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Chest
Diagnosis
Interstitial, Diffuse, and Inhalational Lung Disease
Other Inhalational Disorders
Hypersensitivity Pneumonitis
Hypersensitivity Pneumonitis
Julia Alegría, 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 lung
            • Lycoperdonosis
            • Hot tub lung

          • Definitions

            • Immune-mediated disease that manifests as interstitial lung disease (ILD) in susceptible individuals after exposure to identified or unidentified factor
            • Type of cellular bronchiolitis
            • HP: Transitory pulmonary opacities or irreversible pulmonary fibrosis
            • Classification: Nonfibrotic and fibrotic HP
              • Two clusters that incorporate clinical, imaging, and pathologic findings
                • Nonfibrotic: Symptoms occur hours after exposure; may be recurrent
                • Fibrotic: 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. Raghu G et al: Diagnosis of hypersensitivity pneumonitis in adults. an official ATS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 202(3):e36-69, 2020
                                  2. Elicker BM et al: Multidisciplinary approach to hypersensitivity pneumonitis. J Thorac Imaging. 31(2):92-103, 2016
                                  3. Magee AL et al: Imaging of hypersensitivity pneumonitis. Radiol Clin North Am. 54(6):1033-46, 2016
                                  4. Spagnolo P et al: Hypersensitivity pneumonitis: a comprehensive Review. J Investig Allergol Clin Immunol. 25(4):237-50; quiz follow 250, 2015
                                  5. 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
                                  6. Lacasse Y et al: Recent advances in hypersensitivity pneumonitis. Chest. 142(1):208-17, 2012
                                  7. Selman M et al: Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med. 186(4):314-24, 2012
                                  8. Sverzellati N et al: Biopsy-proved idiopathic pulmonary fibrosis: spectrum of nondiagnostic thin-section CT diagnoses. Radiology. 254(3):957-64, 2010
                                  9. Hirschmann JV et al: Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 29(7):1921-38, 2009
                                  10. Lacasse Y et al: Classification of hypersensitivity pneumonitis: a hypothesis. Int Arch Allergy Immunol. 149(2):161-6, 2009
                                  11. Hanak V et al: HRCT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis. Chest.
                                  12. Olson AL et al: Acute exacerbations of fibrotic hypersensitivity pneumonitis: a case series. Chest. 134(4):844-50, 2008
                                  13. 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
                                  14. Takemura T et al: Pathology of hypersensitivity pneumonitis. Curr Opin Pulm Med. 14(5):440-54, 2008
                                  15. Sahin H et al: Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival. Radiology. 244(2):591-8, 2007
                                  16. Silva CI et al: Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings. AJR Am J Roentgenol. 188(2):334-44, 2007
                                  17. Lacasse Y et al: Hypersensitivity pneumonitis. Orphanet J Rare Dis. 1:25, 2006
                                  18. Franquet et al: Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr 27(4): 475-8, 2003
                                  19. Lacasse Y et al: Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med. 168(8):952-8, 2003
                                  20. 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
                                  21. Tasaka S et al: Fatal diffuse alveolar damage from bird fanciers' lung. Respiration. 64(4):307-9, 1997
                                  22. 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
                                  23. 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 lung
                                            • Lycoperdonosis
                                            • Hot tub lung

                                          • Definitions

                                            • Immune-mediated disease that manifests as interstitial lung disease (ILD) in susceptible individuals after exposure to identified or unidentified factor
                                            • Type of cellular bronchiolitis
                                            • HP: Transitory pulmonary opacities or irreversible pulmonary fibrosis
                                            • Classification: Nonfibrotic and fibrotic HP
                                              • Two clusters that incorporate clinical, imaging, and pathologic findings
                                                • Nonfibrotic: Symptoms occur hours after exposure; may be recurrent
                                                • Fibrotic: 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. Raghu G et al: Diagnosis of hypersensitivity pneumonitis in adults. an official ATS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 202(3):e36-69, 2020
                                                                  2. Elicker BM et al: Multidisciplinary approach to hypersensitivity pneumonitis. J Thorac Imaging. 31(2):92-103, 2016
                                                                  3. Magee AL et al: Imaging of hypersensitivity pneumonitis. Radiol Clin North Am. 54(6):1033-46, 2016
                                                                  4. Spagnolo P et al: Hypersensitivity pneumonitis: a comprehensive Review. J Investig Allergol Clin Immunol. 25(4):237-50; quiz follow 250, 2015
                                                                  5. 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
                                                                  6. Lacasse Y et al: Recent advances in hypersensitivity pneumonitis. Chest. 142(1):208-17, 2012
                                                                  7. Selman M et al: Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med. 186(4):314-24, 2012
                                                                  8. Sverzellati N et al: Biopsy-proved idiopathic pulmonary fibrosis: spectrum of nondiagnostic thin-section CT diagnoses. Radiology. 254(3):957-64, 2010
                                                                  9. Hirschmann JV et al: Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 29(7):1921-38, 2009
                                                                  10. Lacasse Y et al: Classification of hypersensitivity pneumonitis: a hypothesis. Int Arch Allergy Immunol. 149(2):161-6, 2009
                                                                  11. Hanak V et al: HRCT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis. Chest.
                                                                  12. Olson AL et al: Acute exacerbations of fibrotic hypersensitivity pneumonitis: a case series. Chest. 134(4):844-50, 2008
                                                                  13. 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
                                                                  14. Takemura T et al: Pathology of hypersensitivity pneumonitis. Curr Opin Pulm Med. 14(5):440-54, 2008
                                                                  15. Sahin H et al: Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival. Radiology. 244(2):591-8, 2007
                                                                  16. Silva CI et al: Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings. AJR Am J Roentgenol. 188(2):334-44, 2007
                                                                  17. Lacasse Y et al: Hypersensitivity pneumonitis. Orphanet J Rare Dis. 1:25, 2006
                                                                  18. Franquet et al: Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr 27(4): 475-8, 2003
                                                                  19. Lacasse Y et al: Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med. 168(8):952-8, 2003
                                                                  20. 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
                                                                  21. Tasaka S et al: Fatal diffuse alveolar damage from bird fanciers' lung. Respiration. 64(4):307-9, 1997
                                                                  22. 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
                                                                  23. 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