Exogen allergische Alveolitis – Eine wichtige Differenzialdiagnose der infiltrativen Lungenerkrankungen

 

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Abstract

Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic disease of the lung parenchyma and terminal bronchioles caused by an allergic reaction to inhaled antigens. The immune response following antigen exposure results in lymphocytic inflammation as well as granuloma formation.

The typical histologic pattern of HP consists of cellular interstitial pneumonia, cellular bronchiolitis, and epithelioid cell granulomas. The additional presence of fibrosis has a significant impact on the course as well as the prognosis of the disease and represents a therapeutic approach. Therefore, a classification into a non-fibrotic and a fibrotic phenotype is proposed.

The diagnosis of HP is made by high-resolution computed tomography (HRCT) of the lung, evaluation of possible antigen exposure, and bronchoscopy with bronchoalveolar lavage and, if necessary, forceps biopsy. If the diagnosis is inconclusive, transbronchial cryobiopsy or surgical lung biopsy may need to follow. A multidisciplinary board is critical in making the diagnosis.

Publication History

Article published online:
20 October 2021

© 2021. Thieme. All rights reserved.

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• Literatur

• 1 Mooney JJ, Elicker BM, Urbania TH. et al. Radiographic fibrosis score predicts survival in hypersensitivitiy pneumonitis. Chest 2013; 144: 586-592
  CrossrefPubMedGoogle Scholar
• 2 Fernández Pérez ER, Swigris JJ, Forssén AV. et al. Identifying an inciting antigen is associated with improved survival in patients with chronic hypersensitivity pneumonitis. Chest 2013; 144: 1644-1651
  CrossrefPubMedGoogle Scholar
• 3 Fernández Pérez ER, Kong AM, Raimundo K. et al. Epidemiology of hypersensitivity pneumonitis among an insured population in the United States: a claims-based cohort analysis. Ann Am Thorac Soc 2018; 15: 460-469
  CrossrefPubMedGoogle Scholar
• 4 Raghu G, Remy-Jardin M, Ryerson CJ. et al. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202 (03) e36-e69
  CrossrefPubMedGoogle Scholar
• 5 Lacasse Y, Selman M, Costabel U. et al. Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med 2003; 168: 952-958
  CrossrefPubMedGoogle Scholar
• 6 Vasakova M, Selman M, Morell F. et al. Hypersensitivity pneumonitis: current concepts of pathogenesis and potential targets for treatment. Am J Respir Crit Care Med 2019; 200: 301-308
  CrossrefPubMedGoogle Scholar
• 7 Pardo A, Barrios R, Gaxiola M. et al. Increase of lung neutrophils in hypersensitivity pneumonitis is associated with lung fibrosis. Am J Respir Crit Care Med 2000; 161: 1698-1704
  CrossrefPubMedGoogle Scholar
• 8 Barrera L, Mendoza F, Zuniga J. et al. Functional diversitiy of T-cell subpopulations in subacute and chronic hypersensitivitiy pneumonitis. Am J Respir Crit Care med 2008; 177: 44-55
  CrossrefPubMedGoogle Scholar
• 9 Camarena A, Juárez A, Mejía M. et al. Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder´s disease. Am J Respir Crit Care Med 2001; 163: 1528-1533
  CrossrefPubMedGoogle Scholar
• 10 Yamaguchi E, Itoh A, Furuya K. et al. Release of tumor necrosis factor alpha from human alveolar macrophages is decreased in smokers. Chest 1993; 103: 479-483
  CrossrefPubMedGoogle Scholar
• 11 Sennekamp J, Müller-Wening D, Amthor M. et al. Empfehlungen zur Diagnostik der exogen-allergischen Alveolitis. Pneumologie 2007; 61: 52-56
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Caillaud DM, Vergnon JM, Madroszyk A. et al. Bronchoalveolar lavage in hypersensitivitiy pneumonitis: a series of 139 patients. Inflamm Allergy Drug Targets 2012; 11: 15-19
  CrossrefPubMedGoogle Scholar
• 13 Troy LK, Grainge C, Corte TJ. et al. Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung diseae diagnosis (COLDICE): a prospective comparative study. Lancet Respir Med 2019; 8: 171-181
  CrossrefPubMedGoogle Scholar
• 14 Hagmeyer L, Theegarten D, Wohlschläger J. et al. Transbronchial cryobiopsy in fibrosing interstitial lung disease: modifications of the procedure lead to risk reduction. Thorax 2019; 74: 711-714
  CrossrefPubMedGoogle Scholar
• 15 Hansell DM, Moskovic E. High-resolution computed tomography in extrinsic allergic alveolitis. Clin Radiol 1991; 43: 8-12
  CrossrefPubMedGoogle Scholar
• 16 Barnett J, Molyneaux PL, Rawal B. et al. Variable utility of mosaic attenuation to distinguish fibrotic hypersensitivity fro idiopathic pulmonary fibrosis. Eur Respir J 2019; 54: 1900531
  CrossrefPubMedGoogle Scholar
• 17 Akashi T, Takemura T, Ando N. et al. Histopathologic analysis of sixteen autopsy cases of chronic hypersensitivity pneumonitis and comparison with idiopathic pulmonary fibrosis/usual interstitial pneumonia. Am J Clin Pathol 2009; 131: 405-415
  CrossrefPubMedGoogle Scholar
• 18 Wijsenbeek M, Cottin V. Spectrum of fibrotic lung diseases. N Engl J Med 2020; 383: 958-968
  CrossrefPubMedGoogle Scholar
• 19 Flaherty KR, Wells AU, Cottin V. et al. Nintedanib in progressive fibrosing interstitial lung diseases. N Engl J Med 2019; 381: 1718-1727
  CrossrefPubMedGoogle Scholar
• 20 Behr J, Prasse A, Kreuter M. et al. Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (RELIEF): a double-blind, randomised, placebo-controlled, phase 2b trial. Lancet Respir Med 2021; 9: 476-486
  CrossrefPubMedGoogle Scholar
• 21 Orens JB, erlo CA. Selection of Candidates for Lung Transplantation and Controversial Issues. Semin Respir Crit Care Med 2018; 39: 117-125
  Article in Thieme ConnectPubMedGoogle Scholar
• 22 Ohtani Y, Saiki S, Sumi Y. et al. Cinical features of recurrent and insidious chronic bird fancier´s lung. Ann Allergy Asthma Immunol 2003; 90: 604-610
  CrossrefPubMedGoogle Scholar