Further Care

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.

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.

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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Media Gallery

Photomicrograph of a lung biopsy specimen reveals marked interstitial inflammation with lymphocytic predominance and a multinucleated giant cell (hematoxylin-eosin stain, original magnification 40X). Reprinted with permission from Farber and Budson, 2000.
Photomicrograph of a lung biopsy sample reveals interstitial fibrosis with active interstitial inflammation (hematoxylin-eosin stain, original magnification 10X). Reprinted with permission from Farber and Budson, 2000.
Photograph reveals precipitin lines produced by means of Ouchterlony immunodiffusion assay. Central wells contain the patient's serum. Peripheral wells contain serum or droppings from various birds. Reprinted with permission from Farber and Budson, 2000.
14-year-old girl with subacute hypersensitivity pneumonitis from avian antigen exposure. Chest radiograph demonstrates numerous tiny pulmonary nodules bilaterally.
Chest CT from same patient as previous image reveals widespread poorly-defined centrilobular ground-glass nodules related to bronchiolocentric cellular interstitial pneumonia with poorly-formed granulomas.
A 10-year-old girl with chronic hypersensitivity pneumonitis from avian antigen exposure. Chest CT image shows reticular pulmonary opacities and architectural distortion at the lung bases indicative of pulmonary fibrosis.

of 6

Author

Naga Jaya Smitha Yenduri, MD Assistant Professor, Division of Pediatrics, Pulmonary Section, Texas Children's Hospital, Baylor College of Medicine

Naga Jaya Smitha Yenduri, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

R Paul Guillerman, MD Associate Professor of Radiology, Baylor College of Medicine

R Paul Guillerman, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, Society for Pediatric Radiology, Children's Oncology Group

Disclosure: Nothing to disclose.

Harold J Farber, MD, MSPH Professor of Pediatrics, Section of Pediatric Pulmonology, Baylor College of Medicine, Texas Children's Hospital; Associate Medical Director, Texas Children's Health Plan

Harold J Farber, MD, MSPH is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Texas Children's Health Plan (a not-for-profit Medicaid Manged Care program owned by Texas Children's Hospital).

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler 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, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Bettina Hilman, MD, Nidhy Paulose Varghese, MD, Lori R Johnson, MD, and Laurianne Wild, MD. Leland Fan, MD, reviewed previous versions and provided helpful suggestions.

Sections Pediatric Hypersensitivity Pneumonitis
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Medication
Follow-up
Media Gallery
Tables
References

Exposure	Disease	Source of Antigen
Avian	Bird fancier's lung, pigeon breeder's lung, poultry worker's lung, feather duvet lung	Feathers, droppings, serum proteins, intestinal mucins, avian immunoglobulin A
Agriculture	Farmer's lung, Bagasse (sugar cane) lung, mushroom worker's lung, potato riddler's lung, paprika slicer's lung, wine maker's lung	Thermophilic actinomycetes, Aspergillus species, and other fungi in moldy hay or grains; moldy sugar cane; mushroom spores and thermophilic actinomycetes; moldy hay around potatoes, thermophilic actinomycetes, and others; Mucor stolonifer (on moldy paprika pods); B cinerea (noble rot on grapes)
Water-based systems	Humidifier lung, hot-tub lung, sauna taker's lung, lifeguard's lung, sewage pneumonitis, wind instrument lung	Aerosolized molds, endotoxins, mycobacteria, thermophilic actinomycetes, Penicillium species, others
Home environment	Summer-type pneumonitis, mold-contaminated walls, humidifiers, wallpaper	Trichosporon species, mold contamination in older and/or water-damaged homes
Chemicals	Chemical worker's lung, epoxy-resin lung, pyrethrum pneumonitis	Exposure to chemicals in manufacturing, laboratories, spray paints, heated epoxy resins, insecticides

Pediatric Hypersensitivity Pneumonitis Follow-up

Further Care

Further outpatient care

Further inpatient care

Deterrence/prevention

References

Tables

Contributor Information and Disclosures

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