Advertisement

Hypersensitivity Pneumonitis

  • Moisés Selman
  • Andrew Churg
Part of the Allergy Frontiers book series (ALLERGY, volume 4)

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.

Keywords

Interstitial Lung Disease Respir Crit Hypersensitivity Pneumonitis Usual Interstitial Pneumonia Idiopathic Interstitial Pneumonia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Selman M (2004). Hypersensitivity pneumonitis: a multifaceted deceiving disorder. Clin Chest Med 25:531–547.PubMedCrossRefGoogle Scholar
  2. 2.
    Lacasse Y, Cormier Y (2006). Hypersensitivity pneumonitis. Orphanet J Rare Dis 1:25.PubMedCrossRefGoogle Scholar
  3. 3.
    Christensen LT, Schmidt CD, Robbins L (1975). Pigeon breeders' disease: a prevalence study and review. Clin Allergy 5:417–430.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 7.
    NIOSH (1977). National Occupational Hazard Survey. Publ 78–114. Washington, DC: USDHEW, 369p.Google Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. 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.PubMedGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 14.
    Gudmundsson G, Monick MM, Hunninghake GW (1999). Viral infection modulates expression of hypersensitivity pneumonitis. J Immunol 162:7397–7401.PubMedGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.PubMedGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 19.
    Warren CPW (1977). Extrinsic allergic alveolitis: a disease commoner in non-smokers. Thorax 32:567–569.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedGoogle Scholar
  23. 23.
    Murin S, Bilello KS, Matthay R (2000). Other smoking-affected pulmonary diseases. Clin Chest Med 21:121–137.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.Google Scholar
  27. 27.
    Silva CI, Churg A, Müller NL (2007). Hypersensitivity pneumonitis: spectrum of highresolution CT and pathologic findings. AJR Am J Roentgenol 188:334–344.PubMedCrossRefGoogle Scholar
  28. 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.PubMedCrossRefGoogle Scholar
  29. 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.PubMedGoogle Scholar
  30. 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.Google Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 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.PubMedGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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.PubMedGoogle Scholar
  41. 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. 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.PubMedCrossRefGoogle Scholar
  43. 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. 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.PubMedGoogle Scholar
  45. 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.PubMedGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 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.PubMedGoogle Scholar
  48. 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. 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.PubMedCrossRefGoogle Scholar
  50. 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.PubMedCrossRefGoogle Scholar
  51. 51.
    Cormier Y, Belanger J, Laviolette M (1986). Persistent bronchoalveolar lymphocytosis in asymptomatic farmers. Am Rev Respir Dis 133:843–847.PubMedGoogle Scholar
  52. 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. 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.PubMedCrossRefGoogle Scholar
  54. 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.PubMedGoogle Scholar
  55. 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.PubMedCrossRefGoogle Scholar
  56. 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.PubMedCrossRefGoogle Scholar
  57. 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.PubMedCrossRefGoogle Scholar
  58. 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.PubMedGoogle Scholar
  59. 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.PubMedCrossRefGoogle Scholar
  60. 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.PubMedCrossRefGoogle Scholar
  61. 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.PubMedGoogle Scholar
  62. 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. 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. 64.
    Coleman A, Colby TV (1988). Histologic diagnosis of extrinsic allergic alveolitis. Am J Surg Pathol 12:514–518.PubMedCrossRefGoogle Scholar
  65. 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.PubMedCrossRefGoogle Scholar
  66. 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. 67.
    Reyes CN, Wenzel FJ, Lawton BR Emanuel DA (1982). The pulmonary pathology of farmer's lung disease. Chest 81:142–146.PubMedCrossRefGoogle Scholar
  68. 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.PubMedGoogle Scholar
  69. 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.PubMedCrossRefGoogle Scholar
  70. 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.PubMedCrossRefGoogle Scholar
  71. 71.
    Churg A, Muller NL, Flint J, Wright JL (2006). Chronic hypersensitivity pneumonitis. Am J Surg Pathol 30:201–208.PubMedCrossRefGoogle Scholar
  72. 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.PubMedCrossRefGoogle Scholar
  73. 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.PubMedGoogle Scholar
  74. 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.PubMedCrossRefGoogle Scholar
  75. 75.
    Cormier Y, Bélanger J (1985). Long-term physiologic outcome after acute farmer's lung. Chest 87:796–800.PubMedCrossRefGoogle Scholar
  76. 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.PubMedGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Moisés Selman
    • 1
  • Andrew Churg
    • 2
  1. 1.Instituto Nacional de Enfermedades RespiratoriasMéxico
  2. 2.Department of PathologyUniversity of British ColumbiaVancouverCanada

Personalised recommendations