Accesses

Hypersensitivity pneumonitis is a complex syndrome that develops after exposure to a large variety of environmental antigens, causing variable clinical symptoms often making diagnosis uncertain. Diagnosis of HP relies on a constellation of findings that include a suggestive environmental history, symptoms, physical findings, BAL lymphocytosis, imaging abnormalities, pulmonary function changes, and serum-specific antibodies. HRCT has improved diagnostic confidence. In the acute and subacute forms, removing the patient from the suspected environment often results in spontaneous amelioration of symptoms and this finding is a useful clue to the diagnosis. Inhalation challenge may be performed in selected patients in whom the causal relationship between antigen and lung disease has not been established. Finally, lung biopsy is recommended when the diagnosis is not apparent.

The pathogenesis of HP is intricate, and it is likely that both immune complexes and T-cell abnormalities participate in the development of the alveolitis, but in different phases and clinical forms of the disease. Importantly, HP occurs only in a few exposed individuals suggesting that some additional promoting factors (either genetic or environmental) play a role.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Selman M (2004). Hypersensitivity pneumonitis: a multifaceted deceiving disorder. Clin Chest Med 25:531–547.

    Article  PubMed  Google Scholar 

  2. Lacasse Y, Cormier Y (2006). Hypersensitivity pneumonitis. Orphanet J Rare Dis 1:25.

    Article  PubMed  Google Scholar 

  3. Christensen LT, Schmidt CD, Robbins L (1975). Pigeon breeders' disease: a prevalence study and review. Clin Allergy 5:417–430.

    Article  PubMed  CAS  Google Scholar 

  4. Hendrick DJ, Faux JA, Marshall R (1978). Budgerigar-fancier's lung: the commonest variety of allergic alveolitis in Britain. Br Med J 2:81–84.

    Article  PubMed  CAS  Google Scholar 

  5. Wallace Jr RJ, Zhang Y, Wilson RW, Mann L, Rossmoore H (2002). Presence of a single genotype of the newly described species Mycobacterium immunogenum in industrial metal working fluids associated with hypersensitivity pneumonitis. Appl Environ Microbiol 68:5580–5584.

    Article  CAS  Google Scholar 

  6. Fishwick D, Tate P, Elms J, Robinson E, Crook B, Gallagher F, Lennox R, Curran A (2005). Respiratory symptoms, immunology and organism identification in contaminated metalworking fluid workers. What you see is not what you get. Occup Med (Lond) 55:238–241.

    Article  Google Scholar 

  7. NIOSH (1977). National Occupational Hazard Survey. Publ 78–114. Washington, DC: USDHEW, 369p.

    Google Scholar 

  8. Camarena A, Juárez A, Mejía M, Estrada A, Carrillo G, Falfán R, Zuñiga J, Navarro C, Granados J, Selman M (2001). Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder's disease. Am J Respir Crit Care Med 163:1528–1533.

    PubMed  CAS  Google Scholar 

  9. Ando M, Hirayama K, Soda K, Okubo R, Araki S, Sasazuki T (1989). HLA-DQw3 in Japanese summer-type hypersensitivity pneumonitis induced by Trichosporon cutaneum. Am Rev Respir Dis 140:948–950.

    PubMed  CAS  Google Scholar 

  10. Rittner C, Sennekamp J, Mollenhauer E, Rösinger N, Niese D, Lüttkenhorst M, Baur MP, Stroehmann I (1983). Pigeon breeder's lung: association with HLA-DR 3. Tissue Antigens 21:374–379.

    PubMed  CAS  Google Scholar 

  11. Donnelly KB, Brooks BO, Cruz ES, Wassom DL (1996). Major histocompatibility complex class II genes control susceptibility to hypersensitivity pneumonitis in the mouse. Chest 109(3 Suppl):73S.

    Article  PubMed  CAS  Google Scholar 

  12. Schaaf BM, Seitzer U, Pravica V, Aries SP, Zabel P (2001). Tumor necrosis factor-alpha-308G/A promoter gene polymorphism and increased tumor necrosis factor serum bioactivity in farmer's lung patients. Am J Respir Crit Care Med 163:379–382.

    PubMed  CAS  Google Scholar 

  13. Kondoh K, Usui Y, Ohtani Y, Inase N, Miyake S, Yoshizawa Y (2006). Proinflammatory and anti-inflammatory cytokine gene polymorphisms in hypersensitivity pneumonitis. J Med Dent Sci 53:75–83.

    PubMed  Google Scholar 

  14. Gudmundsson G, Monick MM, Hunninghake GW (1999). Viral infection modulates expression of hypersensitivity pneumonitis. J Immunol 162:7397–7401.

    PubMed  CAS  Google Scholar 

  15. Cormier Y, Israel-Assayag E, Fournier M, Tremblay GM (1993). Modulation of experimental hypersensitivity pneumonitis by Sendai virus. J Lab Clin Med 121:683–688.

    PubMed  CAS  Google Scholar 

  16. Dakhama A, Hegele RG, Laflamme G, Israël-Assayag E, Cormier Y (1999). Common respiratory viruses in lower airways of patients with acute hypersensitivity pneumonitis. Am J Respir Crit Care Med 159:1316–1322.

    PubMed  CAS  Google Scholar 

  17. Hoppin JA, Umbach DM, Kullman GJ, Henneberger PK, London SJ, Alavanja MC, Sandler DP (2007). Pesticides and other agricultural factors associated with self-reported farmer's lung among farm residents in the Agricultural Health Study. Occup Environ Med 64:334–341.

    Article  PubMed  CAS  Google Scholar 

  18. Bustos ML, Frías S, Ramos S, Estrada A, Arreola JL, Mendoza F, Gaxiola M, Salcedo M, Pardo A, Selman M (2007). Local and circulating microchimerism is associated with hypersensitivity pneumonitis. Am J Respir Crit Care Med 176:90–95.

    Article  PubMed  Google Scholar 

  19. Warren CPW (1977). Extrinsic allergic alveolitis: a disease commoner in non-smokers. Thorax 32:567–569.

    Article  PubMed  CAS  Google Scholar 

  20. Depierre A, Dalphin JC, Pernet D, Dubiez A, Faucompré C, Breton JL (1988). Epidemiological study of farmer's lung in five districts of the French Doubs province. Thorax 43:429–435.

    Article  PubMed  CAS  Google Scholar 

  21. Baur X, Richter G, Pethran A, Czuppon AB (1992). Increased prevalence of IgG-induced sensitization and hypersensitivity pneumonitis (humidifier lung) in nonsmokers exposed to aerosols of a contaminated air conditioner. Respiration 59:211–214.

    Article  PubMed  CAS  Google Scholar 

  22. Arima K, Ando M, Ito K, Sakata T, Yamaguchi T, Araki S, Futatsuka M (1992). Effect of cigarette smoking on prevalence of summer-type hypersensitivity pneumonitis caused by Trichosporon cutaneum. Arch Environ Health 47:274–278.

    PubMed  CAS  Google Scholar 

  23. Murin S, Bilello KS, Matthay R (2000). Other smoking-affected pulmonary diseases. Clin Chest Med 21:121–137.

    Article  PubMed  CAS  Google Scholar 

  24. Blanchet MR, Israël-Assayag E, Cormier Y (2004). Inhibitory effect of nicotine on experimental hypersensitivity pneumonitis in vivo and in vitro. Am J Respir Crit Care Med 169:903–909.

    Article  PubMed  Google Scholar 

  25. Ohtsuka Y, Munakata M, Tanimura K, Ukita H, Kusaka H, Masaki Y, Doi I, Ohe M, Amishima M, Homma Y, Kawakami Y (1995). Smoking promotes insidious and chronic farmer's lung disease, deteriorates the clinical outcome. Intern Med 34:966–971.

    Article  PubMed  CAS  Google Scholar 

  26. Cormier Y, Gagnon L, Bérubé-Genest F, Fournier M (1988). Sequential bronchoalveolar lavage in experimental extrinsic allergic alveolitis. The influence of cigarette smoking. Am Rev Respir Dis 137:1104–1109.

    CAS  Google Scholar 

  27. Silva CI, Churg A, Müller NL (2007). Hypersensitivity pneumonitis: spectrum of highresolution CT and pathologic findings. AJR Am J Roentgenol 188:334–344.

    Article  PubMed  Google Scholar 

  28. Yoshizawa Y, Ohtani Y, Hayakawa H, Sato A, Suga M, Ando M (1999). Chronic hypersensitivity pneumonitis in Japan: a nationwide epidemiologic survey. J Allergy Clin Immunol 103:315–320.

    Article  PubMed  CAS  Google Scholar 

  29. Ohtani Y, Saiki S, Sumi Y, Inase N, Miyake S, Costabel U, Yoshizawa Y (2003). Clinical features of recurrent and insidious chronic bird fanciers lung. Ann Allergy Asthma Immunol 90:604–610.

    PubMed  Google Scholar 

  30. Sansores R, Salas J, Chapela R, Barquin N, Selman M (1990). Clubbing in hypersensitivity pneumonitis. Its prevalence and possible prognostic role. Arch Intern Med 150:1849–1851.

    CAS  Google Scholar 

  31. Seifert SA, Von Essen S, Jacobitz K, Crouch R, Lintner CP (2003). Organic dust toxic syndrome: a review. J Toxicol Clin Toxicol 41:185–193.

    Article  PubMed  CAS  Google Scholar 

  32. Lacasse Y, Selman M, Costabel U, Dalphin JC, Ando M, Morell F, Erkinjuntti-Pekkanen R, Muller N, Colby TV, Schuyler M, Cormier Y, HP Study Group (2003).Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med 168:952–958.

    Article  PubMed  Google Scholar 

  33. Remy-Jardin M, Remy J, Wallaert B, Muller NL (1993). Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage. Radiology 189:111–118.

    PubMed  CAS  Google Scholar 

  34. Hodgson MJ, Parkinson DK, Karpf M (1989). Chest x-rays in hypersensitivity pneumonitis: a metaanalysis of secular trend. Am J Ind Med 16:45–53.

    Article  PubMed  CAS  Google Scholar 

  35. Franquet T, Hansell DM, Senbanjo T, Remy-Jardin M, Müller NL (2003). Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr 27:475–478.

    Article  PubMed  Google Scholar 

  36. Cormier Y, Brown M, Worthy S, Racine G, Müller NL (2000). High-resolution computed tomographic characteristics in acute farmer's lung and in its follow-up. Eur Respir J 16:56–60.

    Article  PubMed  CAS  Google Scholar 

  37. Sansores RH, Ramirez-Venegas A, Pérez-Padilla R, Montaño M, Ramos C, Becerril C, Gaxiola M, Paré P, Selman M (1996). Correlation between pulmonary fibrosis and the lung pressure-volume curve. Lung 174:315–323.

    Article  PubMed  CAS  Google Scholar 

  38. Schwaiblmair M, Beinert T, Vogelmeier C, Fruhmann G (1997). Cardiopulmonary exercise testing following hay exposure challenge in farmer's lung. Eur Respir J 10:2360–2365.

    Article  PubMed  CAS  Google Scholar 

  39. Pérez-Neria J, Selman M, Rubio H, et al. (1987). Relationship between lung inflammation or fibrosis and frequency dependence of compliance in interstitial pulmonary diseases. Respiration 52:254–262.

    Article  PubMed  Google Scholar 

  40. Erkinjuntti-Pekkanen R, Rytkonen H, Kokkarinen JI, Tukiainen HO, Partanen K, Terho EO (1998). Long-term risk of emphysema in patients with farmer's lung and matched control farmers. Am J Respir Crit Care Med 158:662–665.

    PubMed  CAS  Google Scholar 

  41. Matusiewiez SP, Williamson IJ, Sime PJ, Brown PH, Wenham PR, Crompton GK, Greening AP (1993). Plasma lactate dehydrogenase. A marker of disease activity in cryptogenic fibrosing alveolitis and extrinsic allergic alveolitis. Eur Respir J 6:1282–1286.

    Google Scholar 

  42. Ratjen F, Costabel U, Griese M, Paul K (2003). Bronchoalveolar lavage fluid findings in children with hypersensitivity pneumonitis. Eur Respir J 21:144–148.

    Article  PubMed  CAS  Google Scholar 

  43. Pardo A, Smith KM, Abrams J, Coffman R, Bustos M, McClanahan TK, Grein J, Murphy EE, Zlotnik A, Selman M (2004). CCL18/DC-CK-1/PARC up-regulation in hypersensitivity pneumonitis. J Leukocyte Biol 70:610–616.

    Google Scholar 

  44. Remy-Jardin M, Remy J, Wallaert B, Muller NL (1993). Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage. Radiology 189:111–118.

    PubMed  CAS  Google Scholar 

  45. Semenzato G (1991). Immunology of interstitial lung diseases: cellular events taking place in the lung of sarcoidosis, hypersensitivity pneumonitis and HIV infection. Eur Respir J 4:94–102.

    PubMed  CAS  Google Scholar 

  46. Tsushima K, Fujimoto K, Yamazaki Y, Takamizawa A, Amari T, Koizumi T, Kubo K (2001). Hypersensitivity pneumonitis induced by spores of Lyophyllum aggregatum. Chest 120:1085–1093.

    Article  PubMed  CAS  Google Scholar 

  47. Murayama J, Yoshizawa Y, Ohtsuka M, Hasegawa S (1993). Lung fibrosis in hypersensitivity pneumonitis. Association with CD4+ but not CD8+ cell dominant alveolitis and insidious onset. Chest 104:38–43.

    PubMed  CAS  Google Scholar 

  48. Barrera L, Mendoza F, Carrillo G, Estrada A, Melendro E, Zaragoza M, Pardo A, Selman M (2003). Patients with chronic hypersensitivity pneumonitis displayed an increased CD4/CD8 ratio, and a polarization to helper T type 2 (Th2) response. Am J Respir Crit Care Med 167:A358.

    Google Scholar 

  49. Ando M, Konishi K, Yoneda R, Tamura M (1991). Difference in the phenotypes of bronchoalveolar lavage lymphocytes in patients with summer-type hypersensitivity pneumonitis, farmer's lung, ventilation pneumonitis, and bird fancier's lung: report of a nationwide epidemiologic study in Japan. J Allergy Clin Immunol 87:1002–1009.

    Article  PubMed  CAS  Google Scholar 

  50. Embil J, Warren P, Yakrus M, Stark R, Corne S, Forrest D, Hershfield E (1997). Pulmonary illness associated with exposure to Mycobacterium-avium complex in hot tub water. Hypersensitivity pneumonitis or infection? Chest 111:813–816.

    Article  PubMed  CAS  Google Scholar 

  51. Cormier Y, Belanger J, Laviolette M (1986). Persistent bronchoalveolar lymphocytosis in asymptomatic farmers. Am Rev Respir Dis 133:843–847.

    PubMed  CAS  Google Scholar 

  52. Johnson MA, Nemeth A, Condez A, Clarke SW, Poulter LW (1989). Cell-mediated immunity in pigeon breeder's lung: the effect of removal from antigen exposure. Eur Respir J 2:444–450.

    Google Scholar 

  53. Cormier Y, Létourneau L, Racine G (2004). Significance of precipitins and asymptomatic lymphocytic alveolitis: a 20-yr follow-up. Eur Respir J 23:523–525.

    Article  PubMed  CAS  Google Scholar 

  54. Semenzato G, Trentin L, Zambello R, Agostini C, Cipriani A, Marcer G (1988). Different types of cytotoxic lymphocytes recovered from the lungs of patients with hypersensitivity pneumonitis. Am Rev Respir Dis 137:70–74.

    PubMed  CAS  Google Scholar 

  55. Ratjen F, Costabel U, Griese M, Paul K (2003). Bronchoalveolar lavage fluid findings in children with hypersensitivity pneumonitis. Eur Respir J 21:144–148.

    Article  PubMed  CAS  Google Scholar 

  56. Drent M, Wagenaar SjSc, Velzen-Blad H, Mulder PGH, Hoogsteden HC, van des Bosch JMM (1993). Relationship between plasma cell levels and profile of bronchoalveolar lavage fluid in patients with subacute extrinsic allergic alveolitis. Thorax 48:835–839.

    Article  PubMed  CAS  Google Scholar 

  57. Fournier E, Tonnel AB, Gosset PH, Wallaert B, Ameisen JC, Voisin C (1985). Early neutrophil alveolitis after antigen inhalation in hypersensitivity pneumonitis. Chest 88:563–566.

    Article  PubMed  CAS  Google Scholar 

  58. Haslam PL, Dewar A, Butchers P, Primett ZS, Newman-Taylor A, Turner-Warwick M (1987). Mast cells, atypical lymphocytes, neutrophils in bronchoalveolar lavage in extrinsic allergic alveolitis: comparison with other interstitial lung diseases. Am Rev Respir Dis 135:35–47.

    PubMed  CAS  Google Scholar 

  59. Schildge J, Klar B, Hardung-Backes M (2003). Mast cells in bronchoalveolar lavage fluid of patients with interstitial lung diseases. Pneumologie 57:202–207.

    Article  PubMed  CAS  Google Scholar 

  60. Ishida T, Matsui Y, Matsumura Y, Fujimori N, Furutani M (1995). Bronchoalveolar lavage mast cells in summer-type hypersensitivity pneumonitis: increase in numbers and ultrastructural evidence of degranulation. Intern Med 34:357–363.

    Article  PubMed  CAS  Google Scholar 

  61. Laviolette M, Cormier Y, Loiseau A, Soler P, Leblanc P, Hance AJ (1991). Bronchoalveolar mast cells in normal farmers and subjects with farmer's lung. Am Rev Respir Dis 144:855–860.

    PubMed  CAS  Google Scholar 

  62. Travis WD, Colby TV, Koss MN, Rosado-de-Christenson ML, Müller NL, King TE (2002). Non-neoplastic Disorders of the Lower Respiratory Tract. Washington, DC: American Registry of Pathology, pp. 115–123.

    Google Scholar 

  63. Myers JL (2005). Idiopathic interstitial pneumonias. In: Churg AM, Myers JL, Tazelaar HD, Wright JL, editors: Thurlbeck's Pathology of the Lung, 3rd Edition. New York: Thieme Medical Publishers, pp. 563–600.

    Google Scholar 

  64. Coleman A, Colby TV (1988). Histologic diagnosis of extrinsic allergic alveolitis. Am J Surg Pathol 12:514–518.

    Article  PubMed  CAS  Google Scholar 

  65. Vourlekis JS, Schwarz MI, Cool CD, Tuder RM, King TE, Brown KK (2002). Nonspecific interstitial pneumonitis as the sole histologic expression of hypersensitivity pneumonitis. Am J Med 112:490–493.

    Article  PubMed  Google Scholar 

  66. Kawanami O, Basset F, Barrios R, Lacronique JG, Ferrans VJ, Crystal RG (198). Hypersensitivity pneumonitis in man. Light- and electron-microscopic studies of 18 lung biopsies. Am J Pathol 110:275–289.

    Google Scholar 

  67. Reyes CN, Wenzel FJ, Lawton BR Emanuel DA (1982). The pulmonary pathology of farmer's lung disease. Chest 81:142–146.

    Article  PubMed  CAS  Google Scholar 

  68. Perez-Padilla R, Salas J, Chapela R, Sanchez M, Carrillo G, Perez R, Sansores R, Gaxiola M, Selman M (1993). Mortality in Mexican patients with chronic pigeon breeder's lung compared with those with usual interstitial pneumonia. Am Rev Respir Dis 148:49–53.

    PubMed  CAS  Google Scholar 

  69. Vourlekis JS, Schwarz MI, Cherniack RM, Curran-Everett D, Cool CD, Tuder RM, King TE Jr, Brown KK (2004). The effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis. Am J Med 116:662–668.

    Article  PubMed  Google Scholar 

  70. Seal RM, Hapke EJ, Thomas GO, Meek JC, Hayes M (1968). The pathology of the acute and chronic stages of farmer's lung. Thorax 23:469–489.

    Article  PubMed  CAS  Google Scholar 

  71. Churg A, Muller NL, Flint J, Wright JL (2006). Chronic hypersensitivity pneumonitis. Am J Surg Pathol 30:201–208.

    Article  PubMed  Google Scholar 

  72. Ohtani Y, Saiki S, Kitaichi M, Usui Y, Inase N, Costabel U, Yoshizawa Y (2005). Chronic bird fancier's lung: histopathological and clinical correlation. Thorax 60:665–671.

    Article  PubMed  CAS  Google Scholar 

  73. Yoshida K, Ando M, Sakata T, Araki S (1989). Prevention of summer-type hypersensitivity pneumonitis: effect of elimination of Trichosporon cutaneum from the patient's homes. Arch Environ Health 44:317–322.

    PubMed  CAS  Google Scholar 

  74. Bourke SJ, Banham SW, Carter R, Lynch P, Boyd G (1989). Longitudinal course of extrinsic allergic alveolitis in pigeon breeders. Thorax 44:415–418.

    Article  PubMed  CAS  Google Scholar 

  75. Cormier Y, Bélanger J (1985). Long-term physiologic outcome after acute farmer's lung. Chest 87:796–800.

    Article  PubMed  CAS  Google Scholar 

  76. Erkinjuntti-Pekkanen R, Rytkonen H, Kokkarinen JI, Tukiainen HO, Partanen K, Terho EO (1998). Long-term risk of emphysema in patients with farmer's lung and matched control farmers. Am J Respir Crit Care Med 158:662–665.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Instituto Nacional de Enfermedades Respiratorias, México

    Moisés Selman

  2. Department of Pathology, University of British Columbia, Vancouver, BC, Canada

    Andrew Churg

Authors
  1. Moisés Selman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Churg
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan

    Ruby Pawankar

  2. Southampton General Hospital, University of Southampton, Tremona Road, Southampton, UK

    Stephen T. Holgate

  3. UMKC School of Medicine, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lanny J. Rosenwasser

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer

About this chapter

Cite this chapter

Selman, M., Churg, A. (2009). Hypersensitivity Pneumonitis. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Diagnosis and Health Economics. Allergy Frontiers, vol 4. Springer, Tokyo. https://doi.org/10.1007/978-4-431-98349-1_16

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-98349-1_16

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-98293-7

  • Online ISBN: 978-4-431-98349-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation