Hypersensitivity pneumonitis from Diagnosis to Treatment: A Cases Series with Literature Review
Main Article Content
Abstract
Hypersensitivity pneumonitis (HP) classified as an interstitial lung disease is characterized by a complex immunological reaction of the lung parenchyma in response to repetitive inhalation of a sensitized allergen. The estimated worldwide incidence of hypersensitivity pneumonitis is extremely rare and highly dependent on climatic, geographical, occupational and industrial factors. It might be secondary to a domestic or professional exposure, usually occurs in people who work in places where there are high levels of dust, fungus, or molds. Long-term exposure can lead to lung inflammation and acute lung disease. Over time, the acute condition turns into long-lasting (chronic) lung disease. Thus, we distinguish 2 mains aspects fibrotic HP and Nonfibrotic HP. The diagnosis of HP maybe sophisticated especially in fibrotic form. The prognosis of this disease depends on early diagnosis with complete antigen avoidance and most often corticosteroid therapy.
This work aims to study the epidemiological, clinical, paraclinical aspects of hypersensitivity pneumonitis as well as therapeutic management, through a series of eight cases of HP carried out at the Pulmonology Department 20 August 1953, University Hospital Center IBN ROCHD, between January 2020 and January 2022, analyzed using a pre-established exploitation sheet. The average age of the patients studied was 51 years with a female predominance (sex-ratio M/F= 0.34). Domestic and occupational exposures of our patients were equal. The clinical symptomatology is dominated by almost constant dyspnea in all patients. Physical signs increased by crackles, objectified in 75% of patients. Computed tomography (CT) remains a great diagnostic contribution. Thus, allowing to have two categories of patients, depending on the presence or absence of signs of pulmonary fibrosis.
In our study, five patients had fibrotic HP, and three cases had non- fibrotic HP. Precipitins were positive. Plethysmography objectified a restrictive ventilatory disorder in 62.5%. All patients benefited from antigenic eviction with long-term corticosteroid therapy. The evolution was favorable in 87.5% of cases.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Chauvin, P., Kerjouan, M., Jego, P., Jouneau, S., & Lescoat, A. (2021). Mise Au Point : Pneumopathies D’hypersensibilite. La Revue De Medecine Interne .
3. M Girard , Y Lacasse, Y Cormier-Hypersentivity Pneumonitis.Allergy.2009 :64(3) :322-34.
4. Quirce S, Vvandenplas O, Campo P, Cruz MJ et AL6Ocuupational hypersensitivity pneumonitis : an EAACI position paper. Allergy. 2016 ; 71 (6) :765-79.
5. Santos, V., Martins, N., Sousa, C., Jacob, M., Padrão, E., Melo, N., … Morais, A. (2019). Hypersensitivity pneumonitis: Main features characterization in a Portuguese cohort. Pulmonology.
6. Hanak, V., Golbin, J. M., & Ryu, J. H. (2007). Causes and Presenting Features in 85 Consecutive Patients With Hypersensitivity Pneumonitis. Mayo Clinic Proceedings, 82(7), 812– 816.
7. Lacasse, Y., Selman, M., Costabel, U., Dalphin, J.-C., Morell, F., Erkinjuntti-Pekkanen, R.,
8. Cormier, Y. (2009). Classification of Hypersensitivity Pneumonitis. International Archives of Allergy and Immunology, 149(2).
9. Vasakova M, Morell F, Walsh S, Leslie K, Raghu G. Hypersensitivity pneumonitis: perspectives in diagnosis and management. Am J Respir Crit Care Med. 2017;196(6):680---9.
10. Chauvin, P., Kerjouan, M., Jégo, P., Jouneau, S., & Lescoat, A. (2021). Mise au point : pneumopathies d’hypersensibilité. La Revue de Médecine Interne.
11. Dias OM, Baldi BG, Pennati F, Aliverti A, Chate RC, Sawamura MVY, et al. Computed tomography in hypersensitivity pneumonitis: main findings, differential diagnosis and pitfalls. Expert Rev Respir Med 2018;12(1):5–13.
12. Dalphin J-C. Pneumopathie d’hypersensibilité. EMC - Pneumol 2016;13(3):1–13 [Article 6- 039-E-30]:41.
13. Silva CIS, Müller NL, Lynch DA, Curran-Everett D, Brown KK, Lee KS, et al. Chronic Hypersensitivity Pneumonitis: Differentiation from Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia by Using Thin-Section CT. Radiology 2008;246(1):288–97.
14. Adderley N, Humphreys CJ, Barnes H, Ley B, Premji ZA, Johannson KA. Bronchoalveolar Lavage FluidLymphocytosis inChronicHypersensitivity Pneumonitis: A Systematic Review and Meta-Analysis. Eur Respir J 2020 [20002]
15. Creamer AW, Barratt SL. Prognostic factors in chronic hypersensitivity pneumonitis. Eur Respir Rev 2020;29(156):190167.
16. Dalphin, J.-C. (2005). Pneumopathies d’hypersensibilité. EMC - Médecine, 2(1), 24–33.
17. Chandra D, Cherian SV. Hypersensitivity Pneumonitis. 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29763093.
18. Lacasse Y, Selman M, Costable U, Dalphin JC et AL,-Clinical diagnosis of hypersensitivity pneumonitis.Am J Respir Crit Care Med 2003 :168(8) :952-58.
19. Girard, M., E. Israël-Assayag, and Y. Cormier, 2009a, Mature CD11c(+) cells are enhanced in hypersensitivity pneumonitis. Eur Respir J, v. 34, p. 749-56.