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Hypersensitivity Pneumonitis
Kyung Soo Lee, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Hypersensitivity pneumonitis (HP)
            • Idiopathic pulmonary fibrosis (IPF)
          • Synonyms

            • Extrinsic allergic alveolitis
            • Bird fancier's lung
              • Pigeon breeder or pigeon fancier disease
            • Farmer's lung
            • Bat lung
            • Animal handler's lung
            • Laboratory worker's lung
            • Miller's lung
            • Lycoperdonosis
            • Hot tub lung
          • Definitions

            • Allergic inflammatory response of lungs and airways to inhaled organic antigens or haptens (i.e., low molecular weight inorganic molecules)
            • Type of cellular bronchiolitis
            • HP may manifest with transitory pulmonary opacities or irreversible pulmonary fibrosis
            • Historically classified as acute, subacute, and chronic types (Richerson classification)
              • Predates availability of HRCT
              • Imaging and pathologic findings were extrapolated to fit clinical findings, but were never statistically validated
            • New classification proposes 2 clusters that incorporate clinical, imaging, and pathologic findings
              • Cluster 1: Symptoms occur hours after exposure and may be recurrent
              • Cluster 2: Chronic symptoms (e.g., clubbing, hypoxemia, inspiratory crackles)

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  Selected References

                                  1. Elicker BM et al: Multidisciplinary approach to hypersensitivity pneumonitis. J Thorac Imaging. 31(2):92-103, 2016
                                  2. Magee AL et al: Imaging of Hypersensitivity Pneumonitis. Radiol Clin North Am. 54(6):1033-1046, 2016
                                  3. Spagnolo P et al: Hypersensitivity pneumonitis: a comprehensive Review. J Investig Allergol Clin Immunol. 25(4):237-50; quiz follow 250, 2015
                                  4. Jeong YJ et al: Chronic hypersensitivity pneumonitis and pulmonary sarcoidosis: differentiation from usual interstitial pneumonia using high-resolution computed tomography. Semin Ultrasound CT MR. 35(1):47-58, 2014
                                  5. Lacasse Y et al: Recent advances in hypersensitivity pneumonitis. Chest. 142(1):208-17, 2012
                                  6. Selman M et al: Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med. 186(4):314-24, 2012
                                  7. Sverzellati N et al: Biopsy-proved idiopathic pulmonary fibrosis: spectrum of nondiagnostic thin-section CT diagnoses. Radiology. 254(3):957-64, 2010
                                  8. Hirschmann JV et al: Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 29(7):1921-38, 2009
                                  9. Lacasse Y et al: Classification of hypersensitivity pneumonitis: a hypothesis. Int Arch Allergy Immunol. 149(2):161-6, 2009
                                  10. Hanak V et al: HRCT Findings of Parenchymal Fibrosis Correlate with Prognosis in Hypersensitivity Pneumonitis. Chest.
                                  11. Olson AL et al: Acute exacerbations of fibrotic hypersensitivity pneumonitis: a case series. Chest. 134(4):844-50, 2008
                                  12. Silva CI et al: Chronic hypersensitivity pneumonitis: differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT. Radiology. 246(1):288-97, 2008
                                  13. Takemura T et al: Pathology of hypersensitivity pneumonitis. Curr Opin Pulm Med. 14(5):440-54, 2008
                                  14. Sahin H et al: Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival. Radiology. 244(2):591-8, 2007
                                  15. Silva CI et al: Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings. AJR Am J Roentgenol. 188(2):334-44, 2007
                                  16. Lacasse Y et al: Hypersensitivity pneumonitis. Orphanet J Rare Dis. 1:25, 2006
                                  17. Franquet et al: Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr 27(4): 475-8, 2003
                                  18. Lacasse Y et al: Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med. 168(8):952-8, 2003
                                  19. Selman M et al: Idiopathic pulmonary fibrosis: prevailing and evolving hypotheses about its pathogenesis and implications for therapy. Ann Intern Med. 134(2):136-51, 2001
                                  20. Tasaka S et al: Fatal diffuse alveolar damage from bird fanciers' lung. Respiration. 64(4):307-9, 1997
                                  21. Akira M et al: Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings. AJR Am J Roentgenol. 158(6):1223-8, 1992
                                  22. Richerson HB et al: Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the Subcommittee on Hypersensitivity Pneumonitis. J Allergy Clin Immunol. 84(5 Pt 2):839-44, 1989
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Hypersensitivity pneumonitis (HP)
                                            • Idiopathic pulmonary fibrosis (IPF)
                                          • Synonyms

                                            • Extrinsic allergic alveolitis
                                            • Bird fancier's lung
                                              • Pigeon breeder or pigeon fancier disease
                                            • Farmer's lung
                                            • Bat lung
                                            • Animal handler's lung
                                            • Laboratory worker's lung
                                            • Miller's lung
                                            • Lycoperdonosis
                                            • Hot tub lung
                                          • Definitions

                                            • Allergic inflammatory response of lungs and airways to inhaled organic antigens or haptens (i.e., low molecular weight inorganic molecules)
                                            • Type of cellular bronchiolitis
                                            • HP may manifest with transitory pulmonary opacities or irreversible pulmonary fibrosis
                                            • Historically classified as acute, subacute, and chronic types (Richerson classification)
                                              • Predates availability of HRCT
                                              • Imaging and pathologic findings were extrapolated to fit clinical findings, but were never statistically validated
                                            • New classification proposes 2 clusters that incorporate clinical, imaging, and pathologic findings
                                              • Cluster 1: Symptoms occur hours after exposure and may be recurrent
                                              • Cluster 2: Chronic symptoms (e.g., clubbing, hypoxemia, inspiratory crackles)

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Staging, Grading, & Classification

                                                        • Microscopic Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  Selected References

                                                                  1. Elicker BM et al: Multidisciplinary approach to hypersensitivity pneumonitis. J Thorac Imaging. 31(2):92-103, 2016
                                                                  2. Magee AL et al: Imaging of Hypersensitivity Pneumonitis. Radiol Clin North Am. 54(6):1033-1046, 2016
                                                                  3. Spagnolo P et al: Hypersensitivity pneumonitis: a comprehensive Review. J Investig Allergol Clin Immunol. 25(4):237-50; quiz follow 250, 2015
                                                                  4. Jeong YJ et al: Chronic hypersensitivity pneumonitis and pulmonary sarcoidosis: differentiation from usual interstitial pneumonia using high-resolution computed tomography. Semin Ultrasound CT MR. 35(1):47-58, 2014
                                                                  5. Lacasse Y et al: Recent advances in hypersensitivity pneumonitis. Chest. 142(1):208-17, 2012
                                                                  6. Selman M et al: Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med. 186(4):314-24, 2012
                                                                  7. Sverzellati N et al: Biopsy-proved idiopathic pulmonary fibrosis: spectrum of nondiagnostic thin-section CT diagnoses. Radiology. 254(3):957-64, 2010
                                                                  8. Hirschmann JV et al: Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 29(7):1921-38, 2009
                                                                  9. Lacasse Y et al: Classification of hypersensitivity pneumonitis: a hypothesis. Int Arch Allergy Immunol. 149(2):161-6, 2009
                                                                  10. Hanak V et al: HRCT Findings of Parenchymal Fibrosis Correlate with Prognosis in Hypersensitivity Pneumonitis. Chest.
                                                                  11. Olson AL et al: Acute exacerbations of fibrotic hypersensitivity pneumonitis: a case series. Chest. 134(4):844-50, 2008
                                                                  12. Silva CI et al: Chronic hypersensitivity pneumonitis: differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT. Radiology. 246(1):288-97, 2008
                                                                  13. Takemura T et al: Pathology of hypersensitivity pneumonitis. Curr Opin Pulm Med. 14(5):440-54, 2008
                                                                  14. Sahin H et al: Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival. Radiology. 244(2):591-8, 2007
                                                                  15. Silva CI et al: Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings. AJR Am J Roentgenol. 188(2):334-44, 2007
                                                                  16. Lacasse Y et al: Hypersensitivity pneumonitis. Orphanet J Rare Dis. 1:25, 2006
                                                                  17. Franquet et al: Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr 27(4): 475-8, 2003
                                                                  18. Lacasse Y et al: Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med. 168(8):952-8, 2003
                                                                  19. Selman M et al: Idiopathic pulmonary fibrosis: prevailing and evolving hypotheses about its pathogenesis and implications for therapy. Ann Intern Med. 134(2):136-51, 2001
                                                                  20. Tasaka S et al: Fatal diffuse alveolar damage from bird fanciers' lung. Respiration. 64(4):307-9, 1997
                                                                  21. Akira M et al: Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings. AJR Am J Roentgenol. 158(6):1223-8, 1992
                                                                  22. Richerson HB et al: Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the Subcommittee on Hypersensitivity Pneumonitis. J Allergy Clin Immunol. 84(5 Pt 2):839-44, 1989