Volume 6, Number 37;  October 12, 2006 - Hypersensitivity Pneumonitis - Long Term

Patient:

Session Handout:

Readings:

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Unique Identifier [PMID]: 12421245

Authors: Hayakawa H. Shirai M. Sato A. Yoshizawa Y. Todate A. Imokawa S. Suda T. Chida K. Tamura R. Ishihara K. Saiki S. Ando M.

Institution: Department of Internal Medicine, National Tenryu Hospital, Hamakita, Japan. hayakawh@tenryuu.hosp.go.jp

Title: Clinicopathological features of chronic hypersensitivity pneumonitis.

Source: Respirology. 7(4):359-64, 2002 Dec.

Abstract: OBJECTIVE: Only limited information exists concerning the clinical and pathological features of chronic hypersensitivity pneumonitis (HP) in Japan and elsewhere. We present data on clinicopathological features of chronic HP obtained through a Japanese nationwide survey. METHODOLOGY: We studied the clinical and pathological findings in 10 patients with chronic HP who underwent surgical lung biopsy or postmortem examination. RESULTS: There were three types of clinical course: six of the 10 patients had persistent symptoms followed by repeated acute episodes; two showed a subacute onset with persistent symptoms; and two exhibited an insidious onset. Five patients made no attempt to avoid antigen exposure and they all had progressive disease. Pathological findings indicated that lesions were mainly centrilobular with or without epithelioid cell granulomas in specimens obtained during the acute or subacute stage. In contrast, most patients in the chronic stage predominantly showed interstitial fibrosis with a usual interstitial pneumonia pattern. CONCLUSIONS: The pathological findings of chronic HP depend on the stage of the disease at tissue sampling.

Publication Type: Journal Article.

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Unique Identifier [PMID]: 12221897

Authors: Moran JV. Greenberger PA. Patterson R.

Institution: Division of Allergy-Immunology, Ernest S. Bazley Asthma and Allergic Diseases Center, Department of Medicine of Northwestern Memorial Hospital and Northwestern University Medical School, Chicago, Illinois, USA.

Title: Long-term evaluation of hypersensitivity pneumonitis: a case study follow-up and literature review. [Review] [23 refs]

Source: Allergy & Asthma Proceedings. 23(4):265-70, 2002 Jul-Aug.

Abstract: This study reports a 3-year follow-up of a classic presentation of hypersensitivity pneumonitis (HP), originally reported elsewhere, after removal of the causative antigens. The literature is reviewed and this case is compared with outcomes of series previously reported. The patient was reevaluated by clinical, serologic, radiographic, and pulmonary function testing 3 years after removal of her home's contaminated humidifier, cleaning of the home, and administration of a course of prednisone. Repeat serologic measurements revealed positive serum precipitins only for Aspergillus flavus and Phoma herbarum, significantly fewer than her original panel, which revealed precipitating antibodies to her humidifier water and 10 other specific antigens. Pulmonary function tests remained stable. Physical exam revealed bibasilar rales. Computed tomography scan revealed pulmonary fibrosis, bronchiectasis, and honeycombing that was compared with 3 years earlier. Although most of the data obtained on reevaluation suggest remission, radiographic findings have not remitted. Long-term follow-up of parameters of HP disease activity do not always reveal consistent findings. This patient appears to be in a category of HP between the classic subacute and chronic stages. [References: 23]

Publication Type: Case Reports. Evaluation Studies. Journal Article. Review.

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Unique Identifier [PMID]: 11868922

Authors: Zacharisen MC. Schlueter DP. Kurup VP. Fink JN.

Institution: Medical College of Wisconsin, Milwaukee, USA. mzacharisen@chw.org

Title: The long-term outcome in acute, subacute, and chronic forms of pigeon breeder's disease hypersensitivity pneumonitis.[see comment].

Source: Annals of Allergy, Asthma, & Immunology. 88(2):175-82, 2002 Feb.

Abstract: BACKGROUND: Pigeon breeder's disease (PBD) is an avian-induced hypersensitivity pneumonitis. The limited data that exist on the long-term outcome for the disease are conflicting. OBJECTIVE: We sought to determine the long-term outcome of patients with PBD to evaluate the course of the disease. METHODS: Review a case series of 18 pigeon breeders that were followed from 4 to 26 years after initial diagnosis. RESULTS: Fourteen breeders reduced their bird contact significantly; four kept their birds. In eight patients with the acute form of the disease, pulmonary function either did not change from normal or improved to normal. Of five patients with subacute disease, four had persistent symptoms. All had mildly abnormal spirometry with either restrictive or obstructive changes which persisted. Five patients with chronic disease exhibited daily dyspnea. They had severe abnormalities of lung function at diagnosis. Of these patients, three improved and two deteriorated. Chest radiographs were of little value in predicting outcome. CONCLUSIONS: Patients with the acute form of PBD have the best prognosis, compared with those with subacute and chronic forms. Although some improvement could be seen in most individuals, recovery may still not be complete. Those with the chronic form are at particular risk for morbidity.

Publication Type: Journal Article.

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Unique Identifier [PMID]: 2971707

Authors: Trentin L. Marcer G. Chilosi M. Zambello R. Agostini C. Masciarelli M. Bizzotto R. Gemignani C. Cipriani A. Di Vittorio G. et al.

Institution: Padua University School of Medicine, Department of Clinical Medicine, Italy.

Title: Longitudinal study of alveolitis in hypersensitivity pneumonitis patients: an immunologic evaluation.

Source: Journal of Allergy & Clinical Immunology. 82(4):577-85, 1988 Oct.

Abstract: Cells recovered from bronchoalveolar lavage were studied, both from a phenotypic and functional point of view, in 18 patients with hypersensitivity pneumonitis (HP) during a prolonged follow-up. A series of monoclonal antibodies against different lymphocyte subpopulations, including T cells, T cell subsets, and natural killer (NK) cells have been used. In some cases, an immunohistologic analysis of lung tissue sections has also been performed. The NK activity has been evaluated with regard to the in vitro function. At the time of the first evaluation, a high number of CD8+ cells with an imbalance of CD4/CD8 ratio had been demonstrated in patients with HP. Consecutive bronchoalveolar lavage evaluations demonstrated a persistent increase of CD8+ cells and a reversal of CD4/CD8 ratio in patients who continued to be regularly exposed to etiologic antigens at work (W+). In the same cases, a persistent increase of NK cells was demonstrated. Cytotoxic cells demonstrated a persistently enhanced in vitro lytic function during the follow-up, even though there appeared to be a trend toward the normal range. Patients who continued to live in agricultural environments but were not further exposed to specific antigens at work (W-) exhibited a recovery of CD4+ cells, a decrease in CD8+ cells, and an increase of CD4/CD8 ratio to the normal range 6 months after the first observation. Immunohistologic analysis, performed at the time of the first evaluation, demonstrated a diffuse infiltration of lung parenchyma by CD8+ cells, both in W+ and W- patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication Type: Journal Article.

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Unique Identifier [PMID]: 3338304

Authors: Schmidt CD. Jensen RL. Christensen LT. Crapo RO. Davis JJ.

Institution: Department of Medicine, LDS Hospital, Salt Lake City 84132.

Title: Longitudinal pulmonary function changes in pigeon breeders.

Source: Chest. 93(2):359-63, 1988 Feb.

Abstract: We studied 15 subjects (14 men and one woman; seven symptomatic and eight asymptomatic) at three- to four-year intervals from 1967 through 1985 (18 years) to determine if continued pigeon antigen exposure in these groups was associated with a decline in pulmonary function greater than expected in healthy individuals. We collected immunologic studies at the initial visit, performed sequential pulmonary function studies and obtained chest radiographs. After compensating for the normal changes expected with increasing age, we found the declines in FVC, FEV1, and Dsb in the symptomatic group were nearly four times greater than expected. There was no significant difference in the decline of pulmonary function between asymptomatic subjects and the normal predicted declines with increasing age. We conclude that, if an individual has episodes of acute hypersensitivity pneumonitis, long-term exposure to pigeon antigens will result in an accelerated decline in pulmonary function.

Publication Type: Journal Article.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth