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VOLUME 12 , ISSUE 4 ( October-December, 2023 ) > List of Articles

Original Article

Hypersensitivity Pneumonitis with Environmental Exposure Manifesting as Fibrotic and Nonfibrotic Forms at a Tertiary Care Center in Western Maharashtra

Ajai Kumar Tentu, Samruddhi P Deshpande, Nilesh P Phole, Rongala Laxmivandana

Keywords : Avian droppings, Bronchoalveolar lavage, Exposure history, Forced vital capacity, High-resolution computerized tomography

Citation Information : Tentu AK, Deshpande SP, Phole NP, Laxmivandana R. Hypersensitivity Pneumonitis with Environmental Exposure Manifesting as Fibrotic and Nonfibrotic Forms at a Tertiary Care Center in Western Maharashtra. Indian J Respir Care 2023; 12 (4):345-351.

DOI: 10.5005/jp-journals-11010-1077

License: CC BY-NC-SA 4.0

Published Online: 18-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aims and background: Hypersensitivity pneumonitis (HP) is a complex immune-mediated disease affecting the lung, leading to fibrosis on recurrent exposure to organic/inorganic antigens. The sources of antigens include avian droppings, avian feathers, cotton fibers, metal particles, chemical fumes, etc. Materials and methods: This study comprises 27 adult individuals presenting with HP symptoms like shortness of breath, cough, chest tightness, fatigue, and wheezing who were assessed for clinical, radiological, functional, and bronchoscopic alveolar lavage evaluation. Results: The mean age of 27 patients diagnosed with HP in our study is 67.4 years which comprises 11 males and 16 females. Out of 27 (92.6%), 25 patients had prior comorbidities, of which hypertension (HTN) (44.4%) and type 2 diabetes mellitus (33.3%) were major contributors. Among 27 patients, 55.56% were diagnosed with fibrotic HP and 44.44% with nonfibrotic HP. The average percent predicted forced vital capacity (FVC) of patients was 61.9. The most common high-resolution computerized tomography (HRCT) chest abnormalities were ground glass opacities (GGOs) (27%). In this study, four out of 12 patients reported positive for the HP panel test. The p-value of 0.031 established a statistically significant association between type of HP and history of avian exposure in patients. Conclusion: The prevalence of HP was found to be in patients of older age, and the association of avian exposure in patients has a statistical significance in determining the type of HP. Clinical significance: This study emphasizes the importance of identifying antigen sources related to disease prognosis among HP patients.


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  1. Lacasse Y, Selman M, Costabel U, et al. Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med 2003;168(8):952–958. DOI: 10.1164/rccm.200301-137OC
  2. El-Hefny A, Ekladious EM, El-Sharkawy S, et al. Extrinsic allergic bronchiolo-alveolitis in children. Clin Allergy 1980;10(6):651–658. DOI: 10.1111/j.1365-2222.1980.tb02148.x
  3. 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(3):e36–e69. DOI: 10.1164/rccm.202005-2032ST
  4. Lopez M, Salvaggio JE. Epidemiology of hypersensitivity pneumonitis/allergic alveolitis. Monogr Allergy 1987;21:70–86.
  5. Wuyts W, Sterclova M, Vasakova M. Pitfalls in diagnosis and management of hypersensitivity pneumonitis. Curr Opin Pulm Med 2015;21(5):490–498. DOI: 10.1097/MCP.0000000000000199
  6. Gbaguidi-Haore H, Roussel S, Reboux G, et al. Multilevel analysis of the impact of environmental factors and agricultural practices on the concentration in hay of microorganisms responsible for farmer's lung disease. Ann Agric Environ Med 2009;16(2):219–225. PMID: 20047254.
  7. 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(3):301–308. DOI: 10.1164/rccm.201903-0541PP
  8. Selman M, Pardo A, King TE Jr. Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med 2012;186(4):314–324. DOI: 10.1164/rccm.201203-0513CI
  9. Selman M, Lacasse Y, Pardo A, et al. Hypersensitivity pneumonitis caused by fungi. Proc Am Thorac Soc 2010;7(3):229–236. DOI: 10.1513/pats.200906-041AL
  10. Beniwal A, Chaturvedi S, Bhatt T, et al. Eugenol hypersensitivity in pediatric dental patient: a rare case report. J Mahatma Gandhi Univ Med Sci Tech 2016;1(2):68–70. DOI: 10.5005/jp-journals-10057-0017
  11. Pillai LV, Ambike DP, Husainy S, et al. Severe lung injury following inhalation of nitric acid fumes. Indian J Crit Care Med 2005;9(4):244–277. DOI: 10.4103/0972-5229.19766
  12. Morell F, Villar A, Montero MÁ, et al. Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study. Lancet Respir Med 2013;1(9):685–694. DOI: 10.1016/S2213-2600(13)70191-7
  13. Pereira CAC, Soares MR, Boaventura R, et al. Squawks in interstitial lung disease prevalence and causes in a cohort of one thousand patients. Medicine (Baltimore) 2019;98(29):e16419. DOI: 10.1097/MD.0000000000016419
  14. Leone PM, Richeldi L. Current diagnosis and management of hypersensitivity pneumonitis. Tuberc Respir Dis (Seoul) 2020;83(2):122–131. DOI: 10.4046/trd.2020.0012
  15. Barnes H, Troy L, Lee CT, et al. Hypersensitivity pneumonitis: current concepts in pathogenesis, diagnosis, and treatment. Allergy 2022;77(2):442–453. DOI: 10.1111/all.15017
  16. Adegunsoye A, Oldham JM, Bellam SK, et al. Computed tomography honeycombing identifies a progressive fibrotic phenotype with increased mortality across diverse interstitial lung diseases. Ann Am Thorac Soc 2019;16(5):580–588. DOI: 10.1513/AnnalsATS.201807-443OC
  17. Roberts RC, Moore VL. Immunopathogenesis of hypersensitivity pneumonitis. Am Rev Respir Dis 1977;116(6):1075–1090. DOI: 10.1164/arrd.1977.116.6.1075
  18. Ojanguren I, Morell F, Ramón MA, et al. Long-term outcomes in chronic hypersensitivity pneumonitis. Allergy 2019;74(5):944–952. DOI: 10.1111/all.13692
  19. Soumagne T, Dalphin JC. Current and emerging techniques for the diagnosis of hypersensitivity pneumonitis. Expert Rev Respir Med 2018;12(6):493–507. DOI: 10.1080/17476348.2018.1473036
  20. Chami HA, Diaz-Mendoza J, Chua A, et al. Transbronchial biopsy and cryobiopsy in the diagnosis of hypersensitivity pneumonitis among patients with interstitial lung disease. Ann Am Thorac Soc 2021;18(1):148–161. DOI: 10.1513/AnnalsATS.202005-421OC
  21. Gimenez A, Storrer K, Kuranishi L, et al. Change in FVC and survival in chronic fibrotic hypersensitivity pneumonitis. Thorax 2018;73(4):391–392. DOI: 10.1136/thoraxjnl-2017-210035
  22. 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(5):1644–1651. DOI: 10.1378/chest.12-2685
  23. Adegunsoye A, Oldham JM, Fernández Pérez ER, et al. Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis. ERJ Open Res 2017;3(3):00016–2017. DOI: 10.1183/23120541.00016-2017
  24. Sema M, Miyazaki Y, Tsutsui T, et al. Environmental levels of avian antigen are relevant to the progression of chronic hypersensitivity pneumonitis during antigen avoidance. Immun Inflamm Dis 2018;6(1):154–162. DOI: 10.1002/iid3.202
  25. Churg A, Muller NL, Flint J, et al. Chronic hypersensitivity pneumonitis. Am J Surg Pathol 2006;30(2):201–208. DOI: 10.1097/01.pas.0000184806.38037.3c
  26. Park Y, Oh SJ, Chung DH. CD4(+)CD25(+) regulatory T cells attenuate hypersensitivity pneumonitis by suppressing IFN-gamma production by CD4(+) and CD8(+) T cells. J Leukoc Biol 2009;86(6):1427–1437. DOI: 10.1189/jlb.0908542
  27. Alberti ML, Rincon-Alvarez E, Buendia-Roldan I, et al. Hypersensitivity pneumonitis: diagnostic and therapeutic challenges. Front Med (Lausanne) 2021;8:718299. DOI: 10.3389/fmed.2021.718299
  28. Kumar R, Spalgais S, Ranga V. Hypersensitivity pneumonitis: clinical, radiological and pathological profile of 103 patients from North India. Monaldi Arch Chest Dis 2020;90(3). DOI: 10.4081/monaldi.2020.1307
  29. Wälscher J, Gross B, Morisset J, et al. Comorbidities and survival in patients with chronic hypersensitivity pneumonitis. Respir Res 2020;21(1):12. DOI: 10.1186/s12931-020-1283-8
  30. Blanchet MR, Israël-Assayag E, Cormier Y. Inhibitory effect of nicotine on experimental hypersensitivity pneumonitis in vivo and in vitro. Am J Respir Crit Care Med 2004;169(8):903–909. DOI: 10.1164/rccm.200210-1154OC
  31. Chan AL, Juarez MM, Leslie KO, et al. Bird fancier's lung: a state-of-the-art review. Clin Rev Allergy Immunol 2012;43(1–2):69–83. DOI: 10.1007/s12016-011-8282-y
  32. Chong BJ, Kanne JP, Chung JH. Headcheese sign. J Thorac Imaging 2014;29(1):W13. DOI: 10.1097/rti.0000000000000067
  33. Ohtani Y, Saiki S, Kitaichi M, et al. Chronic bird fancier's lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias. Thorax 2005;60(8):665–671. DOI: 10.1136/thx.2004.027326
  34. Adegunsoye A, Oldham JM, Demchuk C, et al. Predictors of survival in coexistent hypersensitivity pneumonitis with autoimmune features. Respir Med 2016;114:53–60. DOI: 10.1016/j.rmed.2016.03.012
  35. Cormier Y, Létourneau L, Racine G. Significance of precipitins and asymptomatic lymphocytic alveolitis: a 20-yr follow-up. Eur Respir J 2004;23(4):523–525. DOI: 10.1183/09031936.04.00021104
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