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Mullin ML, Fernandez G, Marinescu DC, Zheng B, Wong AW, Assayag D, Fisher JH, Johannson KA, Khalil N, Kolb M, Manganas H, Marcoux V, Morisset J, Min B, Farrand E, Ryerson CJ. Impact of Antigen Exposure on Outcomes and Treatment Response in Fibrotic Hypersensitivity Pneumonitis. Chest 2023:S0012-3692(23)05933-0. [PMID: 38128609 DOI: 10.1016/j.chest.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with fibrotic hypersensitivity pneumonitis (fHP) are frequently treated with immunosuppression to slow lung function decline; however, the impact of this treatment has not been studied across different types of antigen exposure. RESEARCH QUESTION In patients with fHP, do disease outcomes and response to treatment vary by antigen type?. STUDY DESIGN AND METHODS A multicenter interstitial lung disease database (Canadian Registry for Pulmonary Fibrosis) was used to identify patients with fHP. The causative antigen was categorized as avian, mold, unknown, or other. Treatment was defined as mycophenolate ≥ 1,000 mg/d or azathioprine ≥ 75 mg/d for ≥ 30 days. Statistical analysis included t tests, χ2 tests, and one-way analysis of variance. Unadjusted and adjusted competing risks and Cox proportional hazards models were used to assess survival. RESULTS A total of 344 patients were identified with the following causative antigens: avian (n = 93; 27%), mold (n = 88; 26%), other (n = 15; 4%), and unknown (n = 148; 43%). Patient characteristics and lung function were similar among antigen groups with a mean FVC % predicted of 75 ± 20. The percent of patients treated with immunosuppression was similar between antigens with 58% of patients treated. There was no change in lung function or symptom scores with the initiation of immunosuppression in the full cohort. Immunosuppression was not associated with a change in survival for patients with avian or mold antigen (avian: hazard ratio, 0.41; 95% CI, 0.11-1.59; P = .20; mold: hazard ratio, 1.13; 95% CI, 0.26-4.97; P = .88). For patients with unknown causative antigen, survival was worse when treated with immunosuppression (hazard ratio, 2.65; 95% CI, 1.01-6.92; P = .047). INTERPRETATION Response to immunosuppression varies by antigen type in patients with fHP. Additional studies are needed to test the role of immunosuppression in fHP, and particularly in those with an unknown antigen.
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Affiliation(s)
- Monica L Mullin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gustavo Fernandez
- Luis Razetti School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Daniel-Costin Marinescu
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada; Centre for Lung Health, Vancouver General Hospital, Vancouver, BC, Canada
| | - Boyang Zheng
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Helene Manganas
- Département de Médecine, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Julie Morisset
- Département de Médecine, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Bohyung Min
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erica Farrand
- Department of Medicine, University California San Francisco, San Francisco, CA
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
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Kelly G, Idubor OI, Binney S, Schramm PJ, Mirabelli MC, Hsu J. The Impact of Climate Change on Asthma and Allergic-Immunologic Disease. Curr Allergy Asthma Rep 2023; 23:453-461. [PMID: 37284923 PMCID: PMC10613957 DOI: 10.1007/s11882-023-01093-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW This review discusses climate change-related impacts on asthma and allergic-immunologic disease, relevant US public health efforts, and healthcare professional resources. RECENT FINDINGS Climate change can impact people with asthma and allergic-immunologic disease through various pathways, including increased exposure to asthma triggers (e.g., aeroallergens, ground-level ozone). Climate change-related disasters (e.g., wildfires, floods) disrupting healthcare access can complicate management of any allergic-immunologic disease. Climate change disproportionately affects some communities, which can exacerbate disparities in climate-sensitive diseases like asthma. Public health efforts include implementing a national strategic framework to help communities track, prevent, and respond to climate change-related health threats. Healthcare professionals can use resources or tools to help patients with asthma and allergic-immunologic disease prevent climate change-related health impacts. Climate change can affect people with asthma and allergic-immunologic disease and exacerbate health disparities. Resources and tools are available to help prevent climate change-related health impacts at the community and individual level.
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Affiliation(s)
- Grace Kelly
- Epidemiology Elective Program, National Center for STLT Public Health Infrastructure and Workforce, and Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Osatohamwen I Idubor
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
| | - Sophie Binney
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Paul J Schramm
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Maria C Mirabelli
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
| | - Joy Hsu
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA.
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Barnes H, Glaspole I. Occupational Interstitial Lung Diseases. Immunol Allergy Clin North Am 2023; 43:323-339. [PMID: 37055091 DOI: 10.1016/j.iac.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Occupational exposures are directly causal or partially contributory to the development of interstitial lung diseases. A detailed occupational history, relevant high-resolution computed tomography findings, and where relevant additional histopathology, are required to make a diagnosis. Treatment options are limited, and further exposure avoidance is likely to reduce disease progression.
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Yamashita S, Okamoto T, Kawahara T, Tateishi T, Anzai T, Takahashi K, Fushimi K, Miyazaki Y. Database analysis of hypersensitivity pneumonitis in Japan. Respir Investig 2023; 61:172-80. [PMID: 36696702 DOI: 10.1016/j.resinv.2022.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/17/2022] [Accepted: 12/08/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Three epidemiological small-scale studies on hypersensitivity pneumonitis (HP) have been performed in Japan to date. Herein, we aimed to clarify the clinical characteristics of various types of HP diseases using a large nationwide database in Japan. METHODS We used the Japanese Diagnostic Procedure Combination database that includes data from 1,031 participant hospitals. Patients with HP from 2011 to 2017 were identified using International Classification of Diseases 10th Revision codes. We analyzed patient characteristics, the yearly transition of the number of HP cases, rate per one million hospitalizations, geographical distribution, seasonality, and risk factors for in-hospital mortality. RESULTS In total, 3,634 patients with HP were identified, including summer-type HP (SHP) (n = 490), bird fancier's lung (BFL) (n = 199), ventilation pneumonitis (n = 106), farmer's lung (n = 48), and unspecified HP (n = 2761). The length of hospital stay was significantly longer in patients with BFL (19 days) than in patients with SHP (15 days). SHP was more prevalent in the southwestern region of Japan, and hospitalization occurred mainly in summer (37.8%) and fall (37.3%). Ventilation pneumonitis was predominant in winter (28.6%) and spring (38.7%). In-hospital mortality was significantly associated with old age (p < 0.001), low body mass index (p = 0.016), severe dyspnea (p < 0.001), and BFL diagnosis on admission (p = 0.031). CONCLUSIONS This study revealed the clinical characteristics of SHP and BFL, including the frequency of causative antigens, geographical distribution, seasonality, and risk factors for mortality, which may help in diagnosing HP and identifying causative antigens.
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Huang YC, Gu JP. Impact of diagnostic guidelines on the diagnosis of hypersensitivity pneumonitis. Front Med (Lausanne) 2023; 10:1109525. [PMID: 36936212 PMCID: PMC10020512 DOI: 10.3389/fmed.2023.1109525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease from exposure to environmental antigens. Diagnosing HP could be challenging. The American College of Chest Physicians (CHEST) and American Thoracic Society/Japanese Respiratory Society/and Asociación Latinoamericana del Tórax (ATS/JRS/ALAT) have published diagnostic guidelines in 2021 and 2020 respectively. The CHEST guideline uses four grades of confidence: confident (>90%), provisional high (70-89%), provisional low (51-69%), and unlikely (≤50%). The ATS/JRS/ALAT guideline uses five grades of confidence: definite (>90%), high (80-89%), moderate (70-79%), low (51-69%) and not excluded (≤50%). In this study, we determined how these two guidelines could have affected the diagnosis of HP made before the guidelines. Methods Two hundred and fifty-nine adult patients from a previous cohort with HP (ICD-9:495) made between Jan. 1, 2008, and Dec. 31, 2013, at Duke University Medical Center were included. We simplified the diagnostic confidence into three categories so we could compare the guidelines: high (≥90%), intermediate (51-89%), and low (≤50%). Results There were 156 female and 103 male. Mean age was 58 (range: 20-90). 68.8% of the patients had restrictive defects (FVC < 80% pred) and 48.6% had lung biopsy. The CHEST guideline classified 33.6% of the patients into high, 59.5% into intermediate and 6.9% into low confidence categories. The ATS/JRS/ALAT guideline classified 29.7% of the patients into high, 21.2% into intermediate and 49.0% into low confidence categories (p < 0.0001 vs. CHEST). Cohen's kappa was 0.331. In patients with identifiable inciting agents (IAs) (N = 168), the CHEST guideline classified 32.1% of the patients into high, 64.3% into intermediate and 3.6% into low confidence categories. The ATS/JRS/ALAT guideline classified 29.2% of the patients into high, 20.8% into intermediate, and 50.0% into low confidence categories. Cohen's kappa was 0.314. Discussion In our HP cohort with two-thirds of the patients with restrictive defects, we found the two guidelines had fair agreement in diagnosing HP with or without identifiable IAs. They agreed more when the diagnostic confidence was high. When the diagnostic confidence was lower, however, the ATS/JRS/ALAT guideline was more stringent. Clinicians should be aware of the differences between the two guidelines when evaluating patients suspicious of HP.
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Barnes H, Chambers D, Grainge C, Corte TJ, Bastiampillai S, Frenkel S, Westall G, Collard H, Glaspole I. Clinical utility of a standardized chronic hypersensitivity pneumonitis exposure questionnaire. Respirology 2022; 28:366-372. [PMID: 36336654 DOI: 10.1111/resp.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE Identification of an exposure is integral to the diagnosis, management, and prognostication of chronic hypersensitivity pneumonitis (CHP). Standardized questionnaires may aid in the identification of exposures, however, there currently are no evidence-based patient-validated questionnaires available. Key qualifiers (including duration and frequency) which indicate exposure relevance are also poorly defined. This study assessed the use of a standardized CHP exposure questionnaire in the identification of exposures and diagnostic confidence of CHP. METHODS People with a multi-disciplinary meeting (MDM) diagnosis from five Australian interstitial lung disease (ILD) expert centres who provided informed consent were included. Participants completed a previously developed standardized CHP Exposure Questionnaire. Responses were collected with the participant's MDM data, including diagnosis, diagnostic confidence, and clinician-elicited exposures. RESULTS One hundred thirty participants (IPF = 58, CHP = 24, CTD-ILD = 17, unclassifiable = 19, other = 12) were included. In 33% of CHP participants, a standardized questionnaire elicited an exposure where the clinician did not. 63% of these had provisional low confidence CHP; and an exposure history would have increased the diagnostic confidence in these cases. Using the standardized questionnaire, 96% of CHP participants reporting any exposure, compared with 75% of non-HP ILD participants. CHP participants were 3.5 times more likely (p = 0.004) to report their symptoms improved on avoidance, and 2.3 times more likely (p = 0.018) to report daily frequent exposure, compared with non-HP ILDs. CONCLUSION A standardized questionnaire which elicits exposure characteristics in addition to presence or absence of relevant exposures can increase the diagnostic confidence of CHP and reduce the proportion of antigen-indeterminate CHP.
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Affiliation(s)
- Hayley Barnes
- Central Clinical School Monash University Melbourne Victoria Australia
- Department of Respiratory Medicine The Alfred Hospital Melbourne Victoria Australia
| | - Daniel Chambers
- Queensland Lung Transplant Program The Prince Charles Hospital Brisbane Queensland Australia
- Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Chris Grainge
- Department of Respiratory and Sleep Medicine John Hunter Hospital Newcastle New South Wales Australia
- Faculty of Health and Medicine University of Newcastle Callaghan New South Wales Australia
| | - Tamera J. Corte
- Department of Respiratory Medicine Royal Prince Alfred Hospital Sydney New South Wales Australia
- University of Sydney Sydney New South Wales Australia
| | | | - Simon Frenkel
- Department of Respiratory Medicine Western Hospital Footscray Victoria Australia
| | - Glen Westall
- Central Clinical School Monash University Melbourne Victoria Australia
- Department of Respiratory Medicine The Alfred Hospital Melbourne Victoria Australia
| | - Harold Collard
- Department of Medicine University of California San Francisco California USA
| | - Ian Glaspole
- Central Clinical School Monash University Melbourne Victoria Australia
- Department of Respiratory Medicine The Alfred Hospital Melbourne Victoria Australia
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Patel A, Hasany A, Tarlo SM. Pneumopathie d’hypersensibilité après une exposition professionnelle à un produit adhésif à base de polyuréthane. CMAJ 2022; 194:E1360-4. [PMID: 36220168 DOI: 10.1503/cmaj.220052-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kypreos M, Batra K, Glazer CS, Adams TN. Impact of number and type of identified antigen on transplant-free survival in hypersensitivity pneumonitis. PLoS One 2022; 17:e0273544. [PMID: 36048790 PMCID: PMC9436128 DOI: 10.1371/journal.pone.0273544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Identification of inciting antigen can affect diagnostic confidence, quality of life, and prognosis in patients with HP. It is unknown whether the number and type of antigen affect results of diagnostic testing or prognosis, whether antigen identified by clinical history alone affects prognosis, and whether feather exposure is associated with outcomes similar to those of other antigens. Methods To evaluate whether the number or type of antigen identified by clinical history alone affects clinical outcomes, we evaluated a retrospective cohort of patients with a high or definite probability of HP based on recent guidelines. Results In our retrospective cohort, 136 patients met high or definite probability of HP and were included in the analysis. Median transplant-free survival was better in patients with antigen identified on clinical history alone than patients without identified antigen. Feather exposure was associated with improved TFS compared to patients without antigen identified; there was no difference in TFS between patients with feather exposure and either mold or live bird exposure. Mold antigen was associated with increased risk of fibrotic HP compared to avian antigen. Among patients with identified antigen, the number and type of antigen did not affect TFS. Discussion Our study suggests that clinical history is adequate for providing prognostic information to patients with HP and classifying the diagnostic probability of HP according to recent guidelines. Feather exposure should be considered an inciting antigen in patients with ILD.
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Affiliation(s)
- Margaret Kypreos
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Craig S. Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Traci N. Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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Marinescu D, Raghu G, Remy-jardin M, Travis WD, Adegunsoye A, Beasley MB, Chung JH, Churg A, Cottin V, Egashira R, Fernández Pérez ER, Inoue Y, Johannson KA, Kazerooni EA, Khor YH, Lynch DA, Müller NL, Myers JL, Nicholson AG, Rajan S, Saito-koyama R, Troy L, Walsh SL, Wells AU, Wijsenbeek MS, Wright JL, Ryerson CJ. Integration and Application of Clinical Practice Guidelines for the Diagnosis of Idiopathic Pulmonary Fibrosis and Fibrotic Hypersensitivity Pneumonitis. Chest 2022; 162:614-629. [DOI: 10.1016/j.chest.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
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Lee CT, Feary J, Johannson KA. Environmental and occupational exposures in interstitial lung disease. Curr Opin Pulm Med 2022; 28:414-420. [PMID: 35838370 DOI: 10.1097/mcp.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We highlight recent advances in the understanding of how environmental and occupational exposures increase the risk of developing interstitial lung disease (ILD), and how to evaluate a patient for potential exposures. RECENT FINDINGS A review of emerging literature suggests that environmental and occupational exposures can be directly causal, as in the case of the pneumoconioses and smoking-related ILDs, or one of many contributors to disease, as in the case of idiopathic pulmonary fibrosis (IPF). Regardless of the level of association, exposures are clearly prevalent across all ILD subtypes studied. SUMMARY Inhalational exposures are increasingly recognized as an important component in the development of ILDs, and novel exposure-disease associations continue to be discovered. These exposures represent potential opportunities for further understanding the pathobiology of disease and for the prevention of these often progressive and debilitating disorders. Prospective, comprehensive data collection regarding occupational and environmental exposures are needed in ILD patients to fully elucidate specific antigens and their relationships to disease incidence and outcomes. Systematically collected exposure information will also inform potential interventions to remediate exposures and thus mitigate the course of frequently progressive and fatal diseases.
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Affiliation(s)
- Cathryn T Lee
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Johanna Feary
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kerri A Johannson
- Department of Medicine
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Barnes H, Lu J, Johannson KA. Development of a Knowledge-sharing Website for Hypersensitivity Pneumonitis Exposures. ATS Sch 2022; 3:460-467. [PMID: 36312801 PMCID: PMC9590405 DOI: 10.34197/ats-scholar.2021-0139in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Identification of potential inciting antigens known to be associated with
hypersensitivity pneumonitis (HP) is integral to achieving a confident
diagnosis, its management, and prognostication. A barrier to achieving
diagnostic confidence is that evidence for exposure assessment is not
presented in an easily accessible or useful format. Objective To develop a freely available comprehensive living repository of
contemporaneous exposures associated with HP. Methods Electronic searches were performed through Medline, Embase, and Web of
Science from January 1, 2002, to December 31, 2019, using the following
broad MeSH headings: ([allerg* or
hypersensitiv*], and adj [alveol* or
pneumo*]).mp. Articles were included if they described
adults or children with a diagnosis of HP (as defined by authors) and a
description of the causative exposure. Website development used a structured
query language database and was powered by WordPress. Results HPLung.com is a freely available online searchable repository that lists all
exposures and antigens associated with HP and links to their parent studies.
Eighty-five unique exposures from 447 citations have been included thus far.
The website continues to be updated iteratively. Since its launch in 2019,
HPLung.com has been visited over 4,500 times by users from 75 different
countries. Conclusion HPLung.com is a novel knowledge-sharing tool that addresses barriers of
accessibility, contemporaneity, efficient evidence synthesis, and making the
best use of technological platforms to improve the exposure assessment of
those suspected of HP.
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Penagos-Tabares F, Khiaosa-Ard R, Schmidt M, Pacífico C, Faas J, Jenkins T, Nagl V, Sulyok M, Labuda R, Zebeli Q. Fungal species and mycotoxins in mouldy spots of grass and maize silages in Austria. Mycotoxin Res 2022; 38:117-136. [PMID: 35347677 PMCID: PMC9038934 DOI: 10.1007/s12550-022-00453-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 12/23/2022]
Abstract
Fungi and mycotoxins in silage can have detrimental consequences for both cattle and human health. This pilot study identified, via the routinary direct plating method, the dominant cultivable fungi in mouldy grass silages (GS) (n = 19) and maize silages (MS) (n = 28) from Austria. The profiles of regulated, modified, and emerging mycotoxins together with other fungal metabolites were analysed via LC-(ESI)MS/MS. Penicillium roqueforti, Saccharomyces spp., Geotrichum candidum, Aspergillus fumigatus and Monascus ruber were the most frequent fungal organisms identified. Other species including Mucor circinelloides, Fusarium spp. and Paecilomyces niveus were detected at lower frequencies. The presence of complex mixtures of toxic and potentially toxic compounds was evidenced by high levels and occurrences (≥ 50%) of Penicillium-produced compounds such as mycophenolic acid (MPA), roquefortines (ROCs), andrastins (ANDs) and marcfortine A. Mouldy silages contained toxins commonly produced by genus Fusarium (e.g. zearalenone (ZEN) and trichothecenes), Alternaria (like tenuazonic acid (TeA) and alternariol (AHO)) and Aspergillus (such as sterigmatocystin (STC)). Compared to those in GS, mouldy spots in MS presented significantly higher fungal counts and more diverse toxin profiles, in addition to superior levels of Fusarium spp., Penicillium spp. and total fungal metabolites. Generally, no correlation between mould counts and corresponding metabolites was detected, except for the counts of P. roqueforti, which were positively correlated with Penicillium spp. metabolites in mouldy MS. This study represents a first assessment of the fungal diversity in mouldy silage in Austria and highlights its potential role as a substantial contributor to contamination with complex mycotoxin mixtures in cattle diets.
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Affiliation(s)
- Felipe Penagos-Tabares
- Institute of Animal Nutrition and Functional Plant Compounds, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Vienna, Austria
| | - Ratchaneewan Khiaosa-Ard
- Institute of Animal Nutrition and Functional Plant Compounds, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Vienna, Austria.
| | - Marlene Schmidt
- Institute of Animal Nutrition and Functional Plant Compounds, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Vienna, Austria
| | - Cátia Pacífico
- Institute of Animal Nutrition and Functional Plant Compounds, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Vienna, Austria
| | - Johannes Faas
- BIOMIN Research Center, Technopark 1, 3430, Tulln a.d. Donau, Austria
| | - Timothy Jenkins
- BIOMIN Research Center, Technopark 1, 3430, Tulln a.d. Donau, Austria
| | - Veronika Nagl
- BIOMIN Research Center, Technopark 1, 3430, Tulln a.d. Donau, Austria
| | - Michael Sulyok
- Department IFA-Tulln, University of Natural Resources and Life Sciences (BOKU), Konrad Lorenzstrasse 20, 3430, Tulln, Austria
| | - Roman Labuda
- Institute of Food Safety, Food Technology and Veterinary Public Health, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Vienna, Austria
- Research Platform Bioactive Microbial Metabolites (BiMM), 3430, Tulln a.d. Donau, Austria
| | - Qendrim Zebeli
- Institute of Animal Nutrition and Functional Plant Compounds, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Vienna, Austria
- Department for Farm Animals and Veterinary Public Health, Christian-Doppler-Laboratory for Innovative Gut Health Concepts in Livestock (CDL-LiveGUT), University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Vienna, Austria
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Moua T, Petnak T, Charokopos A, Baqir M, Ryu JH. Challenges in the Diagnosis and Management of Fibrotic Hypersensitivity Pneumonitis: A Practical Review of Current Approaches. J Clin Med 2022; 11:jcm11061473. [PMID: 35329800 PMCID: PMC8955902 DOI: 10.3390/jcm11061473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023] Open
Abstract
Recent advances in fibrotic hypersensitivity pneumonitis include improved diagnostic guidance, systematic assessments of immunosuppressive therapy, and the recent availability of antifibrotic therapy (nintedanib) for those with progressive disease. A standardized approach to diagnosis may lead to better inclusion criteria for future therapeutic protocols and delineation of disease or treatment response predictors for real-world management. This review will highlight current diagnostic and treatment challenges and remaining knowledge gaps or areas of uncertainty, with a practical overview of supporting evidence and its clinical implications. Exposure history, serologic testing for antigen sensitivity, bronchoalveolar lavage lymphocytosis, histopathology, and radiologic findings will be covered in the diagnosis section, with immunosuppression, antifibrotic therapy, lung transplantation, and disease prognosis in the treatment and management section.
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Barnes H, Troy L, Lee CT, Sperling A, Strek M, Glaspole I. Hypersensitivity pneumonitis: Current concepts in pathogenesis, diagnosis, and treatment. Allergy 2022; 77:442-453. [PMID: 34293188 DOI: 10.1111/all.15017] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/21/2021] [Indexed: 12/29/2022]
Abstract
Hypersensitivity pneumonitis is an immune-mediated interstitial lung disease caused by an aberrant response to an inhaled exposure, which results in mostly T cell-mediated inflammation, granuloma formation, and fibrosis in some cases. HP is diagnosed by exposure identification, HRCT findings of ground-glass opacities, centrilobular nodules, and mosaic attenuation, with traction bronchiectasis and honeycombing in fibrotic cases. Additional testing including serum IgG testing for the presence of antigen exposure, bronchoalveolar lavage lymphocytosis, and lung biopsy demonstrating granulomas, inflammation, and fibrosis, increases the diagnostic confidence. Treatment for HP includes avoidance of the implicated exposure, immunosuppression, and anti-fibrotic therapy in select cases. This narrative review presents the recent literature in the understanding of the immunopathological mechanisms, diagnosis, and treatment of HP.
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Affiliation(s)
- Hayley Barnes
- Central Clinical School, Monash University, Melbourne, VIC, Australia.,Alfred Hospital, Melbourne, VIC, Australia
| | - Lauren Troy
- Royal Prince Alfred Hospital, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Cathryn T Lee
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL, USA
| | - Anne Sperling
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL, USA
| | - Mary Strek
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL, USA
| | - Ian Glaspole
- Central Clinical School, Monash University, Melbourne, VIC, Australia.,Alfred Hospital, Melbourne, VIC, Australia
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Barnes H, Jones K, Blanc P. The hidden history of hypersensitivity pneumonitis. Eur Respir J 2021; 59:13993003.00252-2021. [PMID: 34083405 DOI: 10.1183/13993003.00252-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/05/2022]
Abstract
Hypersensitivity pneumonitis (HP) is a relatively new construct, first reported in the early 20th century, despite major aetiologic factors (farming, bird husbandry) being part of human activities for millennia. Initial confirmed HP reports include exposure to farming and forestry (1932) and bird exposure (1965), much more recently in time than is often assumed. Later changes in occupational and living practices have led to HP associated with isocyanates, machine coolants, indoor mould, hot tubs, and other exposures. Evolution in our pathological understanding of interstitial lung disease in general, wider computerised tomography (CT) utilisation, and advances in immunology and genomics have shaped our modern conceptualisation of HP. Examining historical accounts of HP and its causative factors not only considers when the first cases were recognised, but also explores why the disease emerged at specific times and places, and may provide further insights relevant to the mechanisms underlying HP and disease prevention.
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Affiliation(s)
- Hayley Barnes
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, USA .,Central Clinical School, Monash University, Melbourne, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Kirk Jones
- Department of Pathology, University of California San Francisco, San Francisco, USA
| | - Paul Blanc
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, USA.,Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, USA
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Johannson KA, Bellanger AP. Birds of a Feather Precipitate Together. Arch Bronconeumol 2021; 58:S0300-2896(21)00167-8. [PMID: 34154840 DOI: 10.1016/j.arbres.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Kerri A Johannson
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Canada; Calvin, Phoebe and Joan Snyder Institute for Chronic Disease, University of Calgary, Calgary, Canada.
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