What is hypersensitivity pneumonitis?

Hypersensitivity pneumonitis is an inflammation of the lung (usually of the very small airways) caused by the body's immune reaction to small air-borne particles. These particles can be bacteria, mold, fungi, or even inorganic.

What is acute versus chronic hypersensitivity pneumonitis?

Hypersensitivity pneumonitis can range from acute to chronic.

Acute hypersensitivity pneumonitis tends to occur 4-12 hours after exposure (usually heavy exposure) to the particles. Symptoms include fever, chills, coughing, shortness of breath, body aches, etc. Chest x-rays may show diffuse small nodules. Typically, the symptoms will subside hours to days after exposure (provided there are no repeated exposures). Chest x-ray abnormalities will also disappear.

Chronic hypersensitivity pneumonitis causes lung scarring (fibrosis) and symptoms of shortness of breath and cough. Chronic disease is believed to occur after prolonged low grade exposure to the offending particles.

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 worker's disease from exposure to moldy compost, bagassosis from exposure to moldy sugar cane, and many others. The most common form of hypersensitivity pneumonitis results from exposure to pet birds.

Many patients with episodes of hypersensitivity pneumonitis are probably unrecognized and undiagnosed. Some "viral pneumonias" may actually be hypersensitivity pneumonitis. The history of repeated episodes of typical symptoms hours after exposure to certain environments are important in diagnosis. Blood antibody tests and skin tests against certain offending molds, bacteria or particles are also available. The interpretation of these tests are complicated, and best performed by a doctor experienced in hypersensitivity pneumonitis.

What is the treatment of hypersensitivity pneumonitis?

The most important treatment of hypersensitivity pneumonitis is avoidance of repeated exposures to the offending particles. With early diagnosis and prevention, prognosis is good. Prolonged, repeated exposures can lead to permanent lung damage and scarring, and significant disability.

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