Progress in clinical treatment of extrinsic allergic alveolitis_West China Medical Journal

Authors：

ZHANG Wei ^1,2 ,  LUO Fengming ³

1. Department of General Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of General Medicine, the People’s Hospital of Jianyang City, Jianyang, Sichuan 641500, P. R. China;
3. Department of Respiratory Medicine and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LUO Fengming, Email: 790847157@qq.com

Keywords：

Extrinsic allergic alveolitis; Clinical treatment; Progress

DOI：

10.7507/1002-0179.201812155

Video：

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Abstract Full text Figures/Tables Video References Cited by

Extrinsic allergic alveolitis is a general term for type Ⅲ or Ⅳ allergic pneumonia caused by repeated inhalation of various antigenic organic dusts and low molecular weight chemicals in susceptible people. The lesions involve alveolar, pulmonary interstitial, and airway. The main clinical manifestations are cough, expectoration, and dyspnea. Clinically, extrinsic allergic alveolitis is classified into acute, subacute, and chronic forms. Extrinsic allergic alveolitis has a great impact on the pulmonary function of patients. Timely treatment will improve clinical symptoms and inhibit the development of disease. The current treatment plan is mainly avoiding exposure to antigen, glucocorticoid therapy, immunosuppressive therapy, anti-fibrotic therapy, and lung transplantation.

Citation： ZHANG Wei, LUO Fengming. Progress in clinical treatment of extrinsic allergic alveolitis. West China Medical Journal, 2019, 34(1): 82-85. doi: 10.7507/1002-0179.201812155 Copy

1.	Zacharisen MC, Fink JN. Hypersensitivity pneumonitis and related conditions in the work Environment. Immunol Allergy Clin North Am, 2011, 31(4): 769-786.
2.	Selman M, Pardo A, King TE Jr. Hypersensitivity pneumonitis insights in diagnosis and pathobiology. Am J Respir Crit Care Med, 2012, 186(4): 314-324.
3.	Lacasse Y, Selman M, Costabel U, et al. Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med, 2003, 168(8): 952-958.
4.	Selman M, Buendía-Roldán I. Immunopathology, diagnosis and management of hypersensitivity pneumonitis. Semin Respir Crit Care Med, 2012, 33(5): 543-554.
5.	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(1): 44-55.
6.	Allen DH, Basten A, Williams GV, et al. Familial hypersensitivity pneumonitis. Am J Med, 1975, 59(4): 505-514.
7.	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(7): 1528-1533.
8.	Hill MR, Briggs L, Montaño MM, et al. Promoter variants in tissue inhibitor of metalloproteinase-3 (TIMP-3) protect against susceptibility in pigeon breeders’ disease. Thorax, 2004, 59(7): 586-590.
9.	Diaz de Leon A, Cronkhite JT, Katzenstein AL, et al. Telomere lengths, pulmonary fibrosis and telomerase (TERT) mutations. PLoS One, 2010, 5(5): e10680.
10.	Oshimo S, Bonella F, Guzman J, et al. Hypersensitivity pneumonitis. Immunol Allergy Clin North Am, 2012, 32(4): 537-556.
11.	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(6): 604-610.
12.	Churg A, Muller NL, Flint J, et al. Chronic hypersensitivity pneumonitis. Am J surg pathol, 2006, 30(2): 201-208.
13.	Motz GT, Eppert BL, Sun G, et al. Persistence of lung CD8 T cell oligoclonal expansions upon smoking cessation in a mouse model of cigarette smoke-induced emphysema. J Immunol, 2008, 181(11): 8036-8043.
14.	Spagnolo P, Rossi G, Cavazza A, et al. Hypersensitivity pneumonitis: a comprehensive review. J Investig Allergol Clin Immunol, 2015, 25(4): 237-250.
15.	Ishikawa R, Kamiya H, Ikushima S, et al. A patient with acute hypersensitivity pneumonitis with a diagnosis of air-conditioner lung, who responded to therapy. Nihon Kokyuki Gakkai Zasshi, 2010, 48(2): 134-139.
16.	Riario Sforza GG, Marino A. Hypersensitivity pneumonitis: a complex lung disease. Clin Mol Allergy, 2017, 15: 6.
17.	Selman M. Hypersensitivity pneumonitis//Schwarz M, King jr TE. Interstitial lung disease. 5th ed. Shelton, CT: People’s Medical Publishing House USA, 2011: 597-625.
18.	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(1): 3-5.
19.	Burge PS, Moore VC, Burge CB, et al. Can serial PEF measurements separate occupational asthma from allergic alveolitis?. Occup Med (Lond), 2015, 65(3): 251-255.
20.	Wuyts W, Sterclova M, Vasakova M. Pitfalls in diagnosis and management of hypersensitivity pneumonitis. Curr Opin Pulm Med, 2015, 21(5): 490-498.
21.	Keir GJ, Maher TM, Ming D, et al. Rituximab in severe, treatment-refractory interstitial lung disease. Respirology, 2014, 19(3): 353-359.
22.	Lota HK, Keir GJ, Hansell DM, et al. Novel use of rituximab in hypersensitivity pneumonitis refractory to conventional treatment. Thorax, 2013, 68(8): 780-781.
23.	Lioté H, Lioté F, Séroussi B, et al. Rituximab-induced lung disease: a systematic literature review. Eur Respir J, 2010, 35(3): 681-687.
24.	Morisset J, Johannson KA, Vittinghoff E, et al. Use of mycophenolate mofetil or azathioprine for the management of chronic hypersensitivity pneumonitis. Chest, 2017, 151(3): 619-625.
25.	Idiopathic Pulmonary Fibrosis Clinical Research Network, Raghu G, Anstrom KJ, et al. Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med, 2012, 366(21): 1968-1977.
26.	Pérez-Padilla R, Salas J, Chapela R, et al. Mortality in mexican patients with chronic pigeon breeder’s lung compared with those with usual interstitial pneumonia. Am Rev Respir Dis, 1993, 148(1): 49-53.
27.	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(6): 690-699.
28.	Miyazaki Y, Tsutsui T, Inase N. Treatment and monitoring of hypersensitivity pneumonitis. Expert Rev Clin Immunol, 2016, 12(9): 953-962.
29.	Kern RM, Singer JP, Koth L, et al. Lung transplantation for hypersensitivity pneumonitis. Chest, 2015, 147(6): 1558-1565.
30.	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(5): 1644-1651.

1. Zacharisen MC, Fink JN. Hypersensitivity pneumonitis and related conditions in the work Environment. Immunol Allergy Clin North Am, 2011, 31(4): 769-786.
2. Selman M, Pardo A, King TE Jr. Hypersensitivity pneumonitis insights in diagnosis and pathobiology. Am J Respir Crit Care Med, 2012, 186(4): 314-324.
3. Lacasse Y, Selman M, Costabel U, et al. Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med, 2003, 168(8): 952-958.
4. Selman M, Buendía-Roldán I. Immunopathology, diagnosis and management of hypersensitivity pneumonitis. Semin Respir Crit Care Med, 2012, 33(5): 543-554.
5. 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(1): 44-55.
6. Allen DH, Basten A, Williams GV, et al. Familial hypersensitivity pneumonitis. Am J Med, 1975, 59(4): 505-514.
7. 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(7): 1528-1533.
8. Hill MR, Briggs L, Montaño MM, et al. Promoter variants in tissue inhibitor of metalloproteinase-3 (TIMP-3) protect against susceptibility in pigeon breeders’ disease. Thorax, 2004, 59(7): 586-590.
9. Diaz de Leon A, Cronkhite JT, Katzenstein AL, et al. Telomere lengths, pulmonary fibrosis and telomerase (TERT) mutations. PLoS One, 2010, 5(5): e10680.
10. Oshimo S, Bonella F, Guzman J, et al. Hypersensitivity pneumonitis. Immunol Allergy Clin North Am, 2012, 32(4): 537-556.
11. 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(6): 604-610.
12. Churg A, Muller NL, Flint J, et al. Chronic hypersensitivity pneumonitis. Am J surg pathol, 2006, 30(2): 201-208.
13. Motz GT, Eppert BL, Sun G, et al. Persistence of lung CD8 T cell oligoclonal expansions upon smoking cessation in a mouse model of cigarette smoke-induced emphysema. J Immunol, 2008, 181(11): 8036-8043.
14. Spagnolo P, Rossi G, Cavazza A, et al. Hypersensitivity pneumonitis: a comprehensive review. J Investig Allergol Clin Immunol, 2015, 25(4): 237-250.
15. Ishikawa R, Kamiya H, Ikushima S, et al. A patient with acute hypersensitivity pneumonitis with a diagnosis of air-conditioner lung, who responded to therapy. Nihon Kokyuki Gakkai Zasshi, 2010, 48(2): 134-139.
16. Riario Sforza GG, Marino A. Hypersensitivity pneumonitis: a complex lung disease. Clin Mol Allergy, 2017, 15: 6.
17. Selman M. Hypersensitivity pneumonitis//Schwarz M, King jr TE. Interstitial lung disease. 5th ed. Shelton, CT: People’s Medical Publishing House USA, 2011: 597-625.
18. 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(1): 3-5.
19. Burge PS, Moore VC, Burge CB, et al. Can serial PEF measurements separate occupational asthma from allergic alveolitis?. Occup Med (Lond), 2015, 65(3): 251-255.
20. Wuyts W, Sterclova M, Vasakova M. Pitfalls in diagnosis and management of hypersensitivity pneumonitis. Curr Opin Pulm Med, 2015, 21(5): 490-498.
21. Keir GJ, Maher TM, Ming D, et al. Rituximab in severe, treatment-refractory interstitial lung disease. Respirology, 2014, 19(3): 353-359.
22. Lota HK, Keir GJ, Hansell DM, et al. Novel use of rituximab in hypersensitivity pneumonitis refractory to conventional treatment. Thorax, 2013, 68(8): 780-781.
23. Lioté H, Lioté F, Séroussi B, et al. Rituximab-induced lung disease: a systematic literature review. Eur Respir J, 2010, 35(3): 681-687.
24. Morisset J, Johannson KA, Vittinghoff E, et al. Use of mycophenolate mofetil or azathioprine for the management of chronic hypersensitivity pneumonitis. Chest, 2017, 151(3): 619-625.
25. Idiopathic Pulmonary Fibrosis Clinical Research Network, Raghu G, Anstrom KJ, et al. Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med, 2012, 366(21): 1968-1977.
26. Pérez-Padilla R, Salas J, Chapela R, et al. Mortality in mexican patients with chronic pigeon breeder’s lung compared with those with usual interstitial pneumonia. Am Rev Respir Dis, 1993, 148(1): 49-53.
27. 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(6): 690-699.
28. Miyazaki Y, Tsutsui T, Inase N. Treatment and monitoring of hypersensitivity pneumonitis. Expert Rev Clin Immunol, 2016, 12(9): 953-962.
29. Kern RM, Singer JP, Koth L, et al. Lung transplantation for hypersensitivity pneumonitis. Chest, 2015, 147(6): 1558-1565.
30. 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(5): 1644-1651.

West China Medical Journal

Progress in clinical treatment of extrinsic allergic alveolitis

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