Occupational hypersensitivity pneumonia

Abstract

Occupational hypersensitivity pneumonia 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.

Contemporary Concise Review 2023: Environmental and occupational lung diseases

“…For clinicians and industrial physicians, considering the possibility of HP, a thorough clinical and occupational exposure history is the most important factor for diagnosing HP 121,133,166 . It is crucial to identify the specific inciting antigen for HP that affects the prognosis and recurrence of HP, as well as the patient's quality of life (QOL) 167,168 …”

“…Hypersensitivity pneumonitis (HP) is an inflammatory and fibrotic lung disease caused by overt or occult inhalation exposure to antigens that provokes immune reactions in susceptible individuals. 133,134 Genetic polymorphisms in the major histocompatibility complex class II and proteasomes have been suggested as genetic factors that influence susceptibility to HP. [135][136][137][138][139][140][141] Preceding respiratory viral infection [142][143][144] and pesticide exposure in the lungs of farmers have 145 been reported as other sensitizers for HP.…”

“…121,133,166 For clinicians and industrial physicians, considering the possibility of HP, a thorough clinical and occupational exposure history is the most important factor for diagnosing HP. 121,133,166 It is crucial to identify the specific inciting antigen for HP that affects the prognosis and recurrence of HP, as well as the patient's quality of life (QOL). 167,168 HP is categorized into two clinical phenotypes: nonfibrotic and fibrotic HP, which are determined by a combination of clinical presentation and radiological and histopathological features.…”

“…Recently, metal working fluids (MWF) have been reported as HP antigens among machine operators, and Mycobacterium immunogenum, which is commonly found in MWF, is suspected to be a causative antigen of HP. 121,133,166 For clinicians and industrial physicians, considering the possibility of HP, a thorough clinical and occupational exposure history is the most important factor for diagnosing HP. 121,133,166 It is crucial to identify the specific inciting antigen for HP that affects the prognosis and recurrence of HP, as well as the patient's quality of life (QOL).…”

“…Hypersensitivity pneumonitis (HP) is an inflammatory and fibrotic lung disease caused by overt or occult inhalation exposure to antigens that provokes immune reactions in susceptible individuals 133,134 . Genetic polymorphisms in the major histocompatibility complex class II and proteasomes have been suggested as genetic factors that influence susceptibility to HP 135–141 .…”