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Koschel D, Behr J, Berger M, Bonella F, Hamer O, Joest M, Jonigk D, Kreuter M, Leuschner G, Nowak D, Raulf M, Rehbock B, Schreiber J, Sitter H, Theegarten D, Costabel U. [Diagnosis and Treatment of Hypersensitivity Pneumonitis - S2k Guideline of the German Respiratory Society and the German Society for Allergology and Clinical Immunology]. Pneumologie 2024. [PMID: 39227017 DOI: 10.1055/a-2369-8458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) in sensitized individuals caused by a large variety of inhaled antigens. The clinical form of acute HP is often misdiagnosed, while the chronic form, especially the chronic fibrotic HP, is difficult to differentiate from other fibrotic ILDs. The present guideline for the diagnosis and treatment of HP replaces the former German recommendations for the diagnosis of HP from 2007 and is amended explicitly by the issue of the chronic fibrotic form, as well as by treatment recommendations for the first time. The evidence was discussed by a multidisciplinary committee of experts. Then, recommendations were formulated for twelve questions on important issues of diagnosis and treatment strategies. Recently published national and international guidelines for ILDs and HP were considered. Detailed background information on HP is useful for a deeper insight into HP and the handling of the guideline.
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Affiliation(s)
- Dirk Koschel
- Abteilung Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig, Deutschland
- Bereich Pneumologie, Medizinische Klinik 1, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
- Ostdeutsches Lungenzentrum (ODLZ), Coswig/Dresden, Deutschland
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - Melanie Berger
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
| | - Okka Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Abteilung für Radiologie, Lungenfachklinik Donaustauf, Donaustauf, Deutschland
| | - Marcus Joest
- Praxis für Pneumologie und Allergologie, Bonn, Deutschland
| | - Danny Jonigk
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
- Institut für Pathologie, RWTH Aachen, Universität Aachen, Aachen, Deutschland
| | - Michael Kreuter
- Lungenzentrum Mainz, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz und Klinik für Pneumologie, ZfT, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, München, Deutschland
| | - Monika Raulf
- Abteilung Kompetenz-Zentrum Allergologie/Immunologie, Institut für Prävention und Arbeitsmedizin der DGUV, Institut der Ruhr-Universität Bochum (IPA), Bochum, Deutschland
| | - Beate Rehbock
- Privatpraxis für Diagnostische Radiologie und Begutachtung, Berlin, Deutschland
| | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - Helmut Sitter
- Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Dirk Theegarten
- Institut für Pathologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
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Robertshaw MJ, Gorman A, Glazer CS, Adams TN. Effect of antigen removal in hypersensitivity pneumonitis. BMC Pulm Med 2024; 24:398. [PMID: 39164720 PMCID: PMC11337626 DOI: 10.1186/s12890-024-03098-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/12/2024] [Indexed: 08/22/2024] Open
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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Affiliation(s)
- Mark J Robertshaw
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - April Gorman
- Department of Statistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig S Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Traci N Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA.
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Yatera K, Nishida C. Contemporary Concise Review 2023: Environmental and occupational lung diseases. Respirology 2024; 29:574-587. [PMID: 38826078 DOI: 10.1111/resp.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
Air pollutants have various effects on human health in environmental and occupational settings. Air pollutants can be a risk factor for incidence, exacerbation/aggravation and death due to various lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis or pneumonia (HP), pulmonary fibrosis such as pneumoconiosis and malignant respiratory diseases such as lung cancer and malignant pleural mesothelioma. Environmental and occupational respiratory diseases are crucial clinical and social issues worldwide, although the burden of respiratory disease due to environmental and occupational causes varies depending on country/region, demographic variables, geographical location, industrial structure and socioeconomic situation. The correct recognition of environmental and occupational lung diseases and taking appropriate measures are essential to their effective prevention.
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Affiliation(s)
- Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Chinatsu Nishida
- Department of Environmental Health Engineering, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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Mullin ML, Fernandez G, Marinescu DC, Zheng B, Wong AW, Assayag D, Fisher JH, Johannson KA, Khalil N, Kolb M, Manganas H, Marcoux V, Morisset J, Min B, Farrand E, Ryerson CJ. Impact of Antigen Exposure on Outcomes and Treatment Response in Fibrotic Hypersensitivity Pneumonitis. Chest 2024; 165:1435-1443. [PMID: 38128609 DOI: 10.1016/j.chest.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with fibrotic hypersensitivity pneumonitis (fHP) are frequently treated with immunosuppression to slow lung function decline; however, the impact of this treatment has not been studied across different types of antigen exposure. RESEARCH QUESTION In patients with fHP, do disease outcomes and response to treatment vary by antigen type? STUDY DESIGN AND METHODS A multicenter interstitial lung disease database (Canadian Registry for Pulmonary Fibrosis) was used to identify patients with fHP. The causative antigen was categorized as avian, mold, unknown, or other. Treatment was defined as mycophenolate ≥ 1,000 mg/d or azathioprine ≥ 75 mg/d for ≥ 30 days. Statistical analysis included t tests, χ2 tests, and one-way analysis of variance. Unadjusted and adjusted competing risks and Cox proportional hazards models were used to assess survival. RESULTS A total of 344 patients were identified with the following causative antigens: avian (n = 93; 27%), mold (n = 88; 26%), other (n = 15; 4%), and unknown (n = 148; 43%). Patient characteristics and lung function were similar among antigen groups with a mean FVC % predicted of 75 ± 20. The percent of patients treated with immunosuppression was similar between antigens with 58% of patients treated. There was no change in lung function or symptom scores with the initiation of immunosuppression in the full cohort. Immunosuppression was not associated with a change in survival for patients with avian or mold antigen (avian: hazard ratio, 0.41; 95% CI, 0.11-1.59; P = .20; mold: hazard ratio, 1.13; 95% CI, 0.26-4.97; P = .88). For patients with unknown causative antigen, survival was worse when treated with immunosuppression (hazard ratio, 2.65; 95% CI, 1.01-6.92; P = .047). INTERPRETATION Response to immunosuppression varies by antigen type in patients with fHP. Additional studies are needed to test the role of immunosuppression in fHP, and particularly in those with an unknown antigen.
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Affiliation(s)
- Monica L Mullin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gustavo Fernandez
- Luis Razetti School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Daniel-Costin Marinescu
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada; Centre for Lung Health, Vancouver General Hospital, Vancouver, BC, Canada
| | - Boyang Zheng
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Helene Manganas
- Département de Médecine, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Julie Morisset
- Département de Médecine, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Bohyung Min
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erica Farrand
- Department of Medicine, University California San Francisco, San Francisco, CA
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
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Okuda R, Takemura T, Misumi T, Sekine A, Hagiwara E, Ogura T. Longitudinal changes in serum immunoglobulin G testing in patients with fibrotic avian hypersensitivity pneumonitis. BMC Pulm Med 2024; 24:245. [PMID: 38762468 PMCID: PMC11102294 DOI: 10.1186/s12890-024-03063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/14/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Evaluation of the antigen responsible for fibrotic hypersensitivity pneumonitis (HP) is challenging. Serum immunoglobulin (Ig) G testing against HP-associated antigens is performed. Although single-serum IgG testing has been investigated, multiple-serum IgG testing has not yet been studied. METHODS This study included patients who underwent histopathological examination and positive inhalation challenge test as well as those with moderate or high HP guideline confidence level. Serum IgG testing against pigeon serum was conducted twice using two methods: enzyme linked-immunosorbent assay (ELISA) and ImmunoCAP. The association between changes in serum IgG antibody titers and changes in forced vital capacity (FVC) and other parameters was investigated. RESULTS In this study, 28 patients (mean age, 64.5 years; mean FVC, 85.3%) with fibrotic avian HP were selected, of whom 20 and 8 underwent surgical lung biopsy and transbronchial lung cryobiopsy, respectively. Of the 28 patients, 19 had been keeping birds for more than 6 months. A correlation was observed between the annual changes in serum IgG antibody titers by ELISA and changes in relative FVC (r = - 0.6221, p < 0.001). Furthermore, there was a correlation between the annual changes in serum IgG antibody titers by ImmunoCAP and changes in relative FVC (r = - 0.4302, p = 0.022). Multiple regression analysis revealed that the change in serum IgG antibody titers by both ELISA and ImmunoCAP also influenced the relative FVC change (p = 0.012 and p = 0.015, respectively). Moreover, 13 patients were given additional treatments between the first and second blood test; however, the additional treatment group was not significantly different in relative FVC change compared to the group with no additional treatment (p = 0.982). CONCLUSIONS In patients with fibrotic avian HP, the annual changes in serum IgG testing were correlated with FVC changes, highlighting the importance of serum IgG testing over time.
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Affiliation(s)
- Ryo Okuda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-Ku, Yokohama, Japan.
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Toshihiro Misumi
- Department of Data Science, National Cancer Center Hospital East, Chiba, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-Ku, Yokohama, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-Ku, Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-Ku, Yokohama, Japan
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Casal A, Suárez-Antelo J, Riveiro V, Ferreiro L, Rodríguez-García C, de Alegría AM, Antúnez JR, Tobes ME, Otero B, Rodríguez-Núñez N, Álvarez-Dobaño JM, Vargas-Osorio K, Gude F, Valdés L. Hypersensitivity pneumonitis: application of a new diagnostic algorithm to a time series of the disease. Expert Rev Respir Med 2024; 18:237-243. [PMID: 38775489 DOI: 10.1080/17476348.2024.2358939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The diagnostic criteria for Hypersensitivity pneumonitis (HP) have changed over time. Our aim is to apply a recent diagnostic algorithm to a historical series of patients diagnosed with HP to assess its distribution according to current diagnostic criteria and the diagnostic confidence achieved. RESEARCH DESIGN AND METHODS Application to each patient the algorithm criteria. The diagnosis was HP (≥90%), provisional high (70-89%) or low confidence (51-69%) or non-HP (unlikely) (≤50%); or HP, provisional or non-HP, if they had lung biopsy. RESULTS 129 patients [mean age 64 ± 12 years; 79 (61.2%) women] were included of which 16 (12.4%) were diagnosed on the basis of high clinical suspicion. After applying the algorithm, 106 patients (82.2%) could be evaluated and 83 (78.3%) had a diagnosis of HP or high confidence. Lung biopsy was able to establish a diagnosis of certainty in another 21 patients and a provisional diagnosis in 9 more [total, 113 (87.6%)]. The 16 patients without strict diagnostic criteria for HP had a low confidence diagnosis. A total of 56 lung biopsies (64.4%) could have been avoided according to the new guidelines. CONCLUSIONS The application of this algorithm achieves a high diagnostic yield in HP, significantly reducing the number of lung biopsies required.
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Affiliation(s)
- Ana Casal
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanessa Riveiro
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Carlota Rodríguez-García
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - José Ramón Antúnez
- Pathological Anatomy Unit, University Clinical Hospital of Santiago de Compostela, Spain
| | - María-Elena Tobes
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Borja Otero
- Nursing Service, Esteve Teijin, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Manuel Álvarez-Dobaño
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Kelly Vargas-Osorio
- Pathological Anatomy Unit, University Clinical Hospital of Santiago de Compostela, Spain
| | - Francisco Gude
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Clinical Epidemiology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de compostela, Spain
| | - Luis Valdés
- Pulmonology Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Department of Medicine, Faculty of Medicine of the University of Santiago de Compostela, Spain
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Nesset K, Kolb M. Examining the incidence of interstitial lung disease subtypes in South America. J Bras Pneumol 2024; 50:e20240028. [PMID: 38422342 PMCID: PMC11095918 DOI: 10.36416/1806-3756/e20240028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Kirsten Nesset
- . Firestone Institute for Respiratory Health, Division of Respirology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Martin Kolb
- . Firestone Institute for Respiratory Health, Division of Respirology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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8
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Calaras D, David A, Vasarmidi E, Antoniou K, Corlateanu A. Hypersensitivity Pneumonitis: Challenges of a Complex Disease. Can Respir J 2024; 2024:4919951. [PMID: 38283656 PMCID: PMC10810695 DOI: 10.1155/2024/4919951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/19/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Hypersensitivity pneumonitis (HP) is a complex interstitial lung disease caused by chronic inhalation of a wide variety of antigens in susceptible and sensitized individuals, commonly associated with an occupational exposure. An impressive number of inciting antigens causing hypersensitivity pneumonitis have been found to cover a wide range of occupations. As working practices have changed over time, especially in industrialized countries, new names for occupational HP have emerged. This review emphasizes the main diagnostic issues arising from the high variability of clinical presentation and the broad spectrum of causal antigens. Furthermore, it provides an overview of current methods to unveil possible causes of hypersensitivity pneumonitis, highlights HP's current diagnostic and treatment challenges and the remaining areas of uncertainty, and presents prevention strategies.
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Affiliation(s)
- Diana Calaras
- Department of Pulmonology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| | - Aliona David
- Outpatient Department, Institute of Phtisiopneumology “Chiril Draganiuc”, Chisinau, Moldova
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pulmonology, School of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Antoniou
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pulmonology, School of Medicine, University of Crete, Heraklion, Greece
| | - Alexandru Corlateanu
- Department of Pulmonology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
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Tomioka H, Miyazaki Y, Inoue Y, Egashira R, Kawamura T, Sano H, Johkoh T, Takemura T, Hisada T, Fukuoka J. Japanese clinical practice guide 2022 for hypersensitivity pneumonitis. Respir Investig 2024; 62:16-43. [PMID: 37931427 DOI: 10.1016/j.resinv.2023.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/23/2023] [Accepted: 07/17/2023] [Indexed: 11/08/2023]
Abstract
Considering recently published two guidelines for the diagnosis of hypersensitivity pneumonitis (HP), the Japanese Respiratory Society (JRS) has now published its own Japanese clinical practice guide for HP. Major types of HP in Japan include summer-type, home-related, bird-related, farmer's lung, painter's lung, humidifier lung, and mushroom grower's lung. Identifying causative antigens is critical for increasing diagnostic confidence, as well as improving prognosis through appropriate antigen avoidance. This guide proposes a comprehensive antigen questionnaire including the outbreak sources reported in Japan. Drawing on the 2021 CHEST guideline, this guide highlights the antigen identification confidence level and adaptations for environmental surveys. The detection of specific antibodies against causative antigens is an important diagnostic predictor of HP. In Japan, the assessments of bird-specific IgG (pigeons, budgerigars) and the Trichosporon asahii antibody are covered by medical insurance. Although this guide adopts the 2020 ATS/JRS/ALAT guideline diagnostic criteria based on the combination of imaging findings, exposure assessment, bronchoalveolar lavage lymphocytosis, and histopathological findings, it added some annotations to facilitate the interpretation of the content and correlate the medical situation in Japan. It recommends checking biomarkers; seasonal changes in the KL-6 concentration (increase in winter for bird-related HP/humidifier lung and in summer for summer-type HP) and high KL-6 concentrations providing a basis for the suspicion of HP. Antigen avoidance is critical for disease management of HP. This guide also addresses the pharmacological management of HP, highlighting the treatment strategy for fibrotic HP including combination therapies with anti-inflammatory/immunosuppressive and antifibrotic drugs.
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Affiliation(s)
- Hiromi Tomioka
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Kobe, Japan.
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Tetsuji Kawamura
- National Hospital Organization Himeji Medical Center, Himeji, Japan
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takeshi Hisada
- Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Junya Fukuoka
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Spagnolo P, Ryerson CJ, Guler S, Feary J, Churg A, Fontenot AP, Piciucchi S, Udwadia Z, Corte TJ, Wuyts WA, Johannson KA, Cottin V. Occupational interstitial lung diseases. J Intern Med 2023; 294:798-815. [PMID: 37535448 DOI: 10.1111/joim.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Millions of workers are exposed to substances known to cause occupational interstitial lung diseases (ILDs), particularly in developing countries. However, the burden of the disease is likely to be underestimated due to under-recognition, under-reporting or both. The diagnosis of occupational ILD requires a high level of suspicion and a thorough occupational history, as occupational and non-occupational ILDs may be clinically, functionally and radiologically indistinguishable, leading to delayed diagnosis and inappropriate management. A potential occupational aetiology should always be considered in the differential diagnosis of ILD, as removal from the workplace exposure, with or without treatment, is a key therapeutic intervention and may lead to significant improvement. In this article, we provide an overview of the 'traditional' inorganic dust-related ILDs but also address idiopathic pulmonary fibrosis and the immunologically mediated chronic beryllium disease, sarcoidosis and hypersensitivity pneumonitis, with emphasis on the importance of surveillance and prevention for reducing the burden of these conditions. To this end, health-care professionals should be specifically trained about the importance of occupational exposures as a potential cause of ILD.
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Affiliation(s)
- Paolo Spagnolo
- Respiratory, Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Christopher J Ryerson
- Department of Medicine, St. Paul's Hospital, University of British Columbia and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Sabina Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna Feary
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Churg
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew P Fontenot
- Department of Medicine, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado, USA
| | - Sara Piciucchi
- Department of Radiology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Zarir Udwadia
- Hinduja Hospital and Research Center, Breach Candy Hospital, Mumbai, Maharashtra, India
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, University of Leuven, Leuven, Belgium
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Coordinating Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, UMR754, IVPC, Lyon, France
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11
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Kadura S, Raghu G. Hypersensitivity pneumonitis: Principles in diagnosis and management. Respirology 2023; 28:599-602. [PMID: 37140095 DOI: 10.1111/resp.14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Suha Kadura
- Center for Interstitial Lung Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ganesh Raghu
- Center for Interstitial Lung Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
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12
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Pandya SM, Pandya AP, Fels Elliott DR, Hamblin MJ. Hypersensitivity Pneumonitis: Updates in Evaluation, Management, and Ongoing Dilemmas. Immunol Allergy Clin North Am 2023; 43:245-257. [PMID: 37055087 DOI: 10.1016/j.iac.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Hypersensitivity pneumonitis (HP) is a heterogenous disease entity characterized by an aberrant immune response to inhalational antigens. Disease modification hinges on early antigen remediation with a goal to attenuate immune dysregulation. Disease severity and progression are mediated by an interface between degree, type and chronicity of exposure, genetic predisposition, and biochemical properties of the inducing agent. Guidelines have provided a standardized approach; however, decision-making remains with many clinical dilemmas. The delineation of fibrotic and nonfibrotic HP is crucial to identify the differences in clinical trajectories, and further clinical trials are needed to understand optimal therapeutic strategies.
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Affiliation(s)
- Sahil M Pandya
- University of Kansas Medical Center, 4000 Cambridge Street, Mail Stop 3007, Kansas City, KS 66160, USA.
| | - Aarti P Pandya
- Children's Mercy Hospital, 3101 Broadway Boulevard, Kansas City, MO 64111, USA
| | | | - Mark J Hamblin
- University of Kansas Medical Center, 4000 Cambridge Street, Mail Stop 3007, Kansas City, KS 66160, USA
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13
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Akkale T, Sarı G, Şimşek C. Occupational hypersensitivity pneumonia. Tuberk Toraks 2023; 71:94-104. [PMID: 36912413 PMCID: PMC10854060 DOI: 10.5578/tt.20239911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Hypersensitivity pneumonitis (HP) is an immunological lung disease that affects individuals who are sensitive and susceptible to occupational and environmental exposures. While clinical and radiological findings may resemble other interstitial lung diseases, identifying the causative agents can aid in the differential diagnosis. However, this can be challenging and may result in delayed diagnosis and poor prognosis. A gold standard test for diagnosis is currently unavailable, and therefore, a multidisciplinary approach involving a clinician, radiologist, and pathologist is necessary. Avoiding exposure is the first step in treatment, with immunosuppressive therapeutics also being used. Antifibrotic agents show promise for future treatment approaches. Despite recent advancements in data and guidelines, knowledge about managing occupational HP remains limited. This review provides a summary of the epidemiological, clinical, and radiological findings, as well as diagnostic and treatment principles of occupational HP based on current literature.
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Affiliation(s)
- Tuğba Akkale
- Clinic of Occupational Medicine, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Türkiye
| | - Gülden Sarı
- Clinic of Occupational Medicine, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Türkiye
| | - Ceprail Şimşek
- Clinic of Occupational Medicine, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Türkiye
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14
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Barnes H, Glaspole I. Occupational Interstitial Lung Diseases. Immunol Allergy Clin North Am 2023; 43:323-339. [PMID: 37055091 DOI: 10.1016/j.iac.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Occupational exposures are directly causal or partially contributory to the development of interstitial lung diseases. A detailed occupational history, relevant high-resolution computed tomography findings, and where relevant additional histopathology, are required to make a diagnosis. Treatment options are limited, and further exposure avoidance is likely to reduce disease progression.
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15
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Fujimoto H, Yasuma T, D'Alessandro-Gabazza CN, Gabazza EC, Hataji O, Kobayashi T. Risk factors for disease progression in fibrotic hypersensitivity pneumonitis. Eur Respir J 2023; 61:13993003.01706-2022. [PMID: 36549705 DOI: 10.1183/13993003.01706-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Hajime Fujimoto
- Department of Pulmonary and Critical Care Medicine, Mie University Faculty and Graduate School of Medicine, Tsu, Japan
| | - Taro Yasuma
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu, Japan
| | | | - Esteban C Gabazza
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Tetsu Kobayashi
- Department of Pulmonary and Critical Care Medicine, Mie University Faculty and Graduate School of Medicine, Tsu, Japan
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16
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Huang YC, Gu JP. Impact of diagnostic guidelines on the diagnosis of hypersensitivity pneumonitis. Front Med (Lausanne) 2023; 10:1109525. [PMID: 36936212 PMCID: PMC10020512 DOI: 10.3389/fmed.2023.1109525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease from exposure to environmental antigens. Diagnosing HP could be challenging. The American College of Chest Physicians (CHEST) and American Thoracic Society/Japanese Respiratory Society/and Asociación Latinoamericana del Tórax (ATS/JRS/ALAT) have published diagnostic guidelines in 2021 and 2020 respectively. The CHEST guideline uses four grades of confidence: confident (>90%), provisional high (70-89%), provisional low (51-69%), and unlikely (≤50%). The ATS/JRS/ALAT guideline uses five grades of confidence: definite (>90%), high (80-89%), moderate (70-79%), low (51-69%) and not excluded (≤50%). In this study, we determined how these two guidelines could have affected the diagnosis of HP made before the guidelines. Methods Two hundred and fifty-nine adult patients from a previous cohort with HP (ICD-9:495) made between Jan. 1, 2008, and Dec. 31, 2013, at Duke University Medical Center were included. We simplified the diagnostic confidence into three categories so we could compare the guidelines: high (≥90%), intermediate (51-89%), and low (≤50%). Results There were 156 female and 103 male. Mean age was 58 (range: 20-90). 68.8% of the patients had restrictive defects (FVC < 80% pred) and 48.6% had lung biopsy. The CHEST guideline classified 33.6% of the patients into high, 59.5% into intermediate and 6.9% into low confidence categories. The ATS/JRS/ALAT guideline classified 29.7% of the patients into high, 21.2% into intermediate and 49.0% into low confidence categories (p < 0.0001 vs. CHEST). Cohen's kappa was 0.331. In patients with identifiable inciting agents (IAs) (N = 168), the CHEST guideline classified 32.1% of the patients into high, 64.3% into intermediate and 3.6% into low confidence categories. The ATS/JRS/ALAT guideline classified 29.2% of the patients into high, 20.8% into intermediate, and 50.0% into low confidence categories. Cohen's kappa was 0.314. Discussion In our HP cohort with two-thirds of the patients with restrictive defects, we found the two guidelines had fair agreement in diagnosing HP with or without identifiable IAs. They agreed more when the diagnostic confidence was high. When the diagnostic confidence was lower, however, the ATS/JRS/ALAT guideline was more stringent. Clinicians should be aware of the differences between the two guidelines when evaluating patients suspicious of HP.
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17
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Keir G. Standardized exposure reporting in hypersensitivity pneumonitis: Making a silk purse from a sow's ear. Respirology 2022; 28:307-308. [PMID: 36513494 DOI: 10.1111/resp.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Gregory Keir
- Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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18
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Mori Y, Nakashima H, Funasaka T, Hori S, Kagajo M, Abe T, Ando M, Shindoh J. Utility of serum immunoglobulin A antibody against glycopeptidolipid core antigen in the diagnosis and management of hypersensitivity pneumonitis associated with Mycobacterium avium complex: A case report. Respir Med Case Rep 2022; 41:101790. [PMID: 36568320 PMCID: PMC9772834 DOI: 10.1016/j.rmcr.2022.101790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Measurement of the levels of serum immunoglobulin A antibody against glycopeptidolipid (GPL) core antigen, a cell surface antigen found in Mycobacterium avium complex (MAC), has been reported to be useful in the diagnosis and management of pulmonary MAC infection. However, evidence on its utility in hypersensitivity pneumonitis (HP) associated with MAC (i.e., "hot-tub lung") is limited. We herein report a case of HP associated with MAC in which the GPL core antibody levels were serially measured from diagnosis to treatment and thereafter. A 61-year-old man was suspected to have non-fibrotic HP based on the clinical course, laboratory findings, imaging pattern, bronchoalveolar lavage (BAL) lymphocytosis, and histopathological findings. Based on the history of whirlpool bath use, inhalation of aerosolized MAC was suspected as the cause of HP. The GPL core antibody level, measured using an enzyme-linked immunosorbent assay kit, was elevated, suggesting an immunological sensitization to MAC. A provocation test using the patient's whirlpool bath was positive. An identical MAC strain was isolated from the BAL fluid and bathtub. Accordingly, the patient was diagnosed with HP caused by the inhalation of aerosolized MAC from the whirlpool bath. The patient recovered after steroid treatment and discontinuation of the whirlpool bath. The GPL core antibody levels decreased with disease improvement. In conclusion, GPL core antibody levels could be elevated in HP associated with MAC and decrease with disease improvement. Thus, measurement of the GPL core antibody level may be useful for the diagnosis and management of HP associated with MAC.
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Key Words
- BAL, bronchoalveolar lavage
- CRP, C-reactive protein
- DLCO, diffusing capacity of the lung for carbon monoxide
- ELISA, enzyme-linked immunosorbent assay
- Enzyme-linked immunosorbent assay
- FVC, forced vital capacity
- GPL, glycopeptidolipid
- HP, hypersensitivity pneumonitis
- HRCT, high-resolution computed tomography
- Hot-tub lung
- Hypersensitivity pneumonitis
- MAC, Mycobacterium avium complex
- Mycobacterium avium complex
- PaO2, partial pressure of oxygen
- WBC, white blood cell
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Affiliation(s)
- Yuta Mori
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan,Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan,Corresponding author. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Harunori Nakashima
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takashi Funasaka
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Sho Hori
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Michiko Kagajo
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takashi Abe
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Morihide Ando
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Joe Shindoh
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
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19
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Kypreos M, Batra K, Glazer CS, Adams TN. Impact of number and type of identified antigen on transplant-free survival in hypersensitivity pneumonitis. PLoS One 2022; 17:e0273544. [PMID: 36048790 PMCID: PMC9436128 DOI: 10.1371/journal.pone.0273544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
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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Affiliation(s)
- Margaret Kypreos
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Craig S. Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Traci N. Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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20
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Integration and Application of Clinical Practice Guidelines for the Diagnosis of Idiopathic Pulmonary Fibrosis and Fibrotic Hypersensitivity Pneumonitis. Chest 2022; 162:614-629. [DOI: 10.1016/j.chest.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
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21
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Lee CT, Feary J, Johannson KA. Environmental and occupational exposures in interstitial lung disease. Curr Opin Pulm Med 2022; 28:414-420. [PMID: 35838370 DOI: 10.1097/mcp.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We highlight recent advances in the understanding of how environmental and occupational exposures increase the risk of developing interstitial lung disease (ILD), and how to evaluate a patient for potential exposures. RECENT FINDINGS A review of emerging literature suggests that environmental and occupational exposures can be directly causal, as in the case of the pneumoconioses and smoking-related ILDs, or one of many contributors to disease, as in the case of idiopathic pulmonary fibrosis (IPF). Regardless of the level of association, exposures are clearly prevalent across all ILD subtypes studied. SUMMARY Inhalational exposures are increasingly recognized as an important component in the development of ILDs, and novel exposure-disease associations continue to be discovered. These exposures represent potential opportunities for further understanding the pathobiology of disease and for the prevention of these often progressive and debilitating disorders. Prospective, comprehensive data collection regarding occupational and environmental exposures are needed in ILD patients to fully elucidate specific antigens and their relationships to disease incidence and outcomes. Systematically collected exposure information will also inform potential interventions to remediate exposures and thus mitigate the course of frequently progressive and fatal diseases.
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Affiliation(s)
- Cathryn T Lee
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Johanna Feary
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kerri A Johannson
- Department of Medicine
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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22
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Mullin ML, Churg A, Ryerson CJ. Management of fibrotic hypersensitivity pneumonitis. Curr Opin Pulm Med 2022; 28:421-431. [PMID: 35861479 DOI: 10.1097/mcp.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Recent guidelines have updated the classification of hypersensitivity pneumonitis, stratifying by the presence or absence of fibrosis as either fibrotic or nonfibrotic hypersensitivity pneumonitis. Fibrotic hypersensitivity pneumonitis represents up to 10% of interstitial lung disease in large cohort studies, and is occasionally even more common in some regions; however, there are many unknown aspects to the diagnosis and management. The goal of this review article is to summarize the management of fibrotic hypersensitivity pneumonitis. RECENT FINDINGS Historically, the only treatment options for patients with hypersensitivity pneumonitis were antigen avoidance and corticosteroids, although other immunosuppressive therapies are increasingly endorsed by experts in the field. There is accumulating evidence that antifibrotic medications can be useful as a second-line therapy in some patients with fibrotic hypersensitivity pneumonitis who have progression despite immunosuppression. There remains no direct comparison of immunosuppressive vs. antifibrotic medication for the management of fibrotic hypersensitivity pneumonitis, but some clinical, radiological and pathological features may suggest greater likelihood of benefit from one option or the other. SUMMARY We anticipate that future treatment of fibrotic hypersensitivity pneumonitis will consider a variety of patient features to suggest the most prominent underlying biology that will then be used to guide initial pharmacotherapy; however, additional data are still needed.
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Affiliation(s)
| | - Andrew Churg
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia
- Centre for Heart Lung Innovation, St. Paul's Hospital
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23
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Rouzet A, Scherer E, Barrera C, Gondouin A, Reboux G, Humbert K, Millon L, Bellanger AP. Bird fancier's lung serodiagnosis by automated r-IgLL1 ELISA. J Immunol Methods 2022; 505:113267. [PMID: 35421363 DOI: 10.1016/j.jim.2022.113267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
CONTEXT Bird fancier's lung (BFL) is the most prevalent form of hypersensitivity pneumonitis (HP) worldwide. The current techniques used for the serological diagnosis of BFL all use crude extracts from feathers, droppings, and blooms as test antigens, which is associated with a lack of standardization and variability of the results. An antigenic protein, immunoglobulin lambda-like polypeptide-1 (IgLL1), isolated from pigeon droppings, was recently identified to be associated with BFL. We used genetic engineering to produce IgLL1 as a recombinant antigen. AIM We aimed to prospectively validate the use of an automated ELISA based on recombinant IgLL1 protein (r-IgLL1) as the test antigen for the serological diagnosis of BFL. METHODS Immunoprecipitation (IP) techniques (immunodiffusion (ID), immunoelectrophoresis (IEP)) and ELISA using r-IgLL1 were performed concomitantly over 10 months on 634 sera from patients with a BFL serodiagnosis request. Questionnaires were sent to obtain details on the avian exposure, clinical data, and final diagnosis. Concordance, sensitivity (Se), and specificity (Sp) of the two techniques were compared. RESULTS In total, 72 completed questionnaires were returned with 18 cases of BFL diagnosed and 54 of non-BFL. The concordance between the ELISA and ID+IEP precipitation techniques was 71%. The combination of immunoprecipitation techniques showed a Se of 78% and a Sp of 67%. The ELISA using r-IgLL1 showed a Se of 89% and a Sp of 91%. The automated r-IgLL1 ELISA test is sufficiently efficient to be used alone for the diagnosis of patients exposed solely to Columbidae. In cases of other avian exposure, the Se and Sp of the r-IgLL1 ELISA used for screening combined with the immunodiffusion test for confirmation were 89% and 93%, respectively. CONCLUSIONS The automated ELISA using r-IgLL1 is a promising tool for BFL serodiagnosis. Replacing immunodiffusion by the automated ELISA using r-IgLL1 as a screening technique will be the basis of our future strategy for BFL serodiagnosis.
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Affiliation(s)
- Adeline Rouzet
- Department of Parasitology-Mycology, University Hospital of Besancon, Besancon, France; Chrono-Environment Research Team UMR/CNRS-6249, University of Bourgogne Franche-Comté, Besancon, France; Referent Biology Medical Laboratory for the serological diagnosis of hypersensitivity pneumonitis, LBMR-PHS, University Hospital of Besancon, France.
| | - Emeline Scherer
- Department of Parasitology-Mycology, University Hospital of Besancon, Besancon, France; Chrono-Environment Research Team UMR/CNRS-6249, University of Bourgogne Franche-Comté, Besancon, France; Referent Biology Medical Laboratory for the serological diagnosis of hypersensitivity pneumonitis, LBMR-PHS, University Hospital of Besancon, France
| | - Coralie Barrera
- Department of Parasitology-Mycology, University Hospital of Besancon, Besancon, France; Chrono-Environment Research Team UMR/CNRS-6249, University of Bourgogne Franche-Comté, Besancon, France; Referent Biology Medical Laboratory for the serological diagnosis of hypersensitivity pneumonitis, LBMR-PHS, University Hospital of Besancon, France
| | - Anne Gondouin
- Department of Pneumology, University Hospital of Besancon, Besancon, France
| | - Gabriel Reboux
- Department of Parasitology-Mycology, University Hospital of Besancon, Besancon, France; Chrono-Environment Research Team UMR/CNRS-6249, University of Bourgogne Franche-Comté, Besancon, France; Referent Biology Medical Laboratory for the serological diagnosis of hypersensitivity pneumonitis, LBMR-PHS, University Hospital of Besancon, France
| | - Karine Humbert
- Department of Parasitology-Mycology, University Hospital of Besancon, Besancon, France; Referent Biology Medical Laboratory for the serological diagnosis of hypersensitivity pneumonitis, LBMR-PHS, University Hospital of Besancon, France
| | - Laurence Millon
- Department of Parasitology-Mycology, University Hospital of Besancon, Besancon, France; Chrono-Environment Research Team UMR/CNRS-6249, University of Bourgogne Franche-Comté, Besancon, France; Referent Biology Medical Laboratory for the serological diagnosis of hypersensitivity pneumonitis, LBMR-PHS, University Hospital of Besancon, France
| | - Anne-Pauline Bellanger
- Department of Parasitology-Mycology, University Hospital of Besancon, Besancon, France; Chrono-Environment Research Team UMR/CNRS-6249, University of Bourgogne Franche-Comté, Besancon, France; Referent Biology Medical Laboratory for the serological diagnosis of hypersensitivity pneumonitis, LBMR-PHS, University Hospital of Besancon, France
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24
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Hamblin M, Prosch H, Vašáková M. Diagnosis, course and management of hypersensitivity pneumonitis. Eur Respir Rev 2022; 31:31/163/210169. [PMID: 35140104 DOI: 10.1183/16000617.0169-2021] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/21/2021] [Indexed: 11/05/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a complex and heterogeneous interstitial lung disease (ILD) that occurs when susceptible individuals develop an exaggerated immune response to an inhaled antigen. In this review, we discuss the latest guidelines for the diagnostic evaluation of patients with suspected HP, the importance of identifying patients with fibrotic and progressive disease, and the evidence supporting the drugs commonly used in the treatment of HP. Differential diagnosis of HP can be challenging and requires a thorough exposure history, multidisciplinary discussion of clinical and radiologic data, and, in some cases, assessment of bronchoalveolar lavage lymphocytosis and histopathologic findings. Patients with HP may be categorised as having non-fibrotic or fibrotic HP. The presence of fibrosis is associated with worse outcomes. A proportion of patients with fibrotic HP develop a progressive phenotype, characterised by worsening fibrosis, decline in lung function and early mortality. There are no established guidelines for the treatment of HP. Antigen avoidance should be implemented wherever possible. Immunosuppressants are commonly used in patients with HP but have not been shown to slow the worsening of fibrotic disease. Nintedanib, a tyrosine kinase inhibitor, has been approved by the US Food and Drug Administration for slowing the progression of chronic fibrosing ILDs with a progressive phenotype, including progressive fibrotic HP. Non-pharmacological interventions, such as oxygen therapy, pulmonary rehabilitation and supportive care, may be important components of the overall care of patients with progressive HP.
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Affiliation(s)
- Mark Hamblin
- Department of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martina Vašáková
- Department of Respiratory Medicine, University Thomayer Hospital, Prague, Czech Republic
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25
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Eberst G, Claudé F, Laurent L, Meurisse A, Roux-Claudé P, Barnig C, Vernerey D, Paget-Bailly S, Bouiller K, Chirouze C, Behr J, Grillet F, Ritter O, Karaer S, Pili-Floury S, Winiszewski H, Samain E, Decavel P, Capellier G, Westeel V. Result of one-year, prospective follow-up of intensive care unit survivors after SARS-CoV-2 pneumonia. Ann Intensive Care 2022; 12:23. [PMID: 35262794 PMCID: PMC8905558 DOI: 10.1186/s13613-022-00997-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Survivors of viral ARDS are at risk of long-term physical, functional and neuropsychological complications resulting from the lung injury itself, but also from potential multiorgan dysfunction, and the long stay in the intensive care unit (ICU). Recovery profiles after severe SARS-CoV-2 pneumonia in intensive care unit survivors have yet to be clearly defined. MATERIAL AND METHODS The goal of this single-center, prospective, observational study was to systematically evaluate pulmonary and extrapulmonary function at 12 months after a stay in the ICU, in a prospectively identified cohort of patients who survived SARS-CoV-2 pneumonia. Eligible patients were assessed at 3, 6 and 12 months after onset of SARS-CoV-2. Patients underwent physical examination, pulmonary function testing, chest computed tomography (CT) scan, a standardized six-minute walk test with continuous oximetry, overnight home respiratory polygraphy and have completed quality of life questionnaire. The primary endpoint was alteration of the alveolar-capillary barrier compared to reference values as measured by DLCO, at 12 months after onset of SARS-CoV-2 symptoms. RESULTS In total, 85 patients (median age 68.4 years, (interquartile range [IQR] = 60.1-72.9 years), 78.8% male) participated in the trial. The median length of hospital stay was 44 days (IQR: 20-60) including 17 days in ICU (IQR: 11-26). Pulmonary function tests were completed at 3 months (n = 85), 6 months (n = 80), and 12 months (n = 73) after onset of symptoms. Most patients showed an improvement in DLCO at each timepoint (3, 6, and 12 months). All patients who normalized their DLCO did not subsequently deteriorate, except one. Chest CT scans were abnormal in 77 patients (96.3%) at 3 months and although the proportion was the same at 12 months, but patterns have changed. CONCLUSION We report the results of a comprehensive evaluation of 85 patients admitted to the ICU for SARS-CoV-2, at one-year follow-up after symptom onset. We show that most patients had an improvement in DLCO at each timepoint. TRIAL REGISTRATION Clinical trial registration number: NCT04519320.
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Affiliation(s)
- Guillaume Eberst
- Respiratory Medicine Department, University Hospital of Besançon, 3 Boulevard Fleming, 25030, Besançon, France.
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France.
- UMR 1098, University of Franche-Comté, Besançon, France.
| | - Fréderic Claudé
- Respiratory Medicine Department, University Hospital of Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Lucie Laurent
- Respiratory Medicine Department, University Hospital of Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Aurelia Meurisse
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France
- UMR 1098, University of Franche-Comté, Besançon, France
| | - Pauline Roux-Claudé
- Respiratory Medicine Department, University Hospital of Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Cindy Barnig
- Respiratory Medicine Department, University Hospital of Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France
- UMR 1098, University of Franche-Comté, Besançon, France
| | - Sophie Paget-Bailly
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France
- UMR 1098, University of Franche-Comté, Besançon, France
| | - Kevin Bouiller
- Department of Infectious Disease, University Hospital of Besançon, Besançon, France
| | - Catherine Chirouze
- Department of Infectious Disease, University Hospital of Besançon, Besançon, France
| | - Julien Behr
- Department of Radiology, University Hospital of Besançon, Besançon, France
| | - Franck Grillet
- Department of Radiology, University Hospital of Besançon, Besançon, France
| | - Ophélie Ritter
- Respiratory Medicine Department, University Hospital of Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Sinan Karaer
- Respiratory Medicine Department, University Hospital of Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Sébastien Pili-Floury
- Anesthesia and Intensive Care Unit, University Hospital of Besançon, Besançon, France
| | - Hadrien Winiszewski
- Medical Intensive Care Unit, University Hospital of Besançon, Besançon, France
| | - Emmanuel Samain
- Anesthesia and Intensive Care Unit, University Hospital of Besançon, Besançon, France
- Research Unit EA3920, Université de Franche Comté, Besançon, France
| | - Pierre Decavel
- Laboratory of Clinical Functional Exploration of Movement, Department of Physical Medicine and Rehabilitation, University Hospital of Besançon, Besançon, France
| | - Gilles Capellier
- Medical Intensive Care Unit, University Hospital of Besançon, Besançon, France
- Research Unit EA3920, Université de Franche Comté, Besançon, France
- Australian and New Zealand Intensive Care Research Center, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Virginie Westeel
- Respiratory Medicine Department, University Hospital of Besançon, 3 Boulevard Fleming, 25030, Besançon, France
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France
- UMR 1098, University of Franche-Comté, Besançon, France
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Barnes H, Troy L, Lee CT, Sperling A, Strek M, Glaspole I. Hypersensitivity pneumonitis: Current concepts in pathogenesis, diagnosis, and treatment. Allergy 2022; 77:442-453. [PMID: 34293188 DOI: 10.1111/all.15017] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/21/2021] [Indexed: 12/29/2022]
Abstract
Hypersensitivity pneumonitis is an immune-mediated interstitial lung disease caused by an aberrant response to an inhaled exposure, which results in mostly T cell-mediated inflammation, granuloma formation, and fibrosis in some cases. HP is diagnosed by exposure identification, HRCT findings of ground-glass opacities, centrilobular nodules, and mosaic attenuation, with traction bronchiectasis and honeycombing in fibrotic cases. Additional testing including serum IgG testing for the presence of antigen exposure, bronchoalveolar lavage lymphocytosis, and lung biopsy demonstrating granulomas, inflammation, and fibrosis, increases the diagnostic confidence. Treatment for HP includes avoidance of the implicated exposure, immunosuppression, and anti-fibrotic therapy in select cases. This narrative review presents the recent literature in the understanding of the immunopathological mechanisms, diagnosis, and treatment of HP.
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Affiliation(s)
- Hayley Barnes
- Central Clinical School, Monash University, Melbourne, VIC, Australia.,Alfred Hospital, Melbourne, VIC, Australia
| | - Lauren Troy
- Royal Prince Alfred Hospital, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Cathryn T Lee
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL, USA
| | - Anne Sperling
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL, USA
| | - Mary Strek
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL, USA
| | - Ian Glaspole
- Central Clinical School, Monash University, Melbourne, VIC, Australia.,Alfred Hospital, Melbourne, VIC, Australia
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27
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Ryu K, Fukutomi Y, Sekiya K, Saito A, Hamada Y, Watai K, Kamide Y, Taniguchi M, Araya J, Kuwano K, Kamei K. Identification of fungi causing humidifier lung: 2 rare cases and a review of the literature. Asia Pac Allergy 2022; 12:e43. [DOI: 10.5415/apallergy.2022.12.e43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kai Ryu
- Clinical Research center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
- Division of Respiratory Disease, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Japan
| | - Yuma Fukutomi
- Clinical Research center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Kiyoshi Sekiya
- Clinical Research center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Akemi Saito
- Clinical Research center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Yuto Hamada
- Clinical Research center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Kentaro Watai
- Clinical Research center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Yosuke Kamide
- Clinical Research center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Masami Taniguchi
- Clinical Research center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
- Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Jun Araya
- Division of Respiratory Disease, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Disease, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Japan
| | - Katsuhiko Kamei
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
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28
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Ito Y, Miwa S, Hayakawa H, Oshima T, Eihuku T, Iwaizumi E, Ohba H, Fujita K, Kanai M, Shirai M. Antigen avoidance and environmental inhalation challenge for successful diagnosis of fibrotic hypersensitivity pneumonitis mimicking idiopathic pulmonary fibrosis. Respir Med Case Rep 2022; 39:101737. [PMID: 36133420 PMCID: PMC9483807 DOI: 10.1016/j.rmcr.2022.101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 08/21/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022] Open
Abstract
A 77-year-old man was initially diagnosed with idiopathic pulmonary fibrosis (IPF) and treated with anti-fibrotic nintedanib. Despite undergoing anti-fibrotic treatment for one year, his condition remained unstable. The patient was admitted to our hospital for exertional dyspnea. We performed an exposure assessment, including 2-week antigen avoidance and an environmental inhalation challenge, and successfully re-diagnosed him with fibrotic hypersensitivity pneumonitis (HP), known as chronic farmer's lung. Adding oral glucocorticoids to the nintedanib treatment improved his condition. Although antigen avoidance and environmental inhalation challenge tests are not standardized, they may be useful for diagnosing fibrotic HP when properly applied. Clinical features of fibrotic HP and IPF are often indistinguishable. Antigen avoidance is crucial in the diagnosis and management of fibrotic HP. Environmental inhalation challenge is useful when applied properly. The seasonal change of clinical parameters helps suspecting fibrotic HP.
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Affiliation(s)
- Yasuhiro Ito
- Corresponding author. 4201-2, Hamamatsu, 434-8511, Japan.
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29
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Bellanger AP, Lallemand S, Tumasyan Horikian A, Navellou JC, Barrera C, Rouzet A, Scherer E, Reboux G, Piton G, Millon L. OUP accepted manuscript. Med Mycol 2022; 60:6590791. [PMID: 35604675 PMCID: PMC9213863 DOI: 10.1093/mmy/myac031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022] Open
Abstract
Although a high prevalence of COVID-19-associated pulmonary aspergillosis has been reported, it is still difficult to distinguish between colonization with Aspergillus fumigatus and infection. Concomitantly, similarities between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hypersensitivity pneumonitis were suggested. The objective of this study was to investigate retrospectively if precipitin assays targeting A. fumigatus could have been useful in the management of SARS-CoV-2 patients hospitalized in an Intensive Care Unit (ICU) in 2020. SARS-CoV-2 ICU patients were screened for Aspergillus co-infection using biomarkers (galactomannan antigen, qPCR) and culture of respiratory samples (tracheal aspirates and bronchoalveolar lavage). For all these patients, clinical data, ICU characteristics and microbial results were collected. Electrosyneresis assays were performed using commercial A. fumigatus somatic and metabolic antigens. ELISA were performed using in-house A. fumigatus purified antigen and recombinant antigens. Our study population consisted of 65 predominantly male patients, with a median ICU stay of 22 days, and a global survival rate of 62%. Thirty-five patients had at least one positive marker for Aspergillus species detection. The number of arcs obtained by electrosyneresis using the somatic A. fumigatus antigen was significantly higher for these 35 SARS-CoV-2 ICU patients (P 0.01, Welch's t-test). Our study showed that SARS-CoV-2 ICU patients with a positive marker for Aspergillus species detection more often presented precipitins towards A. fumigatus. Serology assays could be an additional tool to assess the clinical relevance of the Aspergillus species in respiratory samples of SARS-CoV-2 ICU patients.
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Affiliation(s)
- A P Bellanger
- To whom correspondence should be addressed. Anne-Pauline Bellanger, Pharm-D PhD, Department of Parasitology-Mycology, Jean Minjoz University Hospital, 25030 Besançon, France. Tel: +33 (0)3 70 63 23 51; Fax: +33 (0)3 70 63 23 24; E-mail:
| | - S Lallemand
- Department of Parasitology-Mycology, University Hospital of Besançon, Besancon, France
| | - A Tumasyan Horikian
- Department of Parasitology-Mycology, University Hospital of Besançon, Besancon, France
| | - J C Navellou
- Intensive Medical Care Unit, Regional Hospital of Besancon, Besancon, France
| | - C Barrera
- Department of Parasitology-Mycology, University Hospital of Besançon, Besancon, France
- Referent Laboratory of Medical Biology for the serological diagnosis of hypersensitivity pneumonitis (LBMR PHS), University Hospital of Besançon, Besancon, France
- CNRS-University of Franche-Comte/ UMR 6249 Chrono-environment, Besançon, Besancon, France
| | - A Rouzet
- Department of Parasitology-Mycology, University Hospital of Besançon, Besancon, France
- Referent Laboratory of Medical Biology for the serological diagnosis of hypersensitivity pneumonitis (LBMR PHS), University Hospital of Besançon, Besancon, France
- CNRS-University of Franche-Comte/ UMR 6249 Chrono-environment, Besançon, Besancon, France
| | - E Scherer
- Department of Parasitology-Mycology, University Hospital of Besançon, Besancon, France
- Referent Laboratory of Medical Biology for the serological diagnosis of hypersensitivity pneumonitis (LBMR PHS), University Hospital of Besançon, Besancon, France
- CNRS-University of Franche-Comte/ UMR 6249 Chrono-environment, Besançon, Besancon, France
| | - G Reboux
- Department of Parasitology-Mycology, University Hospital of Besançon, Besancon, France
- Referent Laboratory of Medical Biology for the serological diagnosis of hypersensitivity pneumonitis (LBMR PHS), University Hospital of Besançon, Besancon, France
| | - G Piton
- Intensive Medical Care Unit, Regional Hospital of Besancon, Besancon, France
| | - L Millon
- Department of Parasitology-Mycology, University Hospital of Besançon, Besancon, France
- Referent Laboratory of Medical Biology for the serological diagnosis of hypersensitivity pneumonitis (LBMR PHS), University Hospital of Besançon, Besancon, France
- CNRS-University of Franche-Comte/ UMR 6249 Chrono-environment, Besançon, Besancon, France
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Armentia A, Fernández S, San Miguel Rodríguez A, San Miguel Hernández A, Corell A, Gayoso M. Occupational hypersensitivity pneumonitis caused by fossil-containing rocks. Clin Chim Acta 2022; 524:139-145. [PMID: 34774826 DOI: 10.1016/j.cca.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/19/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022]
Abstract
AIMS We present a hypersensitivity immune response to inhalation of antigens from fossil soils frequently used in tile manufacture. We found that the soil polished by a worker affected by pneumonitis was a paleosol containing bivalves from the cretaceous period called Hippurites. METHODS We made a diagnostic study for pneumonitis (analysis, microbiology, radiology, high-resolution CT, bronchoalveolar lavage, pulmonary biopsy. A biochemical study of the polishing materials used (magnesium hexafluorosilicate crystallizer), steel spoilage, washing liquid and Bilbao red limestone) after scraping of the same. Allergy study included skin tests with extracts from fossil soils, determination of IgG and IgE to mollusks, IgE-immunodetection with soil extracts with the patient's serum and non-atopic controls. Histology was made using scanning electron microscopy of the lung biopsy and the fossil soil to determine the presence of remains of mollusks, fungi, pollen or other fossil elements. RESULTS SDS-PAGE IgE Immunoblotting assay detecting IgE binding in soil extract between 66 and 35 kDa. Likewise, IgE-Immunblotting assay with extracts from bivalve mollusks (razor shell, mussel and scallop) and gastropod (sea snail), detecting IgE binding between 100 kDa - 30 kDa, as well as in some bands with molecular mass between 20 and 14 kDa, proving sensitization to mollusks. CONCLUSIONS Bivalve proteins preserved in fossil soils may produce an immune hypersensitivity response. This may impact on the precautions exposed workers, in this case fossil soil cutters and polishers, should take.
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Affiliation(s)
- Alicia Armentia
- Allergy Unit, Hospital Universitario Río Hortega. Valladolid, Spain
| | - Sara Fernández
- Allergy Unit, Hospital Universitario Río Hortega. Valladolid, Spain
| | - Angel San Miguel Rodríguez
- Clinical Analysis Service. Río Hortega University Hospital. Valladolid. International University of La Rioja, Spain
| | - Angel San Miguel Hernández
- Clinical Analysis Service. Río Hortega University Hospital. Valladolid. International University of La Rioja, Spain.
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31
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Misalignment between Clinical Mold Antigen Extracts and Airborne Molds Found in Water-Damaged Homes. Ann Am Thorac Soc 2021; 19:746-755. [PMID: 34788190 DOI: 10.1513/annalsats.202101-096oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Epidemiologic studies have demonstrated that exposure to molds and other fungi can play a role in a variety of allergic and pulmonary diseases in susceptible individuals. Species-specific mold antigen extracts are used in the clinical evaluation of suspected mold-related conditions, however alignment between these extracts and the species of molds identified in the indoor environment of water-damaged homes has not been rigorously evaluated. OBJECTIVES To identify the predominant genera and species of mold in the air of homes with water damage, mold growth, and/or occupants with respiratory complaints (complaint homes), and to assess their alignment with the mold antigen extracts used in clinical practice. METHODS The genera and species of molds identified in culture-type outdoor and indoor air samples collected from complaint homes throughout the U.S. and Canada from 2002-2017 were examined. Mold antigen extracts available and utilized for skin and serum testing in clinical practice were assessed and alignment between these data were evaluated. RESULTS Culture data from 24,455 indoor air samples from 7,547 complaint homes and 29,493 outdoor samples was evaluated. Mean exposure values (CFU/m3) were calculated for each genus and species, and indoor vs outdoor values compared. Penicillium was the predominant genus identified in water-damaged homes, with a mean exposure (233.3 CFU/m3) 2.9 times higher than that of the Aspergillus genus (81.4 CFU/m3). Five Penicillium (P. aurantiogriseum, P. brevicompactum, P. citrinum, P. crustosum, and P. variabile) and three Aspergillus (A. versicolor, A. sydowii, and A. niger) species were identified as the predominant indoor water-damage related fungi. However, none of these Penicillium species and only one of the Aspergillus species is currently available as an antigen extract for use in skin testing or serum testing panels. CONCLUSIONS Significant misalignment exists between the currently available mold antigen extracts and the predominant species of molds found in water-damaged homes. Improving alignment has the potential to enhance diagnosis of mold-related diseases including allergic asthma and hypersensitivity pneumonitis and to improve patient outcomes via interventions including antigen avoidance through building remediation and occupant relocation, consistent with the findings of a recent ATS Workshop Report.
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32
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Alberti ML, Rincon-Alvarez E, Buendia-Roldan I, Selman M. Hypersensitivity Pneumonitis: Diagnostic and Therapeutic Challenges. Front Med (Lausanne) 2021; 8:718299. [PMID: 34631740 PMCID: PMC8495410 DOI: 10.3389/fmed.2021.718299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is one of the most common interstitial lung diseases (ILD), that presents unique challenges for a confident diagnosis and limited therapeutic options. The disease is triggered by exposure to a wide variety of inciting antigens in susceptible individuals which results in T-cell hyperactivation and bronchioloalveolar inflammation. However, the genetic risk and the pathogenic mechanisms remain incompletely elucidated. Revised diagnostic criteria have recently been proposed, recommending to classify the disease in fibrotic and non-fibrotic HP which has strong therapeutic and outcome consequences. Confident diagnosis depends on the presence of clinical features of ILD, identification of the antigen(s), typical images on high-resolution computed tomography (HRCT), characteristic histopathological features, and lymphocytosis in the bronchoalveolar lavage. However, identifying the source of antigen is usually challenging, and HRCT and histopathology are often heterogeneous and not typical, supporting the notion that diagnosis should include a multidisciplinary assessment. Antigen removal and treating the inflammatory process is crucial in the progression of the disease since chronic persistent inflammation seems to be one of the mechanisms leading to lung fibrotic remodeling. Fibrotic HP has a few therapeutic options but evidence of efficacy is still scanty. Deciphering the molecular pathobiology of HP will contribute to open new therapeutic avenues and will provide vital insights in the search for novel diagnostic and prognostic biomarkers.
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Affiliation(s)
| | | | - Ivette Buendia-Roldan
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
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33
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Podolanczuk AJ, Wong AW, Saito S, Lasky JA, Ryerson CJ, Eickelberg O. Update in Interstitial Lung Disease 2020. Am J Respir Crit Care Med 2021; 203:1343-1352. [PMID: 33835899 DOI: 10.1164/rccm.202103-0559up] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Anna J Podolanczuk
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Shigeki Saito
- Section of Pulmonary Disease, Critical Care and Environmental Medicine, Department of Medicine, Tulane University, New Orleans, Louisiana; and
| | - Joseph A Lasky
- Section of Pulmonary Disease, Critical Care and Environmental Medicine, Department of Medicine, Tulane University, New Orleans, Louisiana; and
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Oliver Eickelberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
Nonidiopathic pulmonary fibrosis (non-IPF) progressive fibrotic interstitial lung diseases (PF-ILDs) are a heterogeneous group of ILDs, often challenging to diagnose, although an accurate diagnosis has significant implications for both treatment and prognosis. A subgroup of these patients experiences progressive deterioration in lung function, physical performance, and quality of life after conventional therapy. Risk factors for ILD progression include older age, lower baseline pulmonary function, and a usual interstitial pneumonia pattern. Management of non-IPF P-ILD is both pharmacologic and nonpharmacologic. Antifibrotic drugs, originally approved for IPF, have been considered in patients with other fibrotic ILD subtypes, with favorable results in clinical trials.
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Affiliation(s)
- Bridget F Collins
- Department of Medicine, Center for Interstitial Lung Diseases, University of Washington Medical Center, 1959 NE Pacific Street, Box 356166, Seattle, WA 98195-6166, USA.
| | - Fabrizio Luppi
- Department of Medicine and Surgery, University of Milan Bicocca; Pneumology Unit, Ospedale "S. Gerardo", ASST Monza, Monza, Italy
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35
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Looking Ahead: Interstitial Lung Disease Diagnosis and Management in 2030. Clin Chest Med 2021; 42:375-384. [PMID: 34024412 DOI: 10.1016/j.ccm.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Important advancements have been made in interstitial lung disease (ILD) in recent years, with improved understanding of risk factors, disease pathogenesis, and clinical care. This article summarizes the current and future state of ILD management, with proposed short-term initiatives for immediate action, and longer-term objectives for innovation and discovery.
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36
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Abstract
Fibrotic hypersensitivity pneumonitis (fHP) is a chronic, often progressive fibrosing form of interstitial lung disease caused by inhaled antigenic exposures. fHP can lead to impaired respiratory function, reduced disease-related quality of life, and early mortality. Management of fHP should start with exposure remediation where possible, with systemic immunosuppression and antifibrotic therapy considered in patients with symptomatic or progressive disease. Nonpharmacologic and supportive management should be offered and, in cases of treatment-resistant, progressive illness, lung transplant should be considered.
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Affiliation(s)
- Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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37
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Buendia-Roldan I, Aguilar-Duran H, Johannson KA, Selman M. Comparing the Performance of Two Recommended Criteria for Establishing a Diagnosis for Hypersensitivity Pneumonitis. Am J Respir Crit Care Med 2021; 204:865-868. [PMID: 34233145 DOI: 10.1164/rccm.202105-1091le] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ivette Buendia-Roldan
- Instituto Nacional de Enfermedades Respiratorias, 42635, Traslational research in aging and lung fibrosis, Mexico, Mexico
| | - Hiram Aguilar-Duran
- Instituto Nacional de Enfermedades Respiratorias, 42635, Traslational Research in aging and lung fibrosis, Mexico, Mexico
| | | | - Moisés Selman
- Instituto Nacional de Enfermedades Respiratorias, 42635, Mexico, Mexico;
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38
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Abstract
PURPOSE OF REVIEW Establishing a diagnosis of hypersensitivity pneumonitis (HP) and distinguishing it from other forms of interstitial lung diseases represents a common challenge in clinical practice. This review summarizes the latest literature and guidelines on HP while integrating some real-life conundrums. RECENT FINDINGS Advances in the understanding of the pathobiology of fibrotic HP and other progressive pulmonary fibrosis have changed how we approach the diagnosis and treatment of interstitial lung disease. Classifications now embrace distinguishing two clinical phenotypes: nonfibrotic and fibrotic HP because of distinct disease behavior and prognosis implications. International guidelines on HP were recently published and proposed a framework and algorithm to guide the diagnostic process. SUMMARY The diagnosis of HP relies on the integration of multiples domains: clinical assessment of exposure, imaging, bronchoalveolar lavage lymphocytosis and histopathological findings. These features are reviewed in multidisciplinary discussion and lead to an estimation of the degree of confidence for HP diagnosis. Further research is warranted to improve knowledge on the pathophysiology of HP and ultimately improve its diagnostic approaches.
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Fiordelisio T, Buendia-Roldan I, Hautefeuille M, Del-Rio D, Ríos-López DG, Zamarrón-Hernández D, Amat-Shapiro S, Campa-Higareda A, Jiménez-Díaz E, González-Villa E, Nelson-Mora J, García-Carreño N, López-Aparicio J, Montes E, Santiago-Ruiz A, Pardo A, Selman M. Development of a Diagnostic Biosensor Method of Hypersensitivity Pneumonitis towards a Point-of-Care Biosensor. BIOSENSORS 2021; 11:bios11060196. [PMID: 34203685 PMCID: PMC8232117 DOI: 10.3390/bios11060196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
In spite of a current increasing trend in the development of miniaturized, standalone point-of-care (PoC) biosensing platforms in the literature, the actual implementation of such systems in the field is far from being a reality although deeply needed. In the particular case of the population screenings for local or regional diseases related to specific pathogens, the diagnosis of the presence of specific antibodies could drastically modify therapies and even the organization of public policies. The aim of this work was to develop a fast, cost-effective detection method based on the manipulation of functionalized magnetic beads for an efficient diagnosis of hypersensitivity pneumonitis (HP), looking for the presence of anti-pigeon antigen antibodies (APAA) in a patient’s serum. We presented a Diagnostic Biosensor Method (DBM) in detail, with validation by comparison with a traditional high-throughput platform (ELISA assay). We also demonstrated that it was compatible with a microfluidic chip that could be eventually incorporated into a PoC for easy and broad deployment using portable optical detectors. After standardization of the different reaction steps, we constructed and validated a plastic chip that could easily be scaled to high-volume manufacturing in the future. The solution proved comparable to conventional ELISA assays traditionally performed by the clinicians in their laboratory and should be compatible with other antibody detection directly from patient samples.
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Affiliation(s)
- Tatiana Fiordelisio
- Departamento de Biología, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (D.D.-R.); (E.J.-D.); (A.P.)
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
- Correspondence:
| | - Ivette Buendia-Roldan
- Instituto Nacional de Enfermedades Respiratorias Dr. Ismael Cosio Villegas, Mexico City 14080, Mexico; (I.B.-R.); (E.M.); (A.S.-R.)
| | - Mathieu Hautefeuille
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
- Departamento de Física, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Diana Del-Rio
- Departamento de Biología, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (D.D.-R.); (E.J.-D.); (A.P.)
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Diana G. Ríos-López
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Diego Zamarrón-Hernández
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Samuel Amat-Shapiro
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
- Departamento de Física, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Andrea Campa-Higareda
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Edgar Jiménez-Díaz
- Departamento de Biología, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (D.D.-R.); (E.J.-D.); (A.P.)
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Erika González-Villa
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Janikua Nelson-Mora
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Natllely García-Carreño
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Jehú López-Aparicio
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
- Departamento de Física, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Eduardo Montes
- Instituto Nacional de Enfermedades Respiratorias Dr. Ismael Cosio Villegas, Mexico City 14080, Mexico; (I.B.-R.); (E.M.); (A.S.-R.)
| | - Armando Santiago-Ruiz
- Instituto Nacional de Enfermedades Respiratorias Dr. Ismael Cosio Villegas, Mexico City 14080, Mexico; (I.B.-R.); (E.M.); (A.S.-R.)
| | - Annie Pardo
- Departamento de Biología, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (D.D.-R.); (E.J.-D.); (A.P.)
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
| | - Moisés Selman
- Laboratorio Nacional de Soluciones Biomiméticas para Diagnóstico y Terapia LANSBioDyT, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (M.H.); (D.G.R.-L.); (D.Z.-H.); (S.A.-S.); (A.C.-H.); (E.G.-V.); (J.N.-M.); (N.G.-C.); (J.L.-A.); (M.S.)
- Instituto Nacional de Enfermedades Respiratorias Dr. Ismael Cosio Villegas, Mexico City 14080, Mexico; (I.B.-R.); (E.M.); (A.S.-R.)
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Barnes H, Jones K, Blanc P. The hidden history of hypersensitivity pneumonitis. Eur Respir J 2021; 59:13993003.00252-2021. [PMID: 34083405 DOI: 10.1183/13993003.00252-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/05/2022]
Abstract
Hypersensitivity pneumonitis (HP) is a relatively new construct, first reported in the early 20th century, despite major aetiologic factors (farming, bird husbandry) being part of human activities for millennia. Initial confirmed HP reports include exposure to farming and forestry (1932) and bird exposure (1965), much more recently in time than is often assumed. Later changes in occupational and living practices have led to HP associated with isocyanates, machine coolants, indoor mould, hot tubs, and other exposures. Evolution in our pathological understanding of interstitial lung disease in general, wider computerised tomography (CT) utilisation, and advances in immunology and genomics have shaped our modern conceptualisation of HP. Examining historical accounts of HP and its causative factors not only considers when the first cases were recognised, but also explores why the disease emerged at specific times and places, and may provide further insights relevant to the mechanisms underlying HP and disease prevention.
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Affiliation(s)
- Hayley Barnes
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, USA .,Central Clinical School, Monash University, Melbourne, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Kirk Jones
- Department of Pathology, University of California San Francisco, San Francisco, USA
| | - Paul Blanc
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, USA.,Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, USA
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Johannson KA, Bellanger AP. Birds of a Feather Precipitate Together. Arch Bronconeumol 2021; 58:S0300-2896(21)00167-8. [PMID: 34154840 DOI: 10.1016/j.arbres.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Kerri A Johannson
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Canada; Calvin, Phoebe and Joan Snyder Institute for Chronic Disease, University of Calgary, Calgary, Canada.
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Barnes H, Lu J, Glaspole I, Collard HR, Johannson KA. Exposures and associations with clinical phenotypes in hypersensitivity pneumonitis: A scoping review. Respir Med 2021; 184:106444. [PMID: 33991845 DOI: 10.1016/j.rmed.2021.106444] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 01/01/2023]
Abstract
Antigen identification is important for establishing a confident diagnosis of hypersensitivity pneumonitis (HP). There are no systematically curated lists of HP-associated exposures that inform clinical relevance or disease phenotype. We sought to systematically identify all reported causes of HP in the literature and evaluate their clinical relevance. A scoping review was performed to identify all publications describing HP cases and their associated exposures (even if unknown) from Jan 1990-June 2020. Frequencies of exposures and meta-analysis of proportions for registry-based studies were determined for specific exposure categories, and associations with fibrotic and non-fibrotic HP were assessed. 24,138 publications were identified, with 967 publications included in the final analysis, representing 62 unique exposures associated with HP. Certain exposures were more frequently reported than others, including birds (comprising 32% of HP cases in registry-based studies) and mould (17% registry study HP cases). Antigen-indeterminate HP comprised 15-24% of registry-based studies. Limited data found contaminated metal-working fluids, isocyanate exposure, and hot tub lung were rarely associated with fibrotic features, whereas antigen-indeterminate HP cases were more frequently associated with fibrosis. There was heterogeneity in HP case definition and how causative exposures were identified. We identified 62 unique exposures associated with HP, with specific exposures associated with clinical phenotypes. These data may inform clinical assessment and the development of questionnaires to identify antigens in the diagnostic evaluation of suspected HP. OPEN SCIENCES FRAMEWORK REGISTRATION: osf.io/4aq5m.
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Affiliation(s)
- Hayley Barnes
- Department of Medicine, University of California, San Francisco, USA; Central Clinical School, Monash University, Melbourne, Australia; Department of Respiratory Medicine, Alfred Health, Melbourne, Australia.
| | - Jesse Lu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Ian Glaspole
- Central Clinical School, Monash University, Melbourne, Australia; Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Harold R Collard
- Department of Medicine, University of California, San Francisco, USA
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. https://twitter.com/KerriBerriKerri
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43
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Teoh AKY, Corte TJ. Contemporary Concise Review 2020: Interstitial lung disease. Respirology 2021; 26:604-611. [PMID: 33913200 DOI: 10.1111/resp.14063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023]
Abstract
The year 2020 was one like no other, as we witnessed the far-reaching impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) global pandemic. Yet despite an unprecedented and challenging year, global research in interstitial lung disease (ILD) continued to break new grounds. Research progress has led to an improved understanding in new diagnostic tools and potential biomarkers for ILD. Studies on the role of antifibrotic therapies, newer therapeutic agents, supportive care strategies and the impact of coronavirus disease 2019 (COVID-19) continue to reshape the management landscape of ILD. In this concise review, we aim to summarize the key studies published in 2020, highlighting their impact on the various aspects of ILD.
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Affiliation(s)
- Alan K Y Teoh
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,Centre of Research Excellence in Pulmonary Fibrosis, Sydney, New South Wales, Australia
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,Centre of Research Excellence in Pulmonary Fibrosis, Sydney, New South Wales, Australia
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Sterclova M, Kremlackova V, Mottlova V, Bruzova M, Sojka P, Vasakova M. Quantitative assessment of specific serum IgGs may verify source of environmental exposure in extrinsic allergic alveolitis (EAA). COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2021.1894688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Martina Sterclova
- Department of Respiratory Medicine of 1st Medical Faculty, Charles University, Thomayer Hospital, Prague, Czech Republic
| | - Veronika Kremlackova
- Department of Respiratory Medicine of 1st Medical Faculty, Charles University, Thomayer Hospital, Prague, Czech Republic
| | - Veronika Mottlova
- Department of Biochemistry, Thomayer Hospital, Prague, Czech Republic
| | - Magdalena Bruzova
- Department of Pathology and Molecular Medicine of 3rd Medical Faculty, Charles University, Thomayer Hospital, Prague, Czech Republic
| | - Pavel Sojka
- Department of Immunology, Thomayer Hospital, Prague, Czech Republic
| | - Martina Vasakova
- Department of Respiratory Medicine, Thomayer Hospital, Prague, Czech Republic
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