Diagnostik und Therapie der exogen-allergischen Alveolitis

Dirk Koschel; Jürgen Behr; Melanie Berger; Francesco Bonella; Okka Hamer; Marcus Joest; Danny Jonigk; Michael Kreuter; Gabriela Leuschner; Dennis Nowak; Monika Raulf; Beate Rehbock; Jens Schreiber; Helmut Sitter; Dirk Theegarten; Ulrich Costabel; Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP) (federführende Fachgesellschaft) und; Deutsche Gesellschaft für Allergologie und klinische Immunologie e. V. (DGAKI); Deutsche Gesellschaft für Pathologie e. V. (DGP); Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin e. V. (DGAUM); Deutsche Röntgengesellschaft e. V. (DRG); Bundesverband Deutscher Pathologen e. V. (BDP)

doi:10.1055/a-2369-8458

Pneumologie 2024; 78(12): 963-1002
DOI: 10.1055/a-2369-8458

Leitlinie

Diagnostik und Therapie der exogen-allergischen Alveolitis

S2k-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. und der Deutschen Gesellschaft für Allergologie und klinische Immunologie e. V.Diagnosis and Treatment of Hypersensitivity PneumonitisS2k Guideline of the German Respiratory Society and the German Society for Allergology and Clinical Immunology

Dirk Koschel

¹Abteilung Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig, Deutschland

²Bereich Pneumologie, Medizinische Klinik 1, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland

³Ostdeutsches Lungenzentrum (ODLZ), Coswig/Dresden, Deutschland

,

Jürgen Behr

⁴Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland

⁵Deutsches Zentrum für Lungenforschung, Gießen, Deutschland

,

Melanie Berger

⁶Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln

⁷Lehrstuhl für Pneumologie, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland

,

Francesco Bonella

⁸Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland

,

Okka Hamer

⁹Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland

¹⁰Abteilung für Radiologie, Lungenfachklinik Donaustauf, Donaustauf, Deutschland

,

Marcus Joest

¹¹Praxis für Pneumologie und Allergologie, Bonn, Deutschland

,

Danny Jonigk

⁵Deutsches Zentrum für Lungenforschung, Gießen, Deutschland

¹²Institut für Pathologie, RWTH Aachen, Universität Aachen, Aachen, Deutschland

,

Michael Kreuter

¹³Lungenzentrum Mainz, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz und Klinik für Pneumologie, ZfT, Universitätsmedizin Mainz, Mainz, Deutschland

,

Gabriela Leuschner

⁴Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland

⁵Deutsches Zentrum für Lungenforschung, Gießen, Deutschland

,

Dennis Nowak

¹⁴Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, München, Deutschland

,

Monika Raulf

¹⁵Abteilung Kompetenz-Zentrum Allergologie/Immunologie, Institut für Prävention und Arbeitsmedizin der DGUV, Institut der Ruhr-Universität Bochum (IPA), Bochum, Deutschland

,

Beate Rehbock

¹⁶Privatpraxis für Diagnostische Radiologie und Begutachtung, Berlin, Deutschland

,

Jens Schreiber

¹⁷Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland

,

Helmut Sitter

¹⁸Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Marburg, Deutschland

,

Dirk Theegarten

¹⁹Institut für Pathologie, Universitätsklinikum Essen, Essen, Deutschland

,

Ulrich Costabel

⁸Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland

,

Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP) (federführende Fachgesellschaft) und, Deutsche Gesellschaft für Allergologie und klinische Immunologie e. V. (DGAKI), Deutsche Gesellschaft für Pathologie e. V. (DGP), Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin e. V. (DGAUM), Deutsche Röntgengesellschaft e. V. (DRG), Bundesverband Deutscher Pathologen e. V. (BDP) › Author Affiliations

Abstract

Zusammenfassung

Die exogen-allergische Alveolitis (EAA) ist eine immunvermittelte interstitielle Lungenerkrankungen (ILD) bei zuvor sensibilisierten Personen, bedingt durch die Inhalation einer Vielzahl von möglichen Antigenen. Die Verlaufsform der akuten EAA wird häufig fehldiagnostiziert, die chronische, insbesondere chronisch-fibrotische Form ist differenzialdiagnostisch oft schwierig von anderen fibrotischen ILDs zu unterscheiden. Die vorliegende Leitlinie zur Diagnostik und Therapie ersetzt die deutschen Empfehlungen zur Diagnostik der EAA von 2007 und ergänzt diese explizit um den Aspekt der chronischen, insbesondere chronisch-fibrotischen Form der EAA sowie erstmals auch um Therapieempfehlungen. Auf Grundlage der aktuellen wissenschaftlichen Evidenz wurden durch eine multidisziplinäre Expertengruppe zu 12 Fragen konsentierte Empfehlungen erstellt, die wichtige zusammenfassende Aussagen zur Diagnosefindung und zu therapeutischen Strategien bei Patienten mit einer EAA enthalten. Andere aktuelle nationale und internationale Leitlinien zur EAA und ILDs wurden berücksichtigt. Ausführliche Hintergrundtexte mit allgemeinen Informationen zur EAA dienen dem vertieften Verständnis und dem Umgang mit den Empfehlungen.

Abstract

Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) in sensitized individuals caused by a large variety of inhaled antigens. The clinical form of acute HP is often misdiagnosed, while the chronic form, especially the chronic fibrotic HP, is difficult to differentiate from other fibrotic ILDs. The present guideline for the diagnosis and treatment of HP replaces the former German recommendations for the diagnosis of HP from 2007 and is amended explicitly by the issue of the chronic fibrotic form, as well as by treatment recommendations for the first time. The evidence was discussed by a multidisciplinary committee of experts. Then, recommendations were formulated for twelve questions on important issues of diagnosis and treatment strategies. Recently published national and international guidelines for ILDs and HP were considered. Detailed background information on HP is useful for a deeper insight into HP and the handling of the guideline.

Full Text

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