eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Hypersensitivity Pneumonitis: Follow-up

Author: Harold J Farber, MD, Associate Professor, Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine
Coauthor(s): Nidhy S Paulose Varghese, MD, Postdoctoral Fellow, Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine; Bettina C Hilman, MD, Consulting Staff, The Asthma and Allergy Center
Contributor Information and Disclosures

Updated: Apr 14, 2008

Follow-up

The patient should be strongly advised to eliminate exposure to the offending antigen. In cases of severe disease, the patient may need to be moved to a new setting to avoid the offending antigen. In some cases, antigen avoidance may include interventions that are very disruptive to the individual’s life or the family’s life, such as moving from the home, changing occupations or both.

Corticosteroid doses and adverse effects must be monitored. Once a clinical response has been achieved, the acute dosing should be gradually tapered. Markers of clinical response consist of resolution of abnormalities on physical and radiologic examination, improvement in pulmonary function measures including vital capacity, diffusing capacity, and oxygen saturation. 

Further Inpatient Care

Monitor corticosteroid doses and adverse effects. Gradually taper dose after clinical response, radiologically visible clearing, and improved pulmonary function are achieved.

Further Outpatient Care

Monitor corticosteroid doses and adverse effects. Serial pulmonary function testing with assessment of lung volumes and diffusion capacity is indicated (if the patient is able to perform the maneuvers) to document resolution of abnormalities. Monitor adherence to recommendations to eliminate exposure to the offending antigen.

Deterrence/Prevention

The immediate family of children with chronic HP should be screened for subclinical disease because both the exposure and genetic predisposition may be shared.

Complications

Complications may include the following:

  • Spontaneous pneumothorax
  • Pulmonary fibrosis
  • Emphysema
  • Respiratory insufficiency or failure
  • Cor pulmonale
  • Death

Prognosis

Overall, the prognosis is good if the antigen is identified and the antigenic exposure is eliminated. In acute HP, removal from exposure generally results in improvement within 12 hours to several days. Complete resolution of clinical and radiographic findings may take several weeks.62  Longer periods are needed for resolution of subacute disease. 

Digital clubbing, pulmonary fibrosis, and prolonged (>2 y) exposure all suggest permanent lung damage and a risk for disease progression. Reports have described this progression among adults with chronic HP despite a reduction or elimination of their antigenic exposures.

Patient Education

Educate the patient and his or her family about the importance of eliminating exposure to the offending antigen. 

Miscellaneous

Medicolegal Pitfalls

Failure to consider hypersensitivity pneumonitis (HP) in the differential diagnosis, resulting in misdiagnosis or delayed diagnosis, can have significant consequences secondary to treatment postponement.

 
Acknowledgments

This article has been extensively revised and updated from the original version by Lori R Johnson, MD; Bettina C Hilman, MD; Laurianne Wild, MD; and Harold J Farber, MD. Leland Fan, MD reviewed this version of the manuscript and provided helpful suggestions.



More on Hypersensitivity Pneumonitis

Overview: Hypersensitivity Pneumonitis
Differential Diagnoses & Workup: Hypersensitivity Pneumonitis
Treatment & Medication: Hypersensitivity Pneumonitis
Follow-up: Hypersensitivity Pneumonitis
Multimedia: Hypersensitivity Pneumonitis
References
Further Reading
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Further Reading

Fan LL. Hypersensitivity Pneumonitis in Children. Curr Opin Pediatr. 2002 Jun;14(3):323-6.

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Keywords

Hypersensitivity pneumonitis, HP, extrinsic allergic alveolitis, EAA, bird fancier's lung, pigeon fancier’s lung, bird breeder's lung, pigeon breeder's lung, farmer's lung, recurrent pneumonitis, pulmonary fibrosis, emphysema, hypersensitivity pneumonitides, farm worker's lung, thermophilic actinomycetes, winemaker's lung, Botrytis cinerea, coffee worker's lung, coffee bean dust, lifeguard's lung

aerosolized endotoxin, poultry worker's lung, avian antigens, laboratory worker's lung, rodent antigens, miller's lung, wheat weevil, woodworker's lung, Bacillus subtilis, epoxy-resin lung, Phthalic anhydride, spontaneous pneumothorax, end-stage lung disease, acute respiratory symptoms, pneumonia, digital clubbing, chronic cough, dyspnea, cyanosis, bird fancier's lung, pigeon breeder's lung, Aspergillus species, moldy hay, Mucor stolonifer, humidifier lung, hot-tub lung, sauna taker's lung, sewage pneumonitis, summer-type pneumonitis, Trichosporon species

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Contributor Information and Disclosures

Author

Harold J Farber, MD, Associate Professor, Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine
Harold J Farber, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Nidhy S Paulose Varghese, MD, Postdoctoral Fellow, Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine
Nidhy S Paulose Varghese, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Bettina C Hilman, MD, Consulting Staff, The Asthma and Allergy Center
Bettina C Hilman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Chest Physicians, American Heart Association, American Medical Association, American Pediatric Society, American Thoracic Society, and Louisiana State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis Center
Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Associate Professor, Department of Clinical Pediatrics, State University of New York at Stony Brook
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics, American Heart Association, and American Thoracic Society
Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD, Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center; Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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