Mayra E Mejía , Teresa de J Suárez , Alejandro Arreola , Delfino Alonso , Andrea Estrada , Ana C Zamora , Fortunato Juárez , Miguel O Gaxiola , Guillermo Carrillo
2007, Number 3
2007; 66 (3)
ABSTRACT
Hypersensitivity pneumonitis (HP) is one of the most frequent causes of interstitial lung diseases in our country, usually related to organic dust inhalation. The prevalence of HP is difficult to estimate because of country and same location variations. Clinically acute and subacute forms are the most frequent forms, but they may become chronic as there is mild contact with the antigen, but for long periods of time, as it happens in our country, where mortality raises to 29% rate in 5 years. Diagnosis is supported by the allergen identification (history of contact and antibodies), dyspnea, rales, a restrictive pattern, ground glass opacities (tomography), centric bronchiole nodes and lymphocytes (in the bronchialveolar lavage), as well as mononuclear interstitial inflammation and poorly defined granulomas (pathology). Early detection of HP may not only change the treatment, but prognosis may improve so here we present the most relevant aspects of this lung disease.
KEYWORDS
Hypersensitivity pneumonitis, diagnosis, radiologic image and therapeutics.
REFERENCES
Selman M, Chapela R, Salas J, et al. Hypersensitivity pneumonitis: clinical approach and integral concept about its pathogenesis. A Mexican point of view. In: Selman M, Barrios R, ed. interstitial pulmonary diseases: selected topics. Boca Raton, Fl: CRC Press, 1991: 171-198.
Selman M. Hypersensitivity pneumonitis. In: King T, Schwarz M, ed. interstitial lung diseases. Hamilton, On: BC Decker, 1998: 393-422.
Selman M. Neumonitis por hipersensibilidad. In: Selman M. ed. Neumopatías intersticiales difusas. México: Panamericana, 1996: 65-82.
Rodríguez de Castro F, Carrillo T, Castillo R, et al. Relationship between Characteristics of exposure to pigeon antigens: clinical manifestations and humoral immune response. Chest 1993; 103: 1059-1063.
Arima K, Ando M, Ito K, et al. Cigarette smoking on prevalence of summer type hypersensitivity pneumonitis caused by trichosporon cutaneum. Arch environ Health 1992; 47: 274-278.
Hughes D, Haslam P. Effect of smoking on the lipid composition of the lung lining fluid and relationship between immunostimulatory lipids, inflammatory cells and foamy macrophages in extrinsic allergic alveolitis. Eur Respir J 1990; 3: 1128-1139.
Ohtsuka Y, Munakata M, Tanimura K, et al. Smoking promotes insidious and chronic farmer’s lung disease deteriorates the clinical outcome. Intern Med 1995; 34: 966-71.
Navarro C, Mejía M, Gaxiola M, et al. Hypersensitivity pneumonitis: a broader perspective. Treat Respir Med 2006; 5: 167-179.
Pérez-Padilla R, Salas J, Chapela R, et al. Mortality in Mexican patients with chronic pigeon breeder’s lung compared to those with usual interstitial pneumonia. Am Rev Respir Dis 1993; 148: 49-53.
Selman M, Chapela R, Raghu G. Hypersensitivity pneumonitis. Clinical manifestations, diagnosis, pathogenesis and therapeutic strategies. Seminars Resp Med 1993; 14: 353.
Hargreave F, Hinson K, Reid L, et al. The radiological appearances of allergic alveolitis due to bird sensitivity (bird fancier’s lung). Clin Radiol 1972: 23: 1-10.
Epler G, McLoud T, Gaensler E, et al. Normal chest roentgenogram in diffuse infiltrative lung disease. N Engl J Med 1978; 298: 934.
Webb R, Müller N, Naidich D. Airway disease. In: High resolution CT of the lung. 3rd edition. Philadelphia: Lippincott Williams & Wilkins 2000: 467-546.
Silva CI, Churg A, Müller N. Hypersensitivity pneumonitis: spectrum of high resolution CT and pathologic findings. AJR 2007; 188: 334-344.
Franquet T, Hansell D, Senbanjo T, Remy-Jardin M, Muller N. Lung Cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr 2003; 27(4): 475-478.
Reyes C, Wenzel F, Lawton B, et al. The pulmonary pathology of farmer’s lung disease. Chest 1982; 81: 142-146.
Churg A, Müller N, Flint J, et al. Chronic hypersensitivity pneumonitis and differential diagnosis. Eur Respir Mon 2007; 39: 189-198.
Vourlekis J, Schwarz M, Cool C, et al. Nonspecific interstitial pneumonitis as the sole histologic expression of hypersensitivity pneumonitis. Am J Med 2002; 112: 490-493.
Travis W, Colby T, Koss M, et al. Idiopathic interstitial pneumonitis and other diffuse parenchymal lung diseases. In: Atlas of nontumor pathology non-neoplastic disorders of the lower respiratory tract. Washington, DC: American registry of pathology and the armed forces institute of pathology, 2002: 115-123.
Pérez-Padilla R, Gaxiola M, Salas J, et al. Bronchiolitis in chronic pigeon breeder’s disease. Morphologic evidence of a spectrum of small airway lesions in hypersensitivity pneumonitis induced by avian antigens. Chest 1996; 110: 371-377.
Cordier J. Challenges in pulmonary fibrosis 2: Bronchiolocentric fibrosis. Thorax 2007; 62: 638-649.
Haslam P, Dewar A, Butchers P, et al. Mast cells, atypical lymphocytes and neutrophils in bronchoalveolar lavage in extrinsic allergic alveolitis. Comparison with other interstitial lung diseases. Am Rev Respir Dis 1987; 135: 35-47.
Mejia M, Estrada A, Suárez T, et al. La linfocitosis en el lavado bronquioloalveolar puede predecir la respuesta al tratamiento en pacientes con neumonitis por hipersensibilidad. Rev Inst Nal Enf Resp Mex 2007; 20: 183-188.
Carrillo G, Estrada A, Mejia M, et al. Inhaled beclomethasone versus prednisone in patients with subacute/chronic hypersensitivity pneumonitis (HP). Two years of follow up (abstract). Am J Respir Crit Care Med 2003; 167: A359.