Pediatric Hypersensitivity Pneumonitis Follow-up

Updated: May 20, 2016
  • Author: Harold J Farber, MD, MSPH; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Follow-up

Further Outpatient Care

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.

The patient with hypersensitivity pneumonitis (HP) 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 removing a family pet, 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.

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Further Inpatient Care

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

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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.

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Complications

Complications may include the following:

  • Spontaneous pneumothorax

  • Pulmonary fibrosis

  • Emphysema

  • Respiratory insufficiency or failure

  • Cor pulmonale

  • Death

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Prognosis

Overall, the prognosis is good if the antigen is identified and the antigenic exposure is eliminated. In acute hypersensitivity pneumonitis, removal from exposure generally results in improvement within 12 hours to several days. Complete resolution of clinical and radiographic findings may take several weeks. [92] 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 hypersensitivity pneumonitis despite a reduction or elimination of their antigenic exposures.

 

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Patient Education

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

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