Hypersensitivity Pneumonitis Syndrome

Hypersensitivity pneumonitis syndrome occurs in both atopic and nonatopic individuals and may present in several clinical forms depending on the duration, frequency, and intensity of antigen exposure, the antigenicity of the offending agent, and the patient's age and immunologic responsiveness. The majority of cases occur in the occupational and agricultural setting. However, various hobbies and medications are also associated with hypersensitivity pneumonitis. Despite the many antigens recognized to cause hypersensitivity pneumonitis, the clinical, immunologic, and pathophysiologic findings are generally similar.

Hypersensitivity pneumonitis is a syndrome of cough, dyspnea, and fatigue caused by sensitization and subsequent hypersensitivity to environmental (frequently occupational) antigens. majority of cases occur in the occupational and agricultural setting. However, various hobbies and medications are also associated with hypersensitivity pneumonitis. We present a case of mesangiopathic glomerulonephritis with renal failure complicated by a hypersensitivity-type pneumonitis, both of which were responsive to corticosteroids. The most common antigens are thermophilic actinomycetes and avian proteins; the most common diseases are farmer's lung and bird fancier's lung. The diagnosis of hypersensitivity pneumonitis requires a high index of suspicion, because the primary focus of treatment is avoidance of the offending allergen even if the specific allergen is not identified. Based on the length and intensity of exposure and subsequent duration of illness, clinical presentations of HP are categorized as acute, subacute (intermittent), and chronic progressive.

The criteria for the diagnosis of hypersensitivity pneumonitis consists of recognizing the clinical features with supporting exposure history, laboratory, pulmonary function, and radiographic characteristics. Although the occurrence of classic hypersensitivity pneumonitis with glomerulonephritis is rare, there is the possibility of at least some commonality of pathologic mechanisms. Although the occurrence of classic hypersensitivity pneumonitis with glomerulonephritis is rare, there is the possibility of at least some commonality of pathologic mechanisms. Diagnosis is based on a combination of history, physical examination, imaging tests, bronchoalveolar lavage, and biopsy. The differential diagnostic considerations and alternate explanations for this syndrome are presented, as is the possibility that the renal and pulmonary abnormalities in this case represent a single disorder.

Causes of Hypersensitivity Pneumonitis Syndrome

The common causes of Hypersensitivity Pneumonitis Syndrome :

• Grain and flour processors and loaders are exposed to grain that may become colonized with a variety of microorganisms that are easily aerosolized.
• Ventilation workers and those exposed to water-related contamination may be exposed to microorganism-colonized forced-air systems, humidifiers, whirlpools, hot tubs, and spas.
• Unmarried maternal status
• Exposure to other children at home or in daycare
• Organic dusts that contain microorganisms or proteins and chemicals, such as isocyanates, may cause hypersensitivity pneumonitis.

Symptoms of Hypersensitivity Pneumonitis Syndrome

Some are common symptoms of Hypersensitivity Pneumonitis Syndrome :

• Breathlessness, especially with exertion .
• Unintentional weight loss
• Frequent chest and sinus infections with recurring pneumonia or bronchitis.
• The chronic disease that develops with prolonged exposure to the irritant may be characterized by fever, rales, cyanosis, and, possibly, expectoration of blood
• A symptom is a phenomenon that is experienced by an individual. Anxiety, lower back pain, and fatigue are all symptoms.

Treatment of Hypersensitivity Pneumonitis Syndrome

The most importent treatment of Hypersensitivity Pneumonitis Syndrome :

• Once the environmental source of inhaled antigen has been identified, primary therapy is to avoid the inciting agent. Acute forms of disease remit without specific therapy.
• Usually, the degree of illness is mild, although clinical and radiographic findings may appear out of proportion (particularly in infants with C trachomatis infection); most infants do not require diagnostic evaluation or hospitalization.
• The initial dose is continued for 2-4 weeks and then tapered over a 4- to 8-week period while evaluating clinical response, pulmonary function, and radiographic improvement.
• A compounding factor is that patients or their families may find it difficult to families to remove treasured pets, move to a new home, or give up certain income-producing activities.
• In chronic forms of the disease, treatment with glucocorticoids (a type of steroid drugs) can be tried because this may decrease inflammation.

Diagnosis of Hypersensitivity Pneumonitis

The criteria for the diagnosis of hypersensitivity pneumonitis consists of recognizing the clinical features with supporting exposure history, laboratory, pulmonary function, and radiographic characteristics. There is no single confirmatory test for hypersensitivity pneumonitis, not even lung biopsy. This makes the diagnosis challenging. The only essential criteria are exposure, sensitization, and clinical response to organic dust or low-molecular-weight compounds. The clinical presentation follows repeat exposure and can vary from sudden and explosive systemic and respiratory symptoms to an insidious, progressive course of dyspnea, fatigue, and weight loss. Based on these clinical presentations, hypersensitivity pneumonitis has been divided into acute, subacute, and chronic forms

Conclusion: - The diagnosis of hypersensitivity pneumonitis requires a high index of suspicion, because the primary focus of treatment is avoidance of the offending allergen even if the specific allergen is not identified. Efforts are needed to prevent recurrent and progressive disease in individuals already sensitized and prevent potential epidemics in occupational settings. Because the diagnosis is difficult and occupational evaluation complex, a team approach including the collaborative efforts of allergists, pulmonologists, occupational physicians, industrial hygienists, and microbiologists is important.

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