Potentially Fatal Hypersensitivity Pneumonitis in a Child

Krasnick, Jane; Patterson, Roy; Stillwell, Paul C.; Basaran, M.; Walker, Lewis; Kishore, Rajeev

doi:10.1177/000992289503400710

Cited by 12 publications

(4 citation statements)

References 6 publications

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“…The most commonly studied are bird (pigeon) fancier’s disease and farmer’s lung, and the immunology of these will form the basis of this review. Most syndromes are occupation‐related and symptom prevalence can be up to 16% of exposed subjects, with significant morbidity [1–3]. In addition to the clinical and economic importance, the disease has considerable research potential as a model of inflammatory lung disease in which the populations at risk can be identified, the relevant antigens purified, and the immunological and clinical consequences of antigen exposure can be monitored.…”

Section: Definition and Scope Of The Diseasementioning

confidence: 99%

Takes your breath away – the immunology of allergic alveolitis

McSharry¹,

Anderson

Bourke

et al. 2002

Clinical and Experimental Immunology

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SUMMARY Extrinsic allergic alveolitis (synonym: hypersensitivity pneumonitis) is caused by inhaling antigenic aerosols which induce hypersensitivity responses in susceptible individuals. It is an interstitial inflammatory disease affecting the distal, gas‐exchanging parts of the lung, in contrast to allergic asthma where the inflammation is more proximal, affecting the conducting airways. The aims of this review are to describe current concepts of the immunology of this model of lung inflammation, to describe some of the constitutional and environmental characteristics which affect disease susceptibility and development, and to describe topics for prospective study.

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Section: Definition and Scope Of The Diseasementioning

confidence: 99%

Takes your breath away – the immunology of allergic alveolitis

McSharry¹,

Anderson

Bourke

et al. 2002

Clinical and Experimental Immunology

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“…This may explain disease which can affect other family members, especially children, who are not directly involved with handling pigeons [ 91–94]. These antigenic dusts can persist for up to 18 months in the home environment after removal of birds [ 95], and this may explain situations where there is no resolution of avian‐specific serology or if clinical progress is slow.…”

Section: Controlling Antigen Exposurementioning

confidence: 99%

A review of antigen diversity causing lung disease among pigeon breeders

McSharry

Anderson

Boyd³

2000

Clin Experimental Allergy

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“…Mold and Thermophilic actinomycete antigens also account for a significant number of HP cases among children [16][17][18][19][20][21][22]. Exposure often occurs in the home environment through spray water air conditioning systems or humidifiers.…”

Section: Epidemiologymentioning

confidence: 99%

Hypersensitivity Pneumonitis

Temprano¹,

Knutsen²,

Slavin³

2005

CPR

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Hypersensitivity pneumonitis (extrinsic allergic alveolitis) is an immunological mediated hypersensitivity reaction to a variety of inhaled allergens that may cause an acute and subacute interstitial pneumonitis and may lead to a chronic end-stage lung disease. Though more common in adults, hypersensitivity pneumonitis needs to be considered in the differential diagnosis of interstitial pneumonitis in children. In children, the most common antigens are from residential exposure to birds, humidifiers and indoor molds. Clinical features are dependent upon stage of disease, and can include fevers, chills, cough, dyspnea, fatigue and weight loss. Physical examination often reveals rales, and dyspnea and hypoxemia are usually present. Routine laboratory testing demonstrates a moderately elevated erythrocyte sedimentation rate, leukocyte count, total IgG level and a positive rheumatoid factor. Though serum IgG antibodies are elevated to the inhaled antigen(s) in hypersensitivity pneumonitis, they may be present in asymptomatic exposed individuals. The immunopathogenesis involves cellular immunity to inhaled allergens, especially CD8+ cytotoxic T cells, multinucleated giant cells, and ultimately granulomas. The role of antigen-specific IgG antibodies is unclear, but may be involved in antibody-dependent-cellular-cytotoxicity (ADCC) and/or interaction with FcRγ on dendritic cells and monocytes that enhance a Th1 response. Pulmonary function studies demonstrate a restrictive pattern with a diffusion defect resulting in hypoxemia. Radiographic changes vary according to the stage of the disease and are best evaluated by high resolution computerized tomography. Bronchoalveolar lavage demonstrates a lymphocytosis with characteristic increase of CD8+ T cells and NK cells. However, recent literature suggests that the CD4+/CD8+ ratio may not be decreased in children as found in adults. Treatment of hypersensitivity pneumonitis is antigen avoidance and systemic corticosteroids, and prognosis depends on early recognition of the disease.

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Potentially Fatal Hypersensitivity Pneumonitis in a Child

Cited by 12 publications

References 6 publications

Takes your breath away – the immunology of allergic alveolitis

Takes your breath away – the immunology of allergic alveolitis

A review of antigen diversity causing lung disease among pigeon breeders

Hypersensitivity Pneumonitis

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