Guidelines Summary

The American College of Chest Physicians (ACCP) published clinical guidelines on the diagnosis and evaluation of hypersensitivity pneumonitis.^[81]The guidelines note that the disease can occur at any age.

The ACCP suggests classifying patients with suspected hypersensitivity pneumonitis based on the likelihood of inciting antigen exposure.

The ACCP suggests classifying the disease as fibrotic or nonfibrotic based on the presence or absence of fibrosis on high-resolution computed tomography (CT) scanning of the chest.

The ACCP suggests bronchoalveolar lavage fluid analysis may not be needed in patients with a compelling exposure history within the appropriate clinical context and a pattern typical of hypersensitivity pneumonitis on high-resolution CT scanning of the chest.

The ACCP suggests that histologic lung biopsy may be considered when clinical, laboratory, and radiologic findings (along with bronchoscopic results) do not yield a confident diagnosis, and the results may help guide management.

Medication

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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.

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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 Guidelines

Guidelines Summary

References

Tables

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