Exogen allergische Alveolitis – Eine wichtige Differenzialdiagnose der infiltrativen Lungenerkrankungen

Die exogen allergische Alveolitis (EAA) ist schwer von anderen interstitiellen Lungenerkrankungen (interstitial lung diseases, ILDs) abzugrenzen. Auch die Verlaufsformen lassen sich nicht eindeutig einteilen. Die aktuelle Leitlinie unterstreicht die Erkenntnis, dass radiologische oder histologische Befunde einer Fibrose über den klinischen Verlauf und die Prognose der EAA entscheiden und zudem einen Therapieansatz darstellen [1].

Abstract

Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic disease of the lung parenchyma and terminal bronchioles caused by an allergic reaction to inhaled antigens. The immune response following antigen exposure results in lymphocytic inflammation as well as granuloma formation.

The typical histologic pattern of HP consists of cellular interstitial pneumonia, cellular bronchiolitis, and epithelioid cell granulomas. The additional presence of fibrosis has a significant impact on the course as well as the prognosis of the disease and represents a therapeutic approach. Therefore, a classification into a non-fibrotic and a fibrotic phenotype is proposed.

The diagnosis of HP is made by high-resolution computed tomography (HRCT) of the lung, evaluation of possible antigen exposure, and bronchoscopy with bronchoalveolar lavage and, if necessary, forceps biopsy. If the diagnosis is inconclusive, transbronchial cryobiopsy or surgical lung biopsy may need to follow. A multidisciplinary board is critical in making the diagnosis.

Schlüsselwörter

exogen allergische Alveolitis - interstitielle Lungenerkrankungen - Lungenfibrose

Key words

hypersensitivity pneumonitis - interstitial lung diseases - lung fibrosis

Publication History

Article published online:
20 October 2021

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