Clinical Information

Hypersensitivity pneumonitis (HP) is a type of interstitial lung disease caused by an immune-mediated response to inhaled environmental antigens.(1) Patients with HP commonly display symptoms of cough, dyspnea, and midinspiratory squeaks. Patients may present with an acute onset of symptoms (within hours of antigen exposure) or a chronic onset (which may occur over a course of weeks to months). The nature of an individual's disease course will be affected by several factors, including quantity of inhaled antigen, intensity/frequency of exposure, and genetic background. The epidemiology of HP is also challenging to understand, as incidence and prevalence of the disease varies with geographic areas, climate, and local customs. While the immunopathogenesis of HP is not completely understood, it is presumed to involve both type III and type IV hypersensitivity reactions, with the type III reaction characterized by the presence of IgG antibodies specific for the inciting antigen.(2,3)

Clinical practice guidelines for HP include a diagnostic algorithm which focuses on exposure identification, imaging evaluation, and bronchoalveolar lavage/histopathology.(4) In patients with clinical, pathological and imaging results consistent with HP, identification of causative exposure is important, as a significant part of treatment is antigen avoidance. There are many antigens, both organic and inorganic, that have been associated with the development of HP.(2,3) Causative organic antigens include a wide array of bacteria, mycobacteria, fungi, and animal proteins. Aspergillus fumigatus is a fungus found in locations with high humidity, including soil, greenhouses, and compost heaps. It is ubiquitous and may even be found in household dust. In patients diagnosed with HP, evaluation for antigen-specific IgG antibodies, in conjunction with known environmental exposures, can help to document the causative exposure for an individual. However, IgG testing is only useful as supportive information for the diagnosis of HP; a positive result only indicates sensitization to the antigen and a negative result does not exclude the possibility that a patient with HP may be sensitized to another antigen.