|Values are valid only on day of printing.|
Evaluation of patients suspected of having hypersensitivity pneumonitis induced by exposure to Aspergillus fumigatus, Thermoactinomyces vulgaris, or Micropolyspora faeni
Hypersensitivity pneumonitis (HP) is a heterogeneous disease caused by exposure to organic dust antigens, animal proteins, chemicals, medications, or microorganisms (eg, Thermoactinomyces vulgaris, Micropolyspora faeni, Aspergillus fumigatus). The immunopathogenesis of disease is not known; but, several immunologic mechanisms may play a role in producing alveolitis, including cellular immunity mediated by CD4 and CD8 T lymphocytes, immune-complex mediated inflammation, complement activation or activation of alveolar macrophages.(1)
HP is suspected clinically in patients who present with intermittent or progressive pulmonary symptoms and interstitial lung disease. The diagnosis is established by compatible clinical and radiographic findings, pulmonary function tests, and demonstration of specific antibodies to organic antigens known to cause the disease.
Aspergillus fumigatus, IgG ANTIBODIES
<4 years: not established
> or =4 years: < or =102 mg/L
Micropolyspora faeni, IgG ANTIBODIES
0-12 years: < or =4.9 mg/L
13-18 years: < or =9.1 mg/L
>18 years: < or =13.2 mg/L
Thermoactinomyces vulgaris, IgG ANTIBODIES
0-12 years: < or =6.6 mg/L
13-18 years: < or =11.0 mg/L
>18 years: < or =23.9 mg/L
Elevated concentrations of IgG antibodies to Aspergillus fumigatus, Thermoactinomyces vulgaris, or Micropolyspora faeni in patients with signs and symptoms of hypersensitivity pneumonitis may be consistent with disease caused by exposure to 1 or more of these organic antigens.
IgG antibodies to Aspergillus fumigatus, Thermoactinomyces vulgaris, or Micropolyspora faeni may be found in sera from healthy individuals; the presence of these specific antibodies is not sufficient to establish the diagnosis of hypersensitivity pneumonitis (HP).
Elevated concentration of antibodies to Aspergillus fumigatus may be also found in patients with invasive aspergillosis and cavitary lung disease.(2)
The concentrations of antibodies to these antigens may decrease following treatment, although elevated concentrations may persist in treated patients.
1. Fink JN, Zacharisen MC: Chapter 69: Hypersensitivity pneumonitis. In Allergy Principles and Practice. Vol 1. Fifth edition. Edited by E Middleton, Jr., CE Reed, EF Ellis, et al. St. Louis, MO, Mosby Year Book, Inc., 1998
2. Girard M, Lacasse Y, Cormier Y: Hypersensitivity pneumonitis. Allergy 2009;64:322-334
3. Grunes D, Beasley MB: Hypersensitivity pneumonitis: A review and update of histologic findings. J Clin Pathol 2013;66:888-895