Hypersensitivity pneumonitis: A comprehensive review

P. Spagnolo, G. Rossi, A. Cavazza, I. Paladini, I. Paladini, F. Bonella, N. Sverzellati, U. Costabel

Research output: Contribution to journalArticlepeer-review

Abstract

Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is a complex pulmonary syndrome mediated by the immune system and caused by inhalation of a wide variety of antigens to which the individual has been previously sensitized. The pathobiology of the disease is not fully understood, but in addition to the triggers that initiate the disease, host/genetic factors are likely to be important, as only a minority of exposed individuals develop HP. Due to the lack of a diagnostic gold standard, the diagnosis of HP is not straightforward and relies on the integration of a number of factors, including history of exposure, precipitating antibodies to the offending antigen, clinical features, bronchoalveolar lavage, and radiological and pathologic features. However, in the appropriate setting, a high index of suspicion is critically important and may obviate the need for more invasive tests. Clinical presentation and natural history vary widely. Acute forms generally resolve without sequelae, while chronic forms, which are caused by persistent low-grade exposures, are associated with poor prognosis. Corticosteroids may be useful in acute episodes for symptomatic relief or in chronic and progressive disease, but their long-term efficacy has never been validated in prospective clinical trials. Ideally, patients with HP should be referred to centers with expertise, as the overlap with other forms of interstitial lung disease may be substantial. Making the correct diagnosis has critical therapeutic and prognostic implications.

Original languageEnglish
Pages (from-to)237-250
Number of pages14
JournalJournal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología
Volume25
Issue number4
Publication statusPublished - Jul 27 2015

Keywords

  • Differential diagnosis
  • Extrinsic allergic alveolitis
  • Hypersensitivity pneumonitis
  • Idiopathic pulmonary fibrosis
  • Interstitial lung disease
  • Management
  • Pathogenesis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Medicine(all)

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