Hypersensitivity pneumonitis and antigen identification – An alternate approach

Millerick-May, Melissa; Mulks, Martha H.; Gerlach, John; Flaherty, Kevin R.; Schmidt, Shelley L.; Martínez, Fernando J.; LeVeque, Rhiannon M.; Rosenman, Kenneth D.

doi:10.1016/j.rmed.2015.09.001

Cited by 52 publications

(33 citation statements)

References 60 publications

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“…We excluded case series limited to a single avocation or occupation (e.g., bird fanciers or machinists) (162,163), if there were insufficient data to determine the proportion due to an occupational exposure (164), or if there were overlapping cases (165) that were included in another publication (166). The studies included (166)(167)(168)(169)(170)(171)(172)(173)(174)(175)(176)(177)(178)(179)(180) were all case series (or registries), except for one case-control design (167), but used variable criteria for diagnosing HP and assessing causation. For the case series, we considered the work-related cases within a larger series to represent the occupational burden of disease.…”

Section: Occupational Burden Of Hp (Extrinsic Allergic Alveolitis) Anmentioning

confidence: 99%

The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement

Blanc¹,

Annesi‐Maesano²,

Balmes³

et al. 2019

Am J Respir Crit Care Med

321

204

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Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.

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Section: Occupational Burden Of Hp (Extrinsic Allergic Alveolitis) Anmentioning

confidence: 99%

The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement

Blanc¹,

Annesi‐Maesano²,

Balmes³

et al. 2019

Am J Respir Crit Care Med

321

204

View full text Add to dashboard Cite

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“…The role of specific IgG to known antigens, 26 cultures from specimens obtained from the patient’s environment, 27 bronchoalveolar lavage cellular analyses, 28 and a bronchoprovocation test for a specific or suspected antigen, are all appropriate considerations but need validation in prospective studies. 29 Testing for serum precipitins (ie, specific IgG against potential antigens) is subject to availability and has not been standardised.…”

Section: Medical History and Clinical Evaluationmentioning

confidence: 99%

The diagnosis of idiopathic pulmonary fibrosis: current and future approaches

Martínez

Chisholm²,

Collard

et al. 2017

The Lancet Respiratory Medicine

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With the recent development of two effective treatments for patients with idiopathic pulmonary fibrosis, an accurate diagnosis is crucial. The traditional approach to diagnosis emphasises the importance of thorough clinical and laboratory evaluations to exclude secondary causes of disease. High-resolution CT is a critical initial diagnostic test and acts as a tool to identify patients who should undergo surgical lung biopsy to secure a definitive histological diagnosis of usual interstitial pneumonia pattern. This diagnostic approach faces several challenges. Many patients with suspected idiopathic pulmonary fibrosis present with atypical high-resolution CT characteristics but are unfit for surgical lung biopsy, therefore preventing a confident diagnosis. The state of the art suggests an iterative, multidisciplinary process that incorporates available clinical, laboratory, imaging, and histological features. Recent research has explored genomic techniques to molecularly phenotype patients with interstitial lung disease. In the future, clinicians will probably use blood-specific or lung-specific molecular markers in combination with other clinical, physiological, and imaging features to enhance diagnostic efforts, refine prognostic recommendations, and influence the initial or subsequent treatment options. There is an urgent and increasing need for well designed, large, prospective studies measuring the effect of different diagnostic approaches. Ultimately, this will help to inform the development of guidelines and tailor clinical practice for the benefit of patients.

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“…In a group of 86 bird breeders with lung disease, the presence of specific immunoglobulins was identified in 92% of patients (only in 2 radiographic signs of UIP were observed), while in the control group comprising healthy pigeon breeders specific antibodies were detected in as many as 87% of subjects [183]. By contrast, in the case of many patients with signs of cHP with positive results for specific antibodies, these antigens are not detected in the patients' domestic environments [184]. The value of positive precipitins in differentiation of cHP from other ILDs associated with pulmonary fibrosis was considered low (sensitivity: 72%, specificity: 68%) vs diagnosis made based on a MDD [185].…”

Section: Question 5 Is It Necessary To Determine Serum Concentrationmentioning

confidence: 90%

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

Piotrowski

Bestry²,

Białas

et al. 2020

Advances in Respiratory Medicine

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Hypersensitivity pneumonitis and antigen identification – An alternate approach

Cited by 52 publications

References 60 publications

The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement

The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement

The diagnosis of idiopathic pulmonary fibrosis: current and future approaches

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

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