Difference between revisions of "Hypersensitivity pneumonitis"
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''' | '''Hypersensitivity pneumonitis''', abbreviated '''[[HP]]''', is a [[diffuse lung diseases]] caused by an allergen. | ||
It is also known as '''extrinsic allergic alveolitis''', abbreviated '''EAA'''. | It is also known as '''extrinsic allergic alveolitis''', abbreviated '''EAA'''. | ||
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*An immune complex-mediated [[hypersensitivity]]<ref name=pmid8279154>{{Cite journal | last1 = Kaltreider | first1 = HB. | title = Hypersensitivity pneumonitis. | journal = West J Med | volume = 159 | issue = 5 | pages = 570-8 | month = Nov | year = 1993 | doi = | PMID = 8279154 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/8279154/?tool=pubmed }}</ref> (Gell-Coombs classification type III). | *An immune complex-mediated [[hypersensitivity]]<ref name=pmid8279154>{{Cite journal | last1 = Kaltreider | first1 = HB. | title = Hypersensitivity pneumonitis. | journal = West J Med | volume = 159 | issue = 5 | pages = 570-8 | month = Nov | year = 1993 | doi = | PMID = 8279154 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/8279154/?tool=pubmed }}</ref> (Gell-Coombs classification type III). | ||
**If chronic, may develop into a cell-mediated hypersensitivity (Gell-Coombs classification type IV).<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html]. Accessed on: 4 December 2011.</ref> | **If chronic, may develop into a cell-mediated hypersensitivity (Gell-Coombs classification type IV).<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html]. Accessed on: 4 December 2011.</ref> | ||
===Specific diseases/etiology=== | |||
Selected causes of hypersensitivity pneumonitis:<ref name=pmid21978856>{{cite journal |author=Zacharisen MC, Fink JN |title=Hypersensitivity pneumonitis and related conditions in the work environment |journal=Immunol Allergy Clin North Am |volume=31 |issue=4 |pages=769–86, vii |year=2011 |month=November |pmid=21978856 |doi=10.1016/j.iac.2011.07.004 |url=}}</ref> | |||
{| class="wikitable sortable" | |||
! Disease | |||
! Cause | |||
|- | |||
| Silicosis | |||
| silica exposure | |||
|- | |||
| |[[Asbestosis]] | |||
| asbestos | |||
|- | |||
| Flavour-worker's lung (popcorn lung) | |||
| diacetyl - used for butter flavour<ref name=pmid21618944>{{cite journal |author=Egilman DS, Schilling JH, Menendez L |title=A proposal for a safe exposure level for diacetyl |journal=Int J Occup Environ Health |volume=17 |issue=2 |pages=122–34 |year=2011 |pmid=21618944 |doi= |url=}}</ref> | |||
|- | |||
| [[Talcosis]] | |||
| | |||
|- | |||
| Sick building syndrome | |||
| volatile organic compounds, smoke, dampness | |||
|- | |||
| Berylliosis | |||
| beryllium | |||
|- | |||
| Coal worker’s pneumoconiosis | |||
| coal dust | |||
|} | |||
==Gross== | |||
*Peripheral or peribronchiolar.<ref name=pmid16434894>{{Cite journal | last1 = Churg | first1 = A. | last2 = Muller | first2 = NL. | last3 = Flint | first3 = J. | last4 = Wright | first4 = JL. | title = Chronic hypersensitivity pneumonitis. | journal = Am J Surg Pathol | volume = 30 | issue = 2 | pages = 201-8 | month = Feb | year = 2006 | doi = | PMID = 16434894 }}</ref> | |||
**Not large airways. | |||
==Microscopic== | ==Microscopic== | ||
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DDx: | DDx: | ||
*[[Usual interstitial pneumonia]]. | *[[Usual interstitial pneumonia]]. | ||
*[[Nonspecific interstitial pneumonia]]. | |||
===Images=== | ===Images=== | ||
| Line 62: | Line 95: | ||
==See also== | ==See also== | ||
*[[Diffuse lung diseases]]. | *[[Diffuse lung diseases]]. | ||
*[[Pneumoconioses]]. | |||
==References== | ==References== | ||
Latest revision as of 19:06, 17 March 2015
| Hypersensitivity pneumonitis | |
|---|---|
| Diagnosis in short | |
 Hypersensitivity pneumonitis. Trichrome stain. | |
|
| |
| Synonyms | extrinsic allergic alveolitis |
|
| |
| LM | centrilobular prominence of lesions, granulomata, chronic interstitial inflammation consisting primarily of lymphocytes, interstitial fibrosis, air space involvement (alveolitis) |
| LM DDx | usual interstitial pneumonia, asbestosis |
| Site | lung - see diffuse lung diseases |
|
| |
| Clinical history | allergen exposure |
| Prevalence | uncommon |
| Radiology | upper lung predominant |
| Prognosis | usu. good if allergen exposure eliminated |
| Clin. DDx | other diffuse lung diseases, esp. idiopathic pulmonary fibrosis |
| Treatment | eliminate allergen exposure |
Hypersensitivity pneumonitis, abbreviated HP, is a diffuse lung diseases caused by an allergen.
It is also known as extrinsic allergic alveolitis, abbreviated EAA.
General
- Exposure to stuffs... e.g. moldy hay - Farmer's lung, atypical mycobacteria - hot tub lung.
- Upper lung predominant disease.
- Mnemonic FASSTEN - upper lung field: Farmer's lung, Ankylosing spondylitis, Sarcoidosis, Silicosis, Tuberculosis (miliary), Eosinophilic granuloma, Neurofibromatosis.
- An immune complex-mediated hypersensitivity[1] (Gell-Coombs classification type III).
- If chronic, may develop into a cell-mediated hypersensitivity (Gell-Coombs classification type IV).[2]
Specific diseases/etiology
Selected causes of hypersensitivity pneumonitis:[3]
| Disease | Cause |
|---|---|
| Silicosis | silica exposure |
| Asbestosis | asbestos |
| Flavour-worker's lung (popcorn lung) | diacetyl - used for butter flavour[4] |
| Talcosis | |
| Sick building syndrome | volatile organic compounds, smoke, dampness |
| Berylliosis | beryllium |
| Coal worker’s pneumoconiosis | coal dust |
Gross
- Peripheral or peribronchiolar.[5]
- Not large airways.
Microscopic
Features:
- Lesions have centrilobular prominence - important feature. [6]
- Allergens enter lung through airway which has a centrilobular location.
- Granulomata (not typically seen in UIP) - important feature.[6]
- Chronic interstitial inflammation consisting primarily of lymphocytes.
- Interstitial fibrosis.
- Air space involvement (alveolitis).
DDx:
Images
Hypersensitivity pneumonitis - low mag. (WC/Nephron)
Hypersensitivity pneumonitis - intermed. mag. (WC/Nephron)
Hypersensitivity pneumonitis - high mag. (WC/Nephron)
See also
References
- ↑ Kaltreider, HB. (Nov 1993). "Hypersensitivity pneumonitis.". West J Med 159 (5): 570-8. PMID 8279154. http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/8279154/?tool=pubmed.
- ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html. Accessed on: 4 December 2011.
- ↑ Zacharisen MC, Fink JN (November 2011). "Hypersensitivity pneumonitis and related conditions in the work environment". Immunol Allergy Clin North Am 31 (4): 769–86, vii. doi:10.1016/j.iac.2011.07.004. PMID 21978856.
- ↑ Egilman DS, Schilling JH, Menendez L (2011). "A proposal for a safe exposure level for diacetyl". Int J Occup Environ Health 17 (2): 122–34. PMID 21618944.
- ↑ Churg, A.; Muller, NL.; Flint, J.; Wright, JL. (Feb 2006). "Chronic hypersensitivity pneumonitis.". Am J Surg Pathol 30 (2): 201-8. PMID 16434894.
- ↑ 6.0 6.1 Ohtani, Y.; Saiki, S.; Kitaichi, M.; Usui, Y.; Inase, N.; Costabel, U.; Yoshizawa, Y. (Aug 2005). "Chronic bird fancier's lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias.". Thorax 60 (8): 665-71. doi:10.1136/thx.2004.027326. PMID 16061708.