Diagnostik und Therapie der exogen-allergischen Alveolitis

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.

Publication History

Article published online:
03 September 2024

• Literatur

• 1 Sennekamp J, Müller-Wening D, Amthor M. et al. [Guidelines for diagnosing extrinsic allergic alveolitis (hypersensitivity pneumonitis) (German Extrinsic Allergic Alveolitis Study Group)]. Pneumologie 2007; 61: 52-56
• 2 Quirce S, Vandenplas O, Campo P. et al. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy 2016; 71: 765-779
• 3 Raghu G, Remy-Jardin M, Ryerson CJ. et al. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202: e36-e69
• 4 Fernández Pérez ER, Travis WD, Lynch DA. et al. Diagnosis and Evaluation of Hypersensitivity Pneumonitis. Chest 2021; 160: e97-e156
• 5 Kreuter M, Behr J, Bonella F. et al. [Consensus guideline on the interdisciplinary diagnosis of interstitial lung diseases]. Pneumologie 2023; 77: 269-302
• 6 Behr J, Bonella F, Frye BC. et al. Pharmakotherapie der idiopathischen Lungenfibrose (ein Update) und anderer progredienter pulmonaler Fibrosen. Pneumologie 2023; 77: 94-119
• 7 Richerson HB, Bernstein IL, Fink JN. et al. Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the Subcommittee on Hypersensitivity Pneumonitis. J Allergy Clin Immunol 1989; 84: 839-844
• 8 Lacasse Y, Selman M, Costabel U. et al. Classification of hypersensitivity pneumonitis: a hypothesis. Int Arch Allergy Immunol 2009; 149: 161-166
• 9 Boyd G, McSharry CP, Banham SW. et al. A current view of pigeon fancier’s lung. A model for pulmonary extrinsic allergic alveolitis. Clin Allergy 1982; 12 Suppl: 53-59
• 10 Fink JN. Epidemiologic aspects of hypersensitivity pneumonitis. Monogr Allergy 1987; 21: 59-69
• 11 Selman M, Vargas MH. Airway involvement in hypersensitivity pneumonitis. Curr Opin Pulm Med 1998; 4: 9-15
• 12 Girard M, Lacasse Y, Cormier Y. Hypersensitivity pneumonitis. Allergy 2009; 64: 322-334
• 13 Vasakova M, Morell F, Walsh S. et al. Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management. Am J Respir Crit Care Med 2017; 196: 680-689
• 14 Salisbury ML, Myers JL, Belloli EA. et al. Diagnosis and Treatment of Fibrotic Hypersensitivity Pneumonia. Where We Stand and Where We Need to Go. Am J Respir Crit Care Med 2017; 196: 690-699
• 15 Costabel U, Miyazaki Y, Pardo A. et al. Hypersensitivity pneumonitis. Nat Rev Dis Primers 2020; 6: 65
• 16 Müller-Wening D. Klinik der exogen-allergischen Alveolitis. Allergologie 1990; 13: 91-103
• 17 Schuyler M, Cormier Y. The diagnosis of hypersensitivity pneumonitis. Chest 1997; 111: 534-536
• 18 Lacasse Y, Selman M, Costabel U. et al. Clinical Diagnosis of Hypersensitivity Pneumonitis. Am J Respir Crit Care Med 2003; 168: 952-958
• 19 Ohtani Y, Saiki S, Sumi Y. et al. Clinical features of recurrent and insidious chronic bird fancier’s lung. Ann Allergy Asthma Immunol 2003; 90: 604-610
• 20 Sansores R, Salas J, Chapela R. et al. Clubbing in hypersensitivity pneumonitis. Its prevalence and possible prognostic role. Arch Intern Med 1990; 150: 1849-1851
• 21 Erkinjuntti-Pekkanen R, Rytkonen H, Kokkarinen JI. et al. Long-term risk of emphysema in patients with farmer’s lung and matched control farmers. Am J Respir Crit Care Med 1998; 158: 662-665
• 22 Cormier Y, Brown M, Worthy S. et al. High-resolution computed tomographic characteristics in acute farmer’s lung and in its follow-up. Eur Respir J 2000; 16: 56-60
• 23 Bourke SJ, Dalphin JC, Boyd G. et al. Hypersensitivity pneumonitis: current concepts. Eur Respir J Suppl 2001; 32: 81s-92s
• 24 Morell F, Villar A, Montero M-Á. et al. Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study. The Lancet Respiratory Medicine 2013; 1: 685-694
• 25 Griese M, Stehling F, Schwerk N. et al. Hypersensitivity pneumonitis: Lessons from a randomized controlled trial in children. Pediatric Pulmonology 2021; 56: 2627-2633
• 26 Torrent-Vernetta A, Gaboli M, Castillo-Corullón S. et al. Incidence and Prevalence of Children’s Diffuse Lung Disease in Spain. Arch Bronconeumol 2022; 58: 22-29
• 27 Fernández Pérez ER, Kong AM, Raimundo K. et al. Epidemiology of Hypersensitivity Pneumonitis among an Insured Population in the United States: A Claims-based Cohort Analysis. Ann Am Thorac Soc 2018; 15: 460-469
• 28 Solaymani-Dodaran M, West J, Smith C. et al. Extrinsic allergic alveolitis: incidence and mortality in the general population. QJM 2007; 100: 233-237
• 29 Warren CP. Extrinsic allergic alveolitis: a disease commoner in non-smokers. Thorax 1977; 32: 567-569
• 30 Rittig AH, Hilberg O, Ibsen R. et al. Incidence, comorbidity and survival rate of hypersensitivity pneumonitis: a national population-based study. ERJ Open Res 2019; 5: 00259-02018
• 31 Thomeer M, Demedts M, Vandeurzen K. et al. Registration of interstitial lung diseases by 20 centres of respiratory medicine in Flanders. Acta Clin Belg 2001; 56: 163-172
• 32 Singh S, Collins BF, Sharma BB. et al. Interstitial Lung Disease in India. Results of a Prospective Registry. Am J Respir Crit Care Med 2017; 195: 801-813
• 33 Staines FH, Forman JA. A Survey of “Farmer’s Lung”. J Coll Gen Pract 1961; 4: 351-382
• 34 Terho EO, Heinonen OP, Lammi S. et al. Incidence of clinically confirmed farmer’s lung in Finland and its relation to meteorological factors. Eur J Respir Dis Suppl 1987; 152: 47-56
• 35 Dalphin JC, Debieuvre D, Pernet D. et al. Prevalence and risk factors for chronic bronchitis and farmer’s lung in French dairy farmers. Br J Ind Med 1993; 50: 941-944
• 36 Depierre A, Dalphin JC, Pernet D. et al. Epidemiological study of farmer’s lung in five districts of the French Doubs province. Thorax 1988; 43: 429-435
• 37 Ferri F, Ruggieri MP, Guidetti G. et al. [Prevalence of extrinsic allergic alveolitis in cattle breeders from the province of Reggio Emilia]. Med Lav 2003; 94: 380-390
• 38 Gruchow HW, Hoffmann RG, Marx JJ. et al. Precipitating Antibodies to Farmer’s Lung Antigens in a Wisconsin Farming Population. Am Rev Respir Dis 1981; 124: 411-415
• 39 Malmberg P, Rask-Andersen A, Höglund S. et al. Incidence of organic dust toxic syndrome and allergic alveolitis in Swedish farmers. Int Arch Allergy Appl Immunol 1988; 87: 47-54
• 40 Marcer G, Simioni L, Saia B. et al. Study of immunological parameters in farmer’s lung. Clin Allergy 1983; 13: 443-449
• 41 Marx JJ, Guernsey J, Emanuel DA. et al. Cohort studies of immunologic lung disease among Wisconsin dairy farmers. Am J Ind Med 1990; 18: 263-268
• 42 Stanford CF, Hall G, Chivers A. et al. Farmer’s lung in Northern Ireland. Br J Ind Med 1990; 47: 314-316
• 43 Vohlonen I, Tupi K, Terho EO. et al. Prevalence and incidence of chronic bronchitis and farmer’s lung with respect to the geographical location of the farm and to the work of farmers. Eur J Respir Dis Suppl 1987; 152: 37-46
• 44 Hendrick DJ, Faux JA, Marshall R. Budgerigar-fancier’s lung: the commonest variety of allergic alveolitis in Britain. Br Med J 1978; 2: 81-84
• 45 Banham SW, McSharry C, Lynch PP. et al. Relationships between avian exposure, humoral immune response, and pigeon breeders’ disease among Scottish pigeon fanciers. Thorax 1986; 41: 274-278
• 46 Christensen LT, Schmidt CD, Robbins L. Pigeon breeders’ disease – a prevalence study and review. Clin Allergy 1975; 5: 417-430
• 47 Rodríguez de Castro F, Carrillo T, Castillo R. et al. Relationships between characteristics of exposure to pigeon antigens. Clinical manifestations and humoral immune response. Chest 1993; 103: 1059-1063
• 48 Barber CM, Wiggans RE, Carder M. et al. Epidemiology of occupational hypersensitivity pneumonitis; reports from the SWORD scheme in the UK from 1996 to 2015. Occup Environ Med 2017; 74: 528-530
• 49 Rittner C, Sennekamp J, Mollenhauer E. et al. Pigeon breeder’s lung: association with HLA-DR 3. Tissue Antigens 1983; 21: 374-379
• 50 Ando M, Hirayama K, Soda K. et al. HLA-DQw3 in Japanese summer-type hypersensitivity pneumonitis induced by Trichosporon cutaneum. Am Rev Respir Dis 1989; 140: 948-950
• 51 Camarena A, Juárez A, Mejía M. et al. Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder’s disease. Am J Respir Crit Care Med 2001; 163: 1528-1533
• 52 Aquino-Galvez A, Camarena A, Montaño M. et al. Transporter associated with antigen processing (TAP) 1 gene polymorphisms in patients with hypersensitivity pneumonitis. Exp Mol Pathol 2008; 84: 173-177
• 53 Camarena A, Aquino-Galvez A, Falfán-Valencia R. et al. PSMB8 (LMP7) but not PSMB9 (LMP2) gene polymorphisms are associated to pigeon breeder’s hypersensitivity pneumonitis. Respir Med 2010; 104: 889-894
• 54 Falfán-Valencia R, Camarena A, Pineda CL. et al. Genetic susceptibility to multicase hypersensitivity pneumonitis is associated with the TNF-238 GG genotype of the promoter region and HLA-DRB1*04 bearing HLA haplotypes. Respir Med 2014; 108: 211-217
• 55 Newton CA, Batra K, Torrealba J. et al. Telomere-related lung fibrosis is diagnostically heterogeneous but uniformly progressive. Eur Respir J 2016; 48: 1710-1720
• 56 Ley B, Newton CA, Arnould I. et al. The MUC5B promoter polymorphism and telomere length in patients with chronic hypersensitivity pneumonitis: an observational cohort-control study. Lancet Respir Med 2017; 5: 639-647
• 57 Ley B, Torgerson DG, Oldham JM. et al. Rare Protein-Altering Telomere-related Gene Variants in Patients with Chronic Hypersensitivity Pneumonitis. Am J Respir Crit Care Med 2019; 200: 1154-1163
• 58 Furusawa H, Cardwell JH, Okamoto T. et al. Chronic Hypersensitivity Pneumonitis, an Interstitial Lung Disease with Distinct Molecular Signatures. Am J Respir Crit Care Med 2020; 202: 1430-1444
• 59 Abbasi A, Chen C, Gandhi CK. et al. Single Nucleotide Polymorphisms (SNP) and SNP-SNP Interactions of the Surfactant Protein Genes Are Associated With Idiopathic Pulmonary Fibrosis in a Mexican Study Group; Comparison With Hypersensitivity Pneumonitis. Front Immunol 2022; 13: 842745
• 60 Ceviz N, Kaynar H, Olgun H. et al. Pigeon breeder’s lung in childhood: is family screening necessary?. Pediatr Pulmonol 2006; 41: 279-282
• 61 Asai N, Kaneko N, Ohkuni Y. et al. Familial Summer-type Hypersensitivity Pneumonitis: A Review of 25 Families and 50 Cases in Japan. Intern Med 2016; 55: 279-283
• 62 du Marchie Sarvaas GJ, Merkus PJ, de Jongste JC. A family with extrinsic allergic alveolitis caused by wild city pigeons: A case report. Pediatrics 2000; 105: E62
• 63 Bustos ML, Frías S, Ramos S. et al. Local and circulating microchimerism is associated with hypersensitivity pneumonitis. Am J Respir Crit Care Med 2007; 176: 90-95
• 64 Tsutsui T, Miyazaki Y, Kuramochi J. et al. The amount of avian antigen in household dust predicts the prognosis of chronic bird-related hypersensitivity pneumonitis. Ann Am Thorac Soc 2015; 12: 1013-1021
• 65 Gudmundsson G, Monick MM, Hunninghake GW. Viral infection modulates expression of hypersensitivity pneumonitis. J Immunol 1999; 162: 7397-7401
• 66 Cormier Y, Israël-Assayag E. The role of viruses in the pathogenesis of hypersensitivity pneumonitis. Curr Opin Pulm Med 2000; 6: 420-423
• 67 Hoppin JA, Umbach DM, Kullman GJ. et al. Pesticides and other agricultural factors associated with self-reported farmer’s lung among farm residents in the Agricultural Health Study. Occup Environ Med 2007; 64: 334-341
• 68 Yamaguchi E, Itoh A, Furuya K. et al. Release of Tumor Necrosis Factor-α From Human Alveolar Macrophages is Decreased in Smokers. CHEST 1993; 103: 479-483
• 69 Arima K, Ando M, Ito K. et al. Effect of cigarette smoking on prevalence of summer-type hypersensitivity pneumonitis caused by Trichosporon cutaneum. Arch Environ Health 1992; 47: 274-278
• 70 Blanchet M-R, Israël-Assayag E, Cormier Y. Inhibitory effect of nicotine on experimental hypersensitivity pneumonitis in vivo and in vitro. Am J Respir Crit Care Med 2004; 169: 903-909
• 71 Ohtsuka Y, Munakata M, Tanimura K. et al. Smoking Promotes Insidious and Chronic Farmer’s Lung Disease, and Deteriorates the Clinical Outcome. Internal Medicine 1995; 34: 966-971
• 72 Fernández Pérez ER, Swigris JJ, Forssén AV. et al. Identifying an Inciting Antigen Is Associated With Improved Survival in Patients With Chronic Hypersensitivity Pneumonitis. Chest 2013; 144: 1644-1651
• 73 Mooney JJ, Elicker BM, Urbania TH. et al. Radiographic Fibrosis Score Predicts Survival in Hypersensitivity Pneumonitis. CHEST 2013; 144: 586-592
• 74 Dasgupta S, Bhattacharya A, Abhijit RD. et al. Risk factors associated with mortality in hypersensitivity pneumonitis: a meta-analysis. Expert Review of Respiratory Medicine 2022; 16: 801-811
• 75 Selman M, Pardo A, King TE. Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med 2012; 186: 314-324
• 76 Gudmundsson G, Hunninghake GW. Respiratory epithelial cells release interleukin-8 in response to a thermophilic bacteria that causes hypersensitivity pneumonitis. Exp Lung Res 1999; 25: 217-228
• 77 Schuyler M, Gott K, Cherne A. Mediators of hypersensitivity pneumonitis. J Lab Clin Med 2000; 136: 29-38
• 78 Facco M, Trentin L, Nicolardi L. et al. T cells in the lung of patients with hypersensitivity pneumonitis accumulate in a clonal manner. J Leukoc Biol 2004; 75: 798-804
• 79 Girard M, Israël-Assayag E, Cormier Y. Pathogenesis of hypersensitivity pneumonitis. Curr Opin Allergy Clin Immunol 2004; 4: 93-98
• 80 Sánchez-Díez S, Cruz MJ, de Homdedeu M. et al. Immunopathological Mechanisms of Bird-Related Hypersensitivity Pneumonitis. Int J Mol Sci 2023; 24: 2884
• 81 Girard M, Israël-Assayag E, Cormier Y. Impaired function of regulatory T-cells in hypersensitivity pneumonitis. Eur Respir J 2011; 37: 632-639
• 82 Burrell R, Rylander R. A critical review of the role of precipitins in hypersensitivity pneumonitis. Eur J Respir Dis 1981; 62: 332-343
• 83 Pignatti P, Brunetti G, Moretto D. et al. Role of the chemokine receptors CXCR3 and CCR4 in human pulmonary fibrosis. Am J Respir Crit Care Med 2006; 173: 310-317
• 84 Kishi M, Miyazaki Y, Jinta T. et al. Pathogenesis of cBFL in common with IPF? Correlation of IP-10/TARC ratio with histological patterns. Thorax 2008; 63: 810-816
• 85 Barrera L, Mendoza F, Zuñiga J. et al. Functional diversity of T-cell subpopulations in subacute and chronic hypersensitivity pneumonitis. Am J Respir Crit Care Med 2008; 177: 44-55
• 86 Simonian PL, Roark CL, Wehrmann F. et al. Th17-polarized immune response in a murine model of hypersensitivity pneumonitis and lung fibrosis. J Immunol 2009; 182: 657-665
• 87 Jinta T, Miyazaki Y, Kishi M. et al. The pathogenesis of chronic hypersensitivity pneumonitis in common with idiopathic pulmonary fibrosis: expression of apoptotic markers. Am J Clin Pathol 2010; 134: 613-620
• 88 García de Alba C, Buendia-Roldán I, Salgado A. et al. Fibrocytes contribute to inflammation and fibrosis in chronic hypersensitivity pneumonitis through paracrine effects. Am J Respir Crit Care Med 2015; 191: 427-436
• 89 Barnes H, Lu J, Johannson KA. Development of a Knowledge-sharing Website for Hypersensitivity Pneumonitis Exposures. ATS Sch 2022; 3: 460-467
• 90 Partridge SJ, Pepperell JCT, Forrester-Wood C. et al. Pheasant rearer’s lung. Occupational Medicine 2004; 54: 500-503
• 91 Funke M, Fellrath J-M. Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier’s disease. Eur Respir J 2008; 32: 517-521
• 92 Borderías L, Morell F, Vera J. et al. [Starling-induced hypersensitivity pneumonitis: minimal but persistent antigen exposure]. Arch Bronconeumol 2010; 46: 607-609
• 93 Sennekamp H-J. Extrinsic Allergic Alveolitis/Hypersensitivity Pneumonitis. Oberhaching: Dustri-Verlag; 2004
• 94 Meyer FJ, Bauer PC, Costabel U. Feather wreath lung: chasing a dead bird. Eur Respir J 1996; 9: 1323-1324
• 95 Greinert U, Lepp U, Vollmer E. et al. Vogelhalterlunge ohne Vogelhaltung. Pneumologie 2000; 54: 179-183
• 96 Merget R, Sander I, Ewig S. et al. Consort hypersensitivity pneumonitis. Eur Respir J 2009; 33: 1223-1225
• 97 Craig TJ, Hershey J, Engler RJ. et al. Bird antigen persistence in the home environment after removal of the bird. Ann Allergy 1992; 69: 510-512
• 98 Sema M, Miyazaki Y, Tsutsui T. et al. Environmental levels of avian antigen are relevant to the progression of chronic hypersensitivity pneumonitis during antigen avoidance. Immun Inflamm Dis 2018; 6: 154-162
• 99 Koschel D, Wittstruck H, Renck T. et al. Presenting features of feather duvet lung. Int Arch Allergy Immunol 2010; 152: 264-270
• 100 Morell F, Villar A, Ojanguren I. et al. Hypersensitivity Pneumonitis and (Idiopathic) Pulmonary Fibrosis Due to Feather Duvets and Pillows. Arch Bronconeumol (Engl Ed) 2021; 57: 87-93
• 101 Koschel D, Lützkendorf L, Wiedemann B. et al. Antigen-specific IgG antibodies in feather duvet lung. European Journal of Clinical Investigation 2010; 40: 797-802
• 102 Shirai T, Tanino Y, Nikaido T. et al. Utility of budgerigar/pigeon/parrot-specific IgG antibody with ImmunoCAP® in bird-related hypersensitivity pneumonitis caused by other bird species and duvet. Respir Investig 2023; 61: 520-526
• 103 Pepys J, Jenkins PA, Festenstein GN. et al. Farmerʼs lung: thermophilic actinomycetes as a source of “farmerʼs lung hay” antigen. The Lancet 1963; 282: 607-611
• 104 Cano-Jiménez E, Acuña A, Botana MI. et al. Farmer’s Lung Disease. A Review. Arch Bronconeumol 2016; 52: 321-328
• 105 Selman M, Lacasse Y, Pardo A. et al. Hypersensitivity pneumonitis caused by fungi. Proc Am Thorac Soc 2010; 7: 229-236
• 106 Sennekamp J, Joest M, Sander I. et al. [Farmer’s lung antigens in Germany]. Pneumologie 2012; 66: 297-301
• 107 Pestalozzi C. [Febrile group diseases in a carpentry shop caused by inhalation of moisture from air humidifiers contaminated with molds]. Schweiz Med Wochenschr 1959; 89: 710-713
• 108 Banaszak EF, Thiede WH, Fink JN. Hypersensitivity Pneumonitis Due to Contamination of an Air Conditioner. NEJM 1970; 283: 271-276
• 109 Bauer KH, Grimm I, Thiel C. „Befeuchterkrankheit “: Forderung nach Prävention und nach Anerkennung als Berufskrankheit. Prax Klin Pneumol 1985; 100: 105
• 110 Koschel D, Stark W, Karmann F. et al. Extrinsic allergic alveolitis caused by misting fountains. Respir Med 2005; 99: 943-947
• 111 Koschel D, Sennekamp J, Schurz C. et al. Zimmerspringbrunnen-Alveolitis. Pneumologie 2004; 58: 666-669
• 112 Shelton BG, Flanders WD, Morris GK. Mycobacterium sp. as a possible cause of hypersensitivity pneumonitis in machine workers. Emerg Infect Dis 1999; 5: 270-273
• 113 Moore JS, Christensen M, Wilson RW. et al. Mycobacterial contamination of metalworking fluids: involvement of a possible new taxon of rapidly growing mycobacteria. AIHAJ 2000; 61: 205-213
• 114 Centers for Disease Control and Prevention (CDC). Respiratory illness in workers exposed to metalworking fluid contaminated with nontuberculous mycobacteria – Ohio, 2001. MMWR Morb Mortal Wkly Rep 2002; 51: 349-352
• 115 Walters GI, Mokhlis JM, Moore VC. et al. Characteristics of hypersensitivity pneumonitis diagnosed by interstitial and occupational lung disease multi-disciplinary team consensus. Respir Med 2019; 155: 19-25
• 116 Kespohl S, Warfolomeow I, Schneider G. et al. Microbial contamination in water-based metalworking fluid as trigger for occupational hypersensitivity pneumonitis – development of specific IgG tools for a suspected clinical case. ALS 2020; 4: 110-117
• 117 Tillie-Leblond I, Grenouillet F, Reboux G. et al. Hypersensitivity pneumonitis and metalworking fluids contaminated by mycobacteria. Eur Respir J 2011; 37: 640-647
• 118 Kespohl S, Warfolomeow I, Merget R. et al. Hypersensitivity pneumonitis due to metal working fluids: Detection of specific IgG antibodies to microbial antigens. Respiratory Physiology & Neurobiology 2023; 315: 104107
• 119 Embil J, Warren P, Yakrus M. et al. Pulmonary illness associated with exposure to Mycobacterium-avium complex in hot tub water. Hypersensitivity pneumonitis or infection?. Chest 1997; 111: 813-816
• 120 Kahana LM, Kay JM, Yakrus MA. et al. Mycobacterium avium complex infection in an immunocompetent young adult related to hot tub exposure. Chest 1997; 111: 242-245
• 121 Marras TK, Wallace RJ, Koth LL. et al. Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water. Chest 2005; 127: 664-671
• 122 Koschel D, Pietrzyk C, Sennekamp J. et al. [Swimming pool lung – extrinsic allergic alveolitis or mycobacterial disease?]. Pneumologie 2006; 60: 285-289
• 123 Metzger WJ, Patterson R, Fink J. et al. Sauna-takers disease. Hypersensitivity pneumonitis due to contaminated water in a home sauna. JAMA 1976; 236: 2209-2211
• 124 Moreno-Ancillo A, Vicente J, Gomez L. et al. Hypersensitivity pneumonitis related to a covered and heated swimming pool environment. Int Arch Allergy Immunol 1997; 114: 205-206
• 125 González-Mancebo E, Díez Gomez ML, Pulido Z. et al. Swimming-pool pneumonitis. Allergy 2000; 55: 782-783
• 126 Fjällbrant H, Akerstrom M, Svensson E. et al. Hot tub lung: an occupational hazard. European Respiratory Review 2013; 22: 88-90
• 127 Moraga-McHaley SA, Landen M, Krapfl H. et al. Hypersensitivity pneumonitis with Mycobacterium avium complex among spa workers. Int J Occup Environ Health 2013; 19: 55-61
• 128 Koschel D. [Extrinsic allergic alveolitis/hypersensitivity pneumonitis]. Pneumologie 2007; 61: 305-322
• 129 Sennekamp J, Lehmann E, Joest M. Work-related extrinsic allergic alveolitis. ASU International 2015; 50: 38-52
• 130 Johannson KA, Elicker BM, Vittinghoff E. et al. A diagnostic model for chronic hypersensitivity pneumonitis. Thorax 2016; 71: 951-954
• 131 Kypreos M, Batra K, Glazer CS. et al. Impact of number and type of identified antigen on transplant-free survival in hypersensitivity pneumonitis. PLoS One 2022; 17: e0273544
• 132 Johannson KA, Barnes H, Bellanger A-P. et al. Exposure Assessment Tools for Hypersensitivity Pneumonitis. An Official American Thoracic Society Workshop Report. Annals ATS 2020; 17: 1501-1509
• 133 Andersen P, Christensen KM, Jensen BE. et al. Antibodies to pigeon antigens in pigeon breeders. Detection of antibodies by an enzyme-linked immunosorbent assay. Eur J Respir Dis 1982; 63: 113-121
• 134 Barnes H, Morisset J, Molyneaux P. et al. A Systematically Derived Exposure Assessment Instrument for Chronic Hypersensitivity Pneumonitis. Chest 2020; 157: 1506-1512
• 135 Kreuter M, Ochmann U, Koschel D. et al. [DGP Interstitial Lung Disease Patient Questionnaire]. Pneumologie 2018; 72: 446-457
• 136 Seed MJ, Enoch SJ, Agius RM. Chemical determinants of occupational hypersensitivity pneumonitis. Occup Med (Lond) 2015; 65: 673-681
• 137 Raulf M, Buters J, Chapman M. et al. Monitoring of occupational and environmental aeroallergens – EAACI Position Paper. Concerted action of the EAACI IG Occupational Allergy and Aerobiology & Air Pollution. Allergy 2014; 69: 1280-1299
• 138 van Heemst RC, Sander I, Rooyackers J. et al. Hypersensitivity pneumonitis caused by occupational exposure to phytase. Eur Respir J 2009; 33: 1507-1509
• 139 Merget R, Sander I, van Kampen V. et al. Hypersensitivity pneumonitis due to metalworking fluids: how to find the antigens. Adv Exp Med Biol 2013; 788: 335-340
• 140 van Toorenenbergen AW. Between-laboratory quality control of automated analysis of IgG antibodies against Aspergillus fumigatus. Diagn Microbiol Infect Dis 2012; 74: 278-281
• 141 Mundt C, Becker WM, Schlaak M. Farmer’s lung: patients’ IgG2 antibodies specifically recognize Saccharopolyspora rectivirgula proteins and carbohydrate structures. J Allergy Clin Immunol 1996; 98: 441-450
• 142 Sennekamp J, Lehmann E, Joest M. Improved IgG antibody diagnostics of hypersensitivity pneumonitis and pulmonary mycoses by means of newly evaluated serum antibody ranges and frequencies using IgG ImmunoCAP^TM . Allergo J Int 2022; 31: 172-182
• 143 Erkinjuntti-Pekkanen R, Reiman M, Kokkarinen JI. et al. IgG antibodies, chronic bronchitis, and pulmonary function values in farmer’s lung patients and matched controls. Allergy 1999; 54: 1181-1187
• 144 McSharry C, Dye GM, Ismail T. et al. Quantifying serum antibody in bird fanciers’ hypersensitivity pneumonitis. BMC Pulm Med 2006; 6: 16
• 145 Samson MH, Vestergaard JM, Knudsen CS. et al. Serum levels of IgG antibodies against Aspergillus fumigatus and the risk of hypersensitivity pneumonitis and other interstitial lung diseases. Scand J Clin Lab Invest 2021; 81: 451-453
• 146 Kränke B, Woltsche M, Woltsche-Kahr I. et al. IgG-Antikörper gegen EAA-spezifische Umweltantigene. Allergologie 2001; 24: 145-154
• 147 Pronk A, Preller L, Raulf-Heimsoth M. et al. Respiratory symptoms, sensitization, and exposure response relationships in spray painters exposed to isocyanates. Am J Respir Crit Care Med 2007; 176: 1090-1097
• 148 Tan YH, Ngan CC, Huang SW. et al. Specific Serum Immunoglobulin G (IgG) Levels Against Antigens Implicated in Hypersensitivity Pneumonitis in Asymptomatic Individuals. Ann Acad Med Singap 2019; 48: 36-38
• 149 Raulf M, Joest M, Sander I. et al. Update of reference values for IgG antibodies against typical antigens of hypersensitivity pneumonitis. Allergo J Int 2019; 28: 192-203
• 150 Joest M, Wessendorf TE, Sennekamp J. Positive Reaktionen gegen ein breites Spektrum von Antigenen der allergischen Alveolitis im IgG-ImmunoCAP® – klinische Relevanz und Spezifität dieser „IgG-Breitspektrum- Reaktion“. Allergologie 2017; 40: 290-298
• 151 Jenkins AR, Chua A, Chami H. et al. Questionnaires or Serum Immunoglobulin G Testing in the Diagnosis of Hypersensitivity Pneumonitis among Patients with Interstitial Lung Disease. Ann Am Thorac Soc 2021; 18: 130-147
• 152 Lee TH, Wraith DG, Bennett CO. et al. Budgerigar fancier’s lung. The persistence of budgerigar precipitins and the recovery of lung function after cessation of avian exposure. Clin Allergy 1983; 13: 197-202
• 153 Settipane GA, Pudupakkam RK, McGowan JH. Corticosteroid effect on immunoglobulins. J Allergy Clin Immunol 1978; 62: 162-166
• 154 Kawano T, Matsuse H, Obase Y. et al. Hypogammaglobulinemia in Steroid-Dependent Asthmatics Correlates with the Daily Dose of Oral Prednisolone. International Archives of Allergy and Immunology 2002; 128: 240-243
• 155 Carrillo T, Rodriguez de Castro F, Cuevas M. et al. Effect of cigarette smoking on the humoral immune response in pigeon fanciers. Allergy 1991; 46: 241-244
• 156 Holfert J, Wiedemann B, Höffken G. et al. Specific IgG antibodies in chronic hypersensitivity pneumonitis. European Respiratory Journal 2015; 46: PA3821
• 157 McSharry C, Anderson K, Bourke SJ. et al. Takes your breath away – the immunology of allergic alveolitis. Clinical and Experimental Immunology 2002; 128: 3-9
• 158 Fenoglio C-M, Reboux G, Sudre B. et al. Diagnostic value of serum precipitins to mould antigens in active hypersensitivity pneumonitis. Eur Respir J 2007; 29: 706-712
• 159 Cormier Y, Bélanger J, Durand P. Factors influencing the development of serum precipitins to farmer’s lung antigen in Quebec dairy farmers. Thorax 1985; 40: 138-142
• 160 Cormier Y, Létourneau L, Racine G. Significance of precipitins and asymptomatic lymphocytic alveolitis: a 20-yr follow-up. Eur Respir J 2004; 23: 523-525
• 161 Aguilar León DE, Novelo Retana V, Martínez-Cordero E. Anti-avian antibodies and rheumatoid factor in pigeon hypersensitivity pneumonitis. Clinical & Experimental Allergy 2003; 33: 226-232
• 162 Bonella F, Sennekamp J, Joest M. et al. Antinukleare Antikörper bei Patienten mit exogen allergischer Alveolitis (EAA): Untersuchung der klinischen Relevanz in einem Einzelzentrum. Pneumologie 2018; 72: S49-S49
• 163 Biblowitz K, Lee C, Zhu D. et al. Association of antinuclear antibody seropositivity with inhaled environmental exposures in patients with interstitial lung disease. ERJ Open Res 2021; 7: 00254-02021
• 164 Long X, He X, Ohshimo S. et al. Serum YKL-40 as predictor of outcome in hypersensitivity pneumonitis. European Respiratory Journal 2017; 49: 1501924
• 165 Pereira JO, Fernandes V, Alfaro TM. et al. Diagnosis of Fibrotic Hypersensitivity Pneumonitis: Is There a Role for Biomarkers?. Life 2023; 13: 565
• 166 Hapke EJ, Seal RM, Thomas GO. et al. Farmer’s lung. A clinical, radiographic, functional, and serological correlation of acute and chronic stages. Thorax 1968; 23: 451-468
• 167 Hanak V, Golbin JM, Ryu JH. Causes and Presenting Features in 85 Consecutive Patients With Hypersensitivity Pneumonitis. Mayo Clinic Proceedings 2007; 82: 812-816
• 168 Morell F, Roger À, Reyes L. et al. Bird fancier’s lung: a series of 86 patients. Medicine (Baltimore) 2008; 87: 110-130
• 169 Schwaiblmair M, Beinert T, Vogelmeier C. et al. Cardiopulmonary exercise testing following hay exposure challenge in farmer’s lung. Eur Respir J 1997; 10: 2360-2365
• 170 Freedman PM, Ault B. Bronchial hyperreactivity to methacholine in farmers’ lung disease. J Allergy Clin Immunol 1981; 67: 59-63
• 171 Ochmann U, Schulte W, Sennekamp J. et al. Bedeutung des Lungenemphysems bei der chronischen exogen-allergischen Alveolitis. Atemwegs- und Lungenkrankheiten 2014; 37: 229-234
• 172 Lalancette M, Carrier G, Laviolette M. et al. Farmer’s lung. Long-term outcome and lack of predictive value of bronchoalveolar lavage fibrosing factors. Am Rev Respir Dis 1993; 148: 216-221
• 173 Remy-Jardin M, Remy J, Wallaert B. et al. Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage. Radiology 1993; 189: 111-118
• 174 Malinen AP, Erkinjuntti-Pekkanen RA, Partanen PLK. et al. Long-term sequelae of Farmer’s lung disease in HRCT: a 14-year follow-up study of 88 patients and 83 matched control farmers. Eur Radiol 2003; 13: 2212-2221
• 175 Lacasse Y, Cormier Y. Hypersensitivity pneumonitis. Orphanet J Rare Dis 2006; 1: 25
• 176 Hodgson MJ, Parkinson DK, Karpf M. Chest X‐rays in hypersensitivity pneumonitis: A metaanalysis of secular trend. American J Industrial Med 1989; 16: 45-53
• 177 Mönkäre S, Ikonen M, Haahtela T. Radiologic Findings in Farmer’s Lung. Chest 1985; 87: 460-466
• 178 Silver SF, Müller NL, Miller RR. et al. Hypersensitivity pneumonitis: evaluation with CT. Radiology 1989; 173: 441-445
• 179 Martínez de Alegría Alonso A, Bermúdez Naveira A, Uceda Navarro D. et al. Expiratory CT scan: When to do it and how to interpret it. Radiologia 2023; 65: 352-361
• 180 Barnett J, Molyneaux PL, Rawal B. et al. Variable utility of mosaic attenuation to distinguish fibrotic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis. Eur Respir J 2019; 54: 1900531
• 181 Gayá García-Manso I, Arenas-Jiménez J, García-Sevila R. et al. Mosaic attenuation in non-fibrotic areas as a predictor of non-usual interstitial pneumonia pathologic diagnosis. Sci Rep 2022; 12: 7289
• 182 Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image – the 2004 Fleischner lecture. Radiology 2006; 239: 322-338
• 183 Franquet T, Hansell DM, Senbanjo T. et al. Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr 2003; 27: 475-478
• 184 Devaraj A, Milanese G, Sverzellati N. Thoracic computed tomography in the progressive fibrotic phenotype. Current Opinion in Pulmonary Medicine 2021; 27: 350
• 185 Hamer OW, Rehbock B. HRCT der Lunge: systematische Analyse bei interstitiellen Lungenerkrankungen. Berlin: S.l.: Springer; 2024
• 186 Soumagne T, Chardon M-L, Dournes G. et al. Emphysema in active farmer’s lung disease. PLOS ONE 2017; 12: e0178263
• 187 Baqir M, White D, Ryu JH. Emphysematous changes in hypersensitivity pneumonitis: A retrospective analysis of 12 patients. Respiratory Medicine Case Reports 2018; 24: 25-29
• 188 Koschel D, Holfert J, Rolle A. et al. Farmer’s Lung in a Case after Bullectomy. International Archives of Allergy and Immunology 2012; 158: 313-316
• 189 Marinescu D-C, Hague CJ, Muller NL. et al. Integration and Application of Radiologic Patterns From Clinical Practice Guidelines on Idiopathic Pulmonary Fibrosis and Fibrotic Hypersensitivity Pneumonitis. CHEST 2023; 164: 1466-1475
• 190 Salisbury ML, Gross BH, Chughtai A. et al. Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis. European Respiratory Journal 2018; 52
• 191 Alberti ML, Rincon-Alvarez E, Buendia-Roldan I. et al. Hypersensitivity Pneumonitis: Diagnostic and Therapeutic Challenges. Front Med (Lausanne) 2021; 8: 718299
• 192 Seixas E, Ferreira M, Serra P. et al. Criteria for progressive fibrotic hypersensitivity pneumonitis in a Portuguese patient cohort. Afr J Thoracic Crit Care Med 2022; 163-166
• 193 Collard HR, Ryerson CJ, Corte TJ. et al. Acute Exacerbation of Idiopathic Pulmonary Fibrosis. An International Working Group Report. Am J Respir Crit Care Med 2016; 194: 265-275
• 194 Olson AL, Huie TJ, Groshong SD. et al. Acute exacerbations of fibrotic hypersensitivity pneumonitis: a case series. Chest 2008; 134: 844-850
• 195 Miyazaki Y, Tateishi T, Akashi T. et al. Clinical predictors and histologic appearance of acute exacerbations in chronic hypersensitivity pneumonitis. Chest 2008; 134: 1265-1270
• 196 Okuda R, Takemura T, Misumi T. et al. Acute Exacerbation and Proposed Criteria for Progressive Pulmonary Fibrosis in Patients with Fibrotic Hypersensitivity Pneumonitis and Idiopathic Pulmonary Fibrosis. Respiration 2023; 102: 803-812
• 197 Koschel DS, Cardoso C, Wiedemann B. et al. Pulmonary Hypertension in Chronic Hypersensitivity Pneumonitis. Lung 2012; 190: 295-302
• 198 Elnady MA, Elkorashy R, Nabil A. et al. Predictors of pulmonary hypertension in patients with hypersensitivity pneumonitis. BMC Pulm Med 2023; 23: 61
• 199 Oliveira RKF, Pereira CAC, Ramos RP. et al. A haemodynamic study of pulmonary hypertension in chronic hypersensitivity pneumonitis. Eur Respir J 2014; 44: 415-424
• 200 Remy-Jardin M, Ryerson CJ, Schiebler ML. et al. Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society. Eur Respir J 2021; 57: 2004455
• 201 Tateishi T, Johkoh T, Sakai F. et al. High-resolution CT features distinguishing usual interstitial pneumonia pattern in chronic hypersensitivity pneumonitis from those with idiopathic pulmonary fibrosis. Jpn J Radiol 2020; 38: 524-532
• 202 Okabayashi H, Fukuda T, Iwasawa T. et al. The new useful high-resolution computed tomography finding for diagnosing fibrotic hypersensitivity pneumonitis: „hexagonal pattern“: a single-center retrospective study. BMC Pulm Med 2022; 22: 76
• 203 Lynch DA, Newell JD, Logan PM. et al. Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis?. American Journal of Roentgenology 1995; 165: 807-811
• 204 Chung MH, Edinburgh KJ, Webb EM. et al. Mixed infiltrative and obstructive disease on high-resolution CT: differential diagnosis and functional correlates in a consecutive series. J Thorac Imaging 2001; 16: 69-75
• 205 Walkoff L, Dixit AS, Ryu JH. et al. Diffuse Pulmonary Ossification on High-Resolution Computed Tomography in Idiopathic Pulmonary Fibrosis, Systemic Sclerosis-Related Interstitial Lung Disease, and Chronic Hypersensitivity Pneumonitis: A Comparative Study. J Comput Assist Tomogr 2020; 44: 667-672
• 206 Ma R, Li S, Wang Y. et al. High-resolution computed tomography features of asbestosis versus fibrotic hypersensitivity pneumonitis: an observational study. BMC Pulm Med 2022; 22: 207
• 207 Roggli V, Gibbs AR, Attanoos R. et al. Pathology of Asbestosis: An Update of the Diagnostic Criteria Response to a Critique. Archives of Pathology & Laboratory Medicine 2016; 140: 950-952
• 208 Kraus T, Teschler H. Update der AWMF-S2k-Leitlinie „Diagnostik und Begutachtung asbestbedingter Erkrankungen“ – Was gibt es Neues?. Pneumologie 2021; 75: 201-205
• 209 Welker L, Jörres RA, Costabel U. et al. Predictive value of BAL cell differentials in the diagnosis of interstitial lung diseases. Eur Respir J 2004; 24: 1000-1006
• 210 Adams TN, Newton CA, Batra K. et al. Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis. Lung 2018; 196: 617-622
• 211 Adderley N, Humphreys CJ, Barnes H. et al. Bronchoalveolar lavage fluid lymphocytosis in chronic hypersensitivity pneumonitis: a systematic review and meta-analysis. Eur Respir J 2020; 56: 2000206
• 212 Murayama J, Yoshizawa Y, Ohtsuka M. et al. Lung fibrosis in hypersensitivity pneumonitis. Association with CD4+ but not CD8+ cell dominant alveolitis and insidious onset. Chest 1993; 104: 38-43
• 213 Pardo A, Barrios R, Gaxiola M. et al. Increase of lung neutrophils in hypersensitivity pneumonitis is associated with lung fibrosis. Am J Respir Crit Care Med 2000; 161: 1698-1704
• 214 Szturmowicz M, Barańska I, Skoczylas A. et al. Correlation of bronchoalveolar lavage lymphocyte count with the extent of lung fibrosis and with plethysmographic lung volumes in patients with newly recognized hypersensitivity pneumonitis. cejoi 2020; 45: 276-282
• 215 Ohshimo S, Bonella F, Cui A. et al. Significance of bronchoalveolar lavage for the diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2009; 179: 1043-1047
• 216 Patolia S, Tamae Kakazu M, Chami HA. et al. Bronchoalveolar Lavage Lymphocytes in the Diagnosis of Hypersensitivity Pneumonitis among Patients with Interstitial Lung Disease. Ann Am Thorac Soc 2020; 17: 1455-1467
• 217 Bonella F, Costabel U. The perpetual enigma of bronchoalveolar lavage fluid lymphocytosis in chronic hypersensitivity pneumonitis: is it of diagnostic value?. Eur Respir J 2020; 56: 2001534
• 218 Sobiecka M, Szturmowicz M, Lewandowska KB. et al. Bronchoalveolar Lavage Cell Count and Lymphocytosis Are the Important Discriminators between Fibrotic Hypersensitivity Pneumonitis and Idiopathic Pulmonary Fibrosis. Diagnostics 2023; 13: 935
• 219 Fournier E, Tonnel AB, Gosset P. et al. Early neutrophil alveolitis after antigen inhalation in hypersensitivity pneumonitis. Chest 1985; 88: 563-566
• 220 Costabel U, Bross KJ, Marxen J. et al. T-lymphocytosis in bronchoalveolar lavage fluid of hypersensitivity pneumonitis. Changes in profile of T-cell subsets during the course of disease. Chest 1984; 85: 514-522
• 221 Bretagne L, Diatta I-D, Faouzi M. et al. Diagnostic Value of the CD103+CD4+/CD4+ Ratio to Differentiate Sarcoidosis from Other Causes of Lymphocytic Alveolitis. Respiration 2016; 91: 486-496
• 222 Ando M, Konishi K, Yoneda R. et al. Difference in the phenotypes of bronchoalveolar lavage lymphocytes in patients with summer-type hypersensitivity pneumonitis, farmer’s lung, ventilation pneumonitis, and bird fancier’s lung: report of a nationwide epidemiologic study in Japan. J Allergy Clin Immunol 1991; 87: 1002-1009
• 223 Chen X, Yang X, Ren Y. et al. Clinical characteristics of hypersensitivity pneumonitis: non-fibrotic and fibrotic subtypes. Chinese Medical Journal 2023; 136: 2839-2846
• 224 Costabel U, Guzman J. Bronchoalveolar lavage in interstitial lung disease. Current Opinion in Pulmonary Medicine 2001; 7: 255
• 225 Lacasse Y, Fraser RS, Fournier M. et al. Diagnostic accuracy of transbronchial biopsy in acute farmer’s lung disease. Chest 1997; 112: 1459-1465
• 226 Botelho AB, Ferreira RG, Coletta ENAM. et al. Transbronchial biopsy in chronic hypersensitivity pneumonitis. Sarcoidosis Vasc Diffuse Lung Dis 2021; 38: e2021018
• 227 Chami HA, Diaz-Mendoza J, Chua A. et al. Transbronchial Biopsy and Cryobiopsy in the Diagnosis of Hypersensitivity Pneumonitis among Patients with Interstitial Lung Disease. Ann Am Thorac Soc 2021; 18: 148-161
• 228 Troy LK, Grainge C, Corte TJ. et al. Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study. Lancet Respir Med 2020; 8: 171-181
• 229 Morris D, Zamvar V. The efficacy of video-assisted thoracoscopic surgery lung biopsies in patients with interstitial lung disease: a retrospective study of 66 patients. J Cardiothorac Surg 2014; 9: 45
• 230 Sonobe M, Handa T, Tanizawa K. et al. Videothoracoscopy-assisted surgical lung biopsy for interstitial lung diseases. Gen Thorac Cardiovasc Surg 2014; 62: 376-382
• 231 Trahan S, Hanak V, Ryu JH. et al. Role of surgical lung biopsy in separating chronic hypersensitivity pneumonia from usual interstitial pneumonia/idiopathic pulmonary fibrosis: analysis of 31 biopsies from 15 patients. Chest 2008; 134: 126-132
• 232 Theegarten D, Müller HM, Bonella F. et al. Diagnostic approach to interstitial pneumonias in a single centre: report on 88 cases. Diagn Pathol 2012; 7: 160
• 233 Coleman A, Colby TV. Histologic diagnosis of extrinsic allergic alveolitis. Am J Surg Pathol 1988; 12: 514-518
• 234 Amthor M. Histologische Differentialdiagnose der exogen-allergischen Alveolitis (EAA) unter besonderer Berücksichtigung der Bronchiolitis obliterans mit organisierender Pneumonie (BOOP). Allergologie 2003; 26: 310-312
• 235 Cheung OY, Muhm JR, Helmers RA. et al. Surgical pathology of granulomatous interstitial pneumonia. Annals of Diagnostic Pathology 2003; 7: 127-138
• 236 Churg A, Muller NL, Flint J. et al. Chronic hypersensitivity pneumonitis. Am J Surg Pathol 2006; 30: 201-208
• 237 Ohtani Y, Saiki S, Kitaichi M. et al. Chronic bird fancier’s lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias. Thorax 2005; 60: 665-671
• 238 Takemura T, Akashi T, Ohtani Y. et al. Pathology of hypersensitivity pneumonitis. Curr Opin Pulm Med 2008; 14: 440-454
• 239 Akashi T, Takemura T, Ando N. et al. Histopathologic analysis of sixteen autopsy cases of chronic hypersensitivity pneumonitis and comparison with idiopathic pulmonary fibrosis/usual interstitial pneumonia. Am J Clin Pathol 2009; 131: 405-415
• 240 Müller-Wening D. Erfahrungen zur inhalativen Allergenprovokation bei exogen-allergischer Alveolitis. Allergologie 1992; 15: 2-14
• 241 Bergmann KC, Kroidl R, Liebetrau G. et al. [Recommendations of the German Society of Pneumology for inhalational provocation testing in exogenous allergic alveolitis. Exogenous-Allergic Alveolitis Study Group of the German Society of Allergology and clinical Immunology and the German Society of Pneumology]. Pneumologie 1998; 52: 444-446
• 242 Muñoz X, Sánchez-Ortiz M, Torres F. et al. Diagnostic yield of specific inhalation challenge in hypersensitivity pneumonitis. Eur Respir J 2014; 44: 1658-1665
• 243 Ishizuka M, Miyazaki Y, Tateishi T. et al. Validation of inhalation provocation test in chronic bird-related hypersensitivity pneumonitis and new prediction score. Ann Am Thorac Soc 2015; 12: 167-173
• 244 Vogelmeier C, Baur X, König G. et al. [The hay dust exposure test in the diagnosis of farmer’s lung: dust measurements and testing of control probands]. Prax Klin Pneumol 1988; 42: 749-752
• 245 Ramírez-Venegas A, Sansores RH, Pérez-Padilla R. et al. Utility of a provocation test for diagnosis of chronic pigeon Breeder’s disease. Am J Respir Crit Care Med 1998; 158: 862-869
• 246 Ohtani Y, Kojima K, Sumi Y. et al. Inhalation provocation tests in chronic bird fancier’s lung. Chest 2000; 118: 1382-1389
• 247 Masuo M, Miyazaki Y, Suhara K. et al. Factors associated with positive inhalation provocation test results in subjects suspected of having chronic bird-related hypersensitivity pneumonitis. Respiratory Investigation 2016; 54: 454-461
• 248 Vogelmeier C, Baur X, Fruhmann G. et al. Kombinierte asthmatisch-alveolitische Reaktion nach Heustaub-Exposition. Internist 1986; 27: 799-801
• 249 Hendrick DJ, Marshall R, Faux JA. et al. Positive „alveolar“ responses to antigen inhalation provocation tests: their validity and recognition. Thorax 1980; 35: 415-427
• 250 Preisser AM, Koschel D, Merget R. et al. Workplace-related inhalation test – Specific inhalation challenge: S2k Guideline of the German Society for Occupational and Environmental Medicine e. V. (DGAUM), the German Society for Pneumology and Respiratory Medicine e. V. (DGP) and the German Society for Allergology and Clinical Immunology e. V. (DGAKI). Allergol Select 2021; 5: 315-334
• 251 Leblanc P, Bélanger J, Laviolette M. et al. Relationship among antigen contact, alveolitis, and clinical status in farmer’s lung disease. Arch Intern Med 1986; 146: 153-157
• 252 De Sadeleer LJ, Meert C, Yserbyt J. et al. Diagnostic Ability of a Dynamic Multidisciplinary Discussion in Interstitial Lung Diseases: A Retrospective Observational Study of 938 Cases. Chest 2018; 153: 1416-1423
• 253 Gimenez A, Storrer K, Kuranishi L. et al. Change in FVC and survival in chronic fibrotic hypersensitivity pneumonitis. Thorax 2018; 73: 391-392
• 254 Ganier M, Lieberman P, Fink J. et al. Humidifier Lung: An Outbreak in Office Workers. Chest 1980; 77: 183-187
• 255 Hanak V, Kalra S, Aksamit TR. et al. Hot tub lung: Presenting features and clinical course of 21 patients. Respiratory Medicine 2006; 100: 610-615
• 256 Morisset J, Johannson KA, Jones KD. et al. Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis. An International Modified Delphi Survey. Am J Respir Crit Care Med 2018; 197: 1036-1044
• 257 Malmberg P. Health effects of organic dust exposure in dairy farmers. Am J Ind Med 1990; 17: 7-15
• 258 Seifert SA, Von Essen S, Jacobitz K. et al. Organic dust toxic syndrome: a review. J Toxicol Clin Toxicol 2003; 41: 185-193
• 259 Tanaka H, Saikai T, Sugawara H. et al. Workplace-related chronic cough on a mushroom farm. Chest 2002; 122: 1080-1085
• 260 Rylander R, Haglind P, Lundholm M. et al. Humidifier fever and endotoxin exposure. Clinical & Experimental Allergy 1978; 8: 511-516
• 261 Fleming GM, Chester EH, Montenegro HD. Dysfunction of small airways following pulmonary injury due to nitrogen dioxide. Chest 1979; 75: 720-721
• 262 Douglas WW, Hepper NGG, Colby TV. Silo-Filler’s Disease. Mayo Clinic Proceedings 1989; 64: 291-304
• 263 Kreiss K, Gomaa A, Kullman G. et al. Clinical Bronchiolitis Obliterans in Workers at a Microwave-Popcorn Plant. New England Journal of Medicine 2002; 347: 330-338
• 264 Moya C, Taylor AJN, Antó JM. et al. Outbreak of organising pneumonia in textile printing sprayers. The Lancet 1994; 344: 498-502
• 265 Eschenbacher WL, Kreiss K, Lougheed MD. et al. Nylon Flock-Associated Interstitial Lung Disease. Am J Respir Crit Care Med 1999; 159: 2003-2008
• 266 Walsh SLF, Wells AU, Desai SR. et al. Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study. Lancet Respir Med 2016; 4: 557-565
• 267 Popper H, Stacher-Priehse E, Brcic L. et al. Lung fibrosis in autoimmune diseases and hypersensitivity: how to separate these from idiopathic pulmonary fibrosis. Rheumatol Int 2022; 42: 1321-1330
• 268 Mönkäre S. Influence of corticosteroid treatment on the course of farmer’s lung. Eur J Respir Dis 1983; 64: 283-293
• 269 Kokkarinen JI, Tukiainen HO, Terho EO. Effect of Corticosteroid Treatment on the Recovery of Pulmonary Function in Farmer’s Lung. Am Rev Respir Dis 1992; 145: 3-5
• 270 Cormier Y, Desmeules M. Treatment of hypersensitivity pneumonitis (HP): comparison between contact avoidance and corticosteroids. Can Respir J 1994; 1: 223-228
• 271 Kokkarinen JI, Tukiainen HO, Terho EO. Recovery of pulmonary function in farmer’s lung. A five-year follow-up study. Am Rev Respir Dis 1993; 147: 793-796
• 272 Petnak T, Thongprayoon C, Baqir M. et al. Antigen identification and avoidance on outcomes in fibrotic hypersensitivity pneumonitis. Eur Respir J 2022; 60: 2101336
• 273 De Sadeleer LJ, Hermans F, De Dycker E. et al. Impact of BAL lymphocytosis and presence of honeycombing on corticosteroid treatment effect in fibrotic hypersensitivity pneumonitis: a retrospective cohort study. Eur Respir J 2020; 55: 1901983
• 274 De Sadeleer LJ, Hermans F, De Dycker E. et al. Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study. Journal of Clinical Medicine 2019; 8: 14
• 275 Morisset J, Johannson KA, Vittinghoff E. et al. Use of Mycophenolate Mofetil or Azathioprine for the Management of Chronic Hypersensitivity Pneumonitis. CHEST 2017; 151: 619-625
• 276 Adegunsoye A, Oldham JM, Fernández Pérez ER. et al. Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis. ERJ Open Res 2017; 3: 00016-02017
• 277 Keir GJ, Maher TM, Ming D. et al. Rituximab in severe, treatment-refractory interstitial lung disease. Respirology 2014; 19: 353-359
• 278 Ferreira M, Borie R, Crestani B. et al. Efficacy and safety of rituximab in patients with chronic hypersensitivity pneumonitis (cHP): A retrospective, multicentric, observational study. Respir Med 2020; 172: 106146
• 279 Zhang D, Adegunsoye A, Oldham JM. et al. Telomere length and immunosuppression in non-idiopathic pulmonary fibrosis interstitial lung disease. Eur Respir J 2023; 62: 2300441
• 280 Wells AU, Flaherty KR, Brown KK. et al. Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet Respir Med 2020; 8: 453-460
• 281 Flaherty KR, Wells AU, Cottin V. et al. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. NEJM 2019; 381: 1718-1727
• 282 Cottin V, Richeldi L, Rosas I. et al. Nintedanib and immunomodulatory therapies in progressive fibrosing interstitial lung diseases. Respir Res 2021; 22: 84
• 283 Behr J, Prasse A, Kreuter M. et al. Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (RELIEF): a double-blind, randomised, placebo-controlled, phase 2b trial. The Lancet Respiratory Medicine 2021; 9: 476-486
• 284 Pérez ERF, Crooks JL, Lynch DA. et al. Pirfenidone in fibrotic hypersensitivity pneumonitis: a double-blind, randomised clinical trial of efficacy and safety. Thorax 2023; 78: 1097-1104
• 285 Shibata S, Furusawa H, Inase N. Pirfenidone in chronic hypersensitivity pneumonitis: a real-life experience. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 139-142
• 286 Mateos-Toledo H, Mejía-Ávila M, Rodríguez-Barreto Ó. et al. An Open-label Study With Pirfenidone on Chronic Hypersensitivity Pneumonitis. Arch Bronconeumol (Engl Ed) 2020; 56: 163-169
• 287 Kern RM, Singer JP, Koth L. et al. Lung transplantation for hypersensitivity pneumonitis. Chest 2015; 147: 1558-1565
• 288 Koschel D. Prävention der exogen-allergischen Alveolitis. Atemwegs- und Lungenkrankheiten 2008; 34: 182
• 289 Respiratory Health Hazards in Agriculture. Am J Respir Crit Care Med 1998; 158: S1-S76
• 290 Hendrick DJ, Marshall R, Faux JA. et al. Protective value of dust respirators in extrinsic allergic alveolitis: clinical assessment using inhalation provocation tests. Thorax 1981; 36: 917-921
• 291 Müller-Wening D, Repp H. Investigation on the protective value of breathing masks in farmer’s lung using an inhalation provocation test. Chest 1989; 95: 100-105
• 292 Müller-Wening D. Effekte von Atemschutzgeräten bei Atemwegserkrankungen in der Landwirtschaft. Allergo J 2004; 13: 460-466
• 293 Rodríguez Perojo A, Matesanz López C, Rodríguez Maestro G. et al. Use of the FFP2 mask as an effective therapeutic measure in a case of hypersensitivity pneumonitis. Open Respir Arch 2023; 5: 100280
• 294 Nishida T, Kawate E, Ishiguro T. et al. Antigen avoidance and outcome of nonfibrotic and fibrotic hypersensitivity pneumonitis. ERJ Open Res 2022; 8: 00474-02021
• 295 Jacob J, Bartholmai BJ, Rajagopalan S. et al. Automated computer-based CT stratification as a predictor of outcome in hypersensitivity pneumonitis. Eur Radiol 2017; 27: 3635-3646
• 296 Trushenko NV, Suvorova OA, Pershina ES. et al. Predictors of Progression and Mortality in Patients with Chronic Hypersensitivity Pneumonitis: Retrospective Analysis of Registry of Fibrosing Interstitial Lung Diseases. Life 2023; 13: 467
• 297 Hanak V, Golbin JM, Hartman TE. et al. High-Resolution CT Findings of Parenchymal Fibrosis Correlate With Prognosis in Hypersensitivity Pneumonitis*. Chest 2008; 134: 133-138
• 298 Chung JH, Zhan X, Cao M. et al. Presence of Air Trapping and Mosaic Attenuation on Chest Computed Tomography Predicts Survival in Chronic Hypersensitivity Pneumonitis. Ann Am Thorac Soc 2017; 14: 1533-1538
• 299 Lynch DA. CT Phenotypes in Hypersensitivity Pneumonitis. Chest 2019; 155: 655-656
• 300 Ojanguren I, Morell F, Ramón M-A. et al. Long-term outcomes in chronic hypersensitivity pneumonitis. Allergy 2019; 74: 944-952
• 301 Adegunsoye A, Oldham JM, Bellam SK. et al. Computed Tomography Honeycombing Identifies a Progressive Fibrotic Phenotype with Increased Mortality across Diverse Interstitial Lung Diseases. Ann Am Thorac Soc 2019; 16: 580-588
• 302 Salisbury ML, Gu T, Murray S. et al. Hypersensitivity Pneumonitis: Radiologic Phenotypes Are Associated With Distinct Survival Time and Pulmonary Function Trajectory. Chest 2019; 155: 699-711
• 303 Oh JH, Kang J, Song JW. Fibrosis score predicts mortality in patients with fibrotic hypersensitivity pneumonitis. Front Med 2023; 10: 1131070
• 304 Raimundo S, Pimenta AC, Cruz-Martins N. et al. Insights on chronic hypersensitivity pneumonitis’ treatment: Factors associated with a favourable response to azathioprine. Life Sciences 2021; 272: 119274
• 305 Hill M, Petnak T, Moua T. Bronchoalveolar lavage lymphocytosis in hypersensitivity pneumonitis: a retrospective cohort analysis with elimination of incorporation bias. BMC Pulm Med 2022; 22: 49
• 306 Vourlekis JS, Schwarz MI, Cherniack RM. et al. The effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis. Am J Med 2004; 116: 662-668
• 307 Churg A, Sin DD, Everett D. et al. Pathologic patterns and survival in chronic hypersensitivity pneumonitis. Am J Surg Pathol 2009; 33: 1765-1770
• 308 Barros CD, Santos V, Alexandre A. Risk Factors for Acute Exacerbations of Fibrotic Hypersensitivity Pneumonitis – Is Exposure a Trigger That We’re Missing?. ARCHIVOS DE Bronconeumología 2023; 59: 59-60 https://www.archbronconeumol.org/en-risk-factors-for-acute-exacerbations-articulo-S0300289622004902
• 309 Adegunsoye A, Oldham JM, Demchuk C. et al. Predictors of survival in coexistent hypersensitivity pneumonitis with autoimmune features. Respiratory Medicine 2016; 114: 53-60
• 310 Buendía-Roldán I, Santiago-Ruiz L, Pérez-Rubio G. et al. A major genetic determinant of autoimmune diseases is associated with the presence of autoantibodies in hypersensitivity pneumonitis. European Respiratory Journal 2020; 56
• 311 Ohnishi H, Miyamoto S, Kawase S. et al. Seasonal variation of serum KL-6 concentrations is greater in patients with hypersensitivity pneumonitis. BMC Pulmonary Medicine 2014; 14: 129
• 312 Miyazaki Y, Unoura K, Tateishi T. et al. Higher serum CCL17 may be a promising predictor of acute exacerbations in chronic hypersensitivity pneumonitis. Respir Res 2013; 14: 57
• 313 Sánchez-Díez S, Munoz X, Ojanguren I. et al. YKL-40 and KL-6 Levels in Serum and Sputum of Patients Diagnosed With Hypersensitivity Pneumonitis. The Journal of Allergy and Clinical Immunology: In Practice 2022; 10: 2414-2423