Hypersensitivity Pneumonitis (cont.)
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- What is hypersensitivity pneumonitis and what are its causes?
- What is acute hypersensitivity pneumonitis?
- What are the symptoms of acute hypersensitivity pneumonitis?
- What is chronic hypersensitivity pneumonitis?
- What are the symptoms of chronic hypersensitivity pneumonitis?
- What are examples of hypersensitivity pneumonitis?
- How is hypersensitivity pneumonitis diagnosed?
- What is the treatment for hypersensitivity pneumonitis?
- Find a local Pulmonologist in your town
What is chronic hypersensitivity pneumonitis?
Chronic (long-term) hypersensitivity pneumonitis causes lung scarring (fibrosis).
What are the symptoms of chronic hypersensitivity pneumonitis?
Symptoms of chronic hypersensitivity pneumonitis include:
- Shortness of breath
Chronic disease is believed to occur after prolonged low grade exposure to the offending particles. It is sometimes quite surprising that individuals with a passion for their hobbies or occupation will continue to allow exposure to lung damage (if the offending particles are related to the hobby or job) despite the knowledge that it is harmful.
What are examples of hypersensitivity pneumonitis?
Examples of hypersensitivity pneumonitis include:
- Farmer's lung disease from exposure to mold spores in hay
- Pigeon breeder's disease from exposure to protein particles in pigeon droppings
- Sauna takers' disease from exposure to mold growing in wet containers
- Mushroom workers' disease from exposure to moldy compost
- Bagassosis from exposure to moldy sugar cane
- Winemaker's lung from exposure to a fungus on grapes called Botrytis cinerea
- An unusual case was published involving a case of hypersensitivity to Canadian goose droppings. The individual was a physician who was exposed to both indoor and outdoor antigens while living in a suburban Illinois community. One can only imagine the tremendous detective work necessary to make this diagnosis.
A more detailed analysis is listed in the table, which includes the types of compounds, bacteria, and molds known to cause hypersensitivity pneumonitis.
|Bagassosis||Bacteria (Thermophilic actinomycetes)||Moldy bagasse (pressed sugarcane)|
|Mushroom worker lung||Bacteria (Thermophilic actinomycetes)||Mushroom compost|
|Metalworking fluids HP||Bacteria (Mycobacterium immunogenum)||Mist from metalworking fluids|
|Hot tub HP||Bacteria (Mycobacterium avium complex)||Mist from hot tubs|
|Lifeguard lung||Bacteria (Endotoxin)||Indoor swimming pool|
|Farmer's lung||Bacteria (Thermophilic actinomycetes)
Fungus (Aspergillus species)
|Humidifer lung||Bacteria (T. candidus, Bacillus subtilis, B. cereus, Klebsiella oxytoca)
Fungus (Aureobasidium pullulans)
Amoebae (Naegleria gruberi, Acanthamoeba polyhaga, Acanthamoeba castellani)
|Mist from standing water|
|Compost HP||Fungus (Aspergillus)||Compost|
|Malt worker lung||Fungus (Aspergillus clavatus)||Moldy barley|
|Peat moss HP||Fungi (Monocillium sp, Penicillium citreonigrum)||Peat moss|
|Suberosis||Fungus (Penicillum frequentans)||Moldy cork dust|
|Maple bark HP||Fungus (Cryptostroma corticale)||Moldy wood bark|
|Wood pulp worker lung||Fungus (Alternaria species)||Moldy wood pulp|
|Wood trimmer lung||Fungus (Rhizopus species)||Moldy wood trimmings|
|Tree cutter lung||Fungi (Penicillium (three species), Paecilomyces sp.,
Aspergillus niger, Aspergillus sp., Rhizopus sp.)
|Wood chips from living maple and oak trees|
|Dry rot HP||Fungus (Merulius lacrymans)||Moldy rotten wood|
|Sequoiosis||Fungi (Graphium species, Pullularia species)||Moldy wood dust|
|Japanese summer-type HP||Fungus (Trichosporon cutaneum)||Damp wood and mats|
|Cheese washer lung||Fungus (Pencillum casei or P.roqueforti)||Cheese casings|
|Tobacco worker lung||Fungus (Aspergillus sp.)||Moldy tobacco|
|Greenhouse HP||Fungi (Aspergillus sp., Penicillium sp., Cryptostroma corticale)||Moldy soil|
|Esparto grass HP||Fungus (Aspergillus fumigatus)||Moldy esparto used to produce ropes, canvas, sandals, mats, baskets, and paper paste|
|Soy sauce brewer lung||Fungus (Aspergillus oryzae)||Fermentation starter for soy sauce|
|Bird breeder lung||Avian proteins||Bird droppings and feathers|
|Mollusc shell HP||Aquatic animal proteins||Mollusc shell dust|
|Animal handler lung||Animal proteins||urine, serum, fur|
|Wheat weevil HP||Wheat weevil (Sitophilus granarius)||Infested flour|
|Silk production HP||Silk worm larvae proteins||Silk worm larvae|
|Isocyanate HP||TDI, HDI, MDI||Paints, resins, polyurethane foams|
|TMA HP||Trimellitic anhydride||Plastics, resins, paints|
|Rose, CS, Lara AR. Hypersenstivity pneumonia In: Mason RJ, Broadus VC, Martin TR, et al. Eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa; Saunders Elsevier; 2010; Chap 66.|
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