Hypersensitivity Pneumonitis

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Hypersensitivity pneumonitis
Last updated: Wednesday, August 17, 2011

BACKGROUND

Pneumonitis is a accepted appellation for deepening of lung tissue.

Hypersensitivity pneumonitis (also alleged allergic alveolitis) is an deepening in the lungs acquired by acknowledgment to an allergen, usually amoebic dust (like bane spores from aged hay or bird droppings). Since these allergens are accepted in assertive curve of plan (farming, for example), hypersensitivity pneumonitis is usually advised an anatomic disease.

When a getting inhales such allergens the aboriginal time, no affection appear. Afterwards again acknowledgment to the allergen, the allowed arrangement of an allergic getting becomes sensitized. Once sensitized, the allowed arrangement can bound ascertain the allergen if it enters the physique and aftermath antibodies alleged immunoglobulin E (IgE) to action off the allergen. These antibodies activate the absolution of actinic mediators, which could could could could cause abhorrence symptoms, such as hives, rash, bathetic eyes and aqueous nose.

Acute hypersensitivity pneumonitis may action in sensitized individuals four to six hours afterwards acknowledgment to the allergen. The alveoli (tiny air sacs in the lung) become inflamed, and their walls ample up with white claret cells. In some cases, the sacs will ample with fluid. Abiding affliction may advance afterwards accepted acknowledgment of top concentrations of the allergen. If the ache is abiding and recurs as a aftereffect of connected allergen exposure, locations of the lung may advance coarse blister tissue (also accepted as pulmonary fibrosis) and may no best action normally. At this point, the accident is usually irreversible.

The prevalence of hypersensitivity pneumonitis depends on the region, altitude and agriculture practices. In the United States, it was estimated in 2003 that the ache affects 0.4-7% of the agriculture population. In the United Kingdom, it was estimated in 2003 there are amid 420-3,000 cases of farmer’s lung per 100,000 humans at accident anniversary year. In France, there are about 4,370 cases per 100,000 at accident anniversary year. In Finland, there are a arise 1,400-1,700 cases per 100,000 humans at accident anniversary year.

CAUSES

Hypersensitivity pneumonitis occurs afterwards acknowledgment to inhaled allergens, such as dust, beastly dander, cast spores or plants.

Hypersensitivity pneumonitis is about advised an anatomic affliction and has different names that reflect the associated occupation. Added than 300 etiologies of hypersensitivity pneumonitis accept been arise from a advanced ambit of aerial antigens. Examples include: farmer’s lung (due to thermophilic actinomycetes and added pathogens), winemaker’s lung (due to Botrytis cinerea), coffee-worker’s lung (due to coffee-bean dust), lifeguard lung (due to aerosolized endotoxin), bird-fancier’s lung (due to aerial antigens), laboratory-worker’s lung (due to rodent antigens), miller’s lung (due to aureate weevil), woodworker’s lung (due to Penicillium chrysogenum), detergent-worker’s lung (due to Bacillus subtilis) and epoxy-resin lung (due to phthalic anhydride).

Farmer’s lung is the a lot of accepted anatomy of hypersensitivity pneumonitis. It is acquired by thermophilic actinomycetes and added bacilli that abound on hay, straw, grains and added amoebic abstracts begin on farms.

The a lot of accepted blazon of hypersensitivity pneumonitis a part of accouchement is alleged bird-fancier’s lung. This ache is usually acquired by allergens (avian or beastly proteins) associated with small, bound birds that are kept as calm pets.

The summer anatomy of the ache is about begin in Japan, breadth the action is attributed to the advance of cast in earlier board homes during the hot, boiling summer months if spores are released. This anatomy clears up by mid autumn and recurs the afterward year in astute individuals who are always apparent to the cast corpuscle allergens.

There is no affirmation that cigarette smoker causes hypersensitivity pneumonitis. However, smoker cigarettes may aggravate the affection of a getting who has the disease. Tobacco smoke briefly paralyzes the cilia (small hairs) the band the bronchial tubes. The cilia are advised to clarify irritants out of the airways. However, if the cilia are paralyzed, irritants abide in the bronchial tubes and access the alveoli, anarchic the tissue and breaking down the adaptable fibers.

SYMPTOMS

Symptoms alter from balmy to severe. Astute affection may endure up to three weeks, and affection about cover conciseness of breath, cough, afire awareness in the chest, malaise, chills and fever. The affection may abide for as little as 12 hours or as continued as 10 days. Amid attacks, the getting may acquaintance no symptoms.

Chronic hypersensitivity pneumonitis lasts best than three weeks. Afterwards again acknowledgment to an allergen, a abiding ahem may advance with boundless sputum, which about contains pus. The accommodating may aswell advance a abiding conciseness of breath, decreased appetence and weight loss. Clubbing (enlarged fingers and toes) is apparent in about 50% of patients with abiding hypersensitivity pneumonitis. Tachypnea (rapid breathing), respiratory ache and rales (crackling complete in the chest, as a aftereffect from aqueous in the alveoli) may occur.

Chronic hypersensitivity pneumonitis may advance to pulmonary fibrosis (scarring of the lung tissue), which is usually irreversible.

INCREASED RISK

Most individuals who accept hypersensitivity pneumonitis are apparent to allergens (usually amoebic dusts) in circadian plan or claimed life. The accident is greater if individuals are apparent frequently to top concentrations of the substances.

However, it is estimated that abandoned about 5-20% of individuals apparent to the accepted allergens advance the disease.

DIAGNOSIS

Blood test: A able healthcare provider may accomplish a claret analysis to advice ascertain allergies.

Challenge test: A claiming analysis may be performed beneath able medical administration to affirm a diagnosis. During the test, the abandoned inhales the doubtable allergen in a controlled ambience and the physician looks for symptoms. This blazon of analysis should abandoned be performed by a able healthcare provider because it may abet astringent allergic reactions.

CT-scan: A high-resolution CT-scan of the lungs may be performed to affirm a diagnosis.

History: A abundant history is bare in adjustment to actuate whether the accident of affection may be accompanying to ecology exposure.

Lung biopsy: A lung biopsy may be performed to analyze the action from added lung diseases. If an abandoned tests absolute for the disease, allegation may cover small, ailing formed noncaseating granulomas abreast the respiratory or terminal bronchioles, patchy mononuclear corpuscle aggression (lymphocytes and claret cells) of alveolar walls and ample histiocytes with barmy cytoplasm in the interstitium.

Physical exam: During the concrete exam, rales (crackling complete in the chest acquired by aqueous in the alveoli) may be heard if a healthcare provider listens to the patient’s chest with a stethoscope.

X-ray: A chest X-ray and lung action analysis may appearance furnishings of the ache during astute episodes or during the abiding date of the disease. However, the analysis after-effects may arise accustomed amid episodes if the accommodating shows no symptoms. These analysis after-effects are not specific for hypersensitivity pneumonitis, and absolute after-effects may be due to added causes.

TREATMENT

Antigen avoidance: Individuals should abstain acknowledgment to accepted allergens because the action is reversible, if diagnosed early. A lot of patients balance absolutely afterwards alienated acknowledgment to allergens.

Corticosteroids: Corticosteroids (like prednisone) may advice abatement deepening in the lungs in the short-term. Corticosteroid analysis has helped abate affection badly afterwards one or two months, according to research. However, the aforementioned studies aswell begin that corticosteroids did not action any added account in the abiding if compared to antigen abstention or placebo. While corticosteroids may advice abate symptoms, they cannot cure the disease.

It may yield up to three weeks to absolutely balance from an astute attack. Lung damage, such as pulmonary fibrosis, is abiding and may action even afterwards affection accept subsided.

Most patients who accept farmer’s lung balance with abandoned accessory anatomic abnormalities in the lungs. Abounding farmers advance balmy abiding lung impairment.

Bird fancier’s lung, although not as able-bodied studied, appears to accept a worse cast than farmer’s lung. According to some research, 30% of bird fancier’s lung cases are baleful aural 5 years. The poorer cast may be the aftereffect of acknowledgment to college concentrations of the antigen, as able-bodied as added accepted acknowledgment in the home environment, according to researchers.

INTEGRATIVE THERAPIES

Note

: Currently, there is bereft affirmation accessible on the assurance and capability of commutual therapies for the analysis of hypersensitivity pneumonitis. The commutual therapies listed beneath should be acclimated abandoned beneath the administration of a able healthcare provider, and should not be acclimated in backup of added accurate therapies or antitoxin measures.

Good accurate evidence

:

Bromelain

: Some physicians use bromelain, an agitator acquired from pineapple, to advice abate inflammation. It is sometimes recommended to be taken with turmeric (Curcuma longa), which may enhance the furnishings of bromelain.

Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, besom pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, aureate flour, or associates of the Bromeliaceae

family. Use carefully with a history of bleeding disorders, abdomen ulcers, or heart, liver, or branch disease. Use attention afore dental or surgical procedures or while active or operating machinery. Abstain if abundant or breastfeeding.

Yoga

: Limited beastly abstraction exists for yoga in the analysis of lung diseases, such as bronchitis, aqueous about the lungs (pleural effusion), or airway obstruction. Better-designed analysis is all-important afore any abstracts can be made.

Yoga is about advised to be safe in advantageous individuals if accomplished appropriately. Abstain some astern poses with disc ache of the spine, brittle or atherosclerotic close arteries, accident for claret clots, acutely top or low claret pressure, glaucoma, disengagement of the retina, ear problems, astringent osteoporosis, or cervical spondylitis. Assertive yoga breath techniques should be abhorred in humans with affection or lung disease. Use carefully with a history of certifiable disorders. Yoga techniques are believed to be safe during abundance and breastfeeding if accomplished beneath the advice of able apprenticeship (the accepted Lamaze techniques are based on yogic breathing). However, poses that put burden on the uterus, such as belly twists, should be abhorred in pregnancy.

Unclear or adverse accurate evidence

:

Black seed

: Studies in patients with allergies begin that atramentous berry decreased allergic ache severity, hardly decreased claret triglycerides (levels of fat aural the blood), and hardly added HDL cholesterol. The aftereffect of atramentous berry for allergies is still not bright and added abstraction is required.

Avoid with a accepted allergy/hypersensitivity to atramentous seed, its constituents, atramentous berry oil, or to associates of the Ranunculaceae family. Allergic acquaintance dermatitis has been arise afterwards contemporary use of atramentous berry or the oil from the seed.

Cat’s claw

: Cat’s barb may accept anti-inflammatory effects, which has led to analysis of this assemble for altitude such as allergies. Large, high-quality beastly studies are bare comparing furnishings of cat’s barb abandoned vs. placebo.

Avoid if allergic to cat’s barb or Uncaria plants or plants in the Rubiaceae ancestors such as gardenia, coffee, or quinine. Abstain with a history of altitude affecting the allowed arrangement (such as AIDS, HIV, some types of cancer, assorted sclerosis, tuberculosis, rheumatoid arthritis, lupus). Use carefully with bleeding disorders or a history of stroke, or if demography drugs that may access the accident of bleeding. Discontinue use two weeks afore surgery/dental/diagnostic procedures with bleeding risk, and do not use anon afterwards these procedures. Cat’s barb may be attenuated with added Uncaria species. Reports abide of a potentially toxic, Texan developed plant, Acacia gregii getting commissioned for cat’s claw. Abstain if pregnant, breastfeeding, or aggravating to become pregnant.

Dandelion

: Analysis in class animals suggests that dandelion basis may acquire anti-inflammatory properties. There is a abridgement of well-conducted beastly studies currently accessible in this area.

Avoid if allergic to chamomile, feverfew, honey, yarrow, or any accompanying plants such as aster, daisies, sunflower, chrysanthemum, mugwort, ragweed, or ragwort. Use carefully with diabetes or bleeding disorders, gastroesophageal abatement ache (GERD), branch or alarmist diseases, or a history of achievement or electrolyte disorders. Potassium claret levels should be monitored. Stop use two weeks afore surgery/dental/diagnostic procedures with bleeding accident and do not use anon afterwards these procedures. Abstain if abundant or breastfeeding.

Euphorbia

: Euphorbia balsamifera has been advised in patients with astute dental pulpitis, and may be commensurable to that of pulpal assumption caustics. Added abstraction is all-important to accomplish a advocacy for inflammation.

Avoid if allergic or acute to pollen from Euphorbia fulgens. Use carefully with history of Epstein Barr virus infection or abdomen conditions. Abstain if abundant or breastfeeding.

Eyebright

: Several iridoid glycosides abandoned from eyebright, decidedly aucubin, may acquire anti-inflammatory backdrop commensurable to those of indomethacin (a nonsteroidal anti-inflammatory drug). However, there is currently bereft affirmation to acclaim for or adjoin eyebright as an anti-inflammatory agent.

Avoid with a accepted abhorrence or hypersensitivity to eyebright. Hypersensitivity to associates of the Scrophulariaceae ancestors may advance to a cross-sensitivity reaction. Use carefully as an eye treatment, decidedly bootleg preparations, due to the accident of infection if not sterile. Use carefully with diabetes and drugs that are torn down by the liver. Abstain if abundant or breastfeeding.

Ginseng

: Several studies accept looked at the furnishings of ginseng in a array of lung conditions. Added analysis is needed.

Avoid ginseng if accepted abhorrence to plants in the Araliaceae family. There has been a address of a austere life-threatening derma reaction, possibly acquired by contaminants in ginseng formulations.

Hypnotherapy

: It has been appropriate that hypnotherapy may be able for allergies. However, added analysis is all-important to actuate whether it is an able analysis for this indication.

Use carefully with brainy illnesses (e.g. psychosis, schizophrenia, berserk depression, assorted personality disorder, or dissociative disorders) or access disorders.

Kiwi

: Kiwi (Actinidia deliciosa, Actinidia chinensis) may be benign in lung altitude such as top respiratory infections (including colds). However, accurate abstracts is lacking. Limited accessible abstraction suggests that kiwi, and added fruits top in vitamin C, may accept a careful aftereffect on lung altitude in children, abnormally wheezing. However, appropriately controlled studies are defective at this time on the use of kiwi for blockage of respiratory problems.

Avoid if allergic or acute to kiwi, latex, besom pollen, banana, chestnut, fig, flour, melon, poppy seeds, rye grain, sesame seeds and accompanying substances. Kiwi is about advised safe if taken in amounts by itself begin in foods. Use carefully with anti-platelet drugs like aspirin, cilostazol or clopidogrel. Use carefully with hormone therapies or serotonergic drugs. Abstain if abundant or breastfeeding. The bulk begin in foods appears to be safe in a lot of people.

Lactobacillus acidophilus

: Limited accessible abstraction suggests that the Lactobacillus acidophilus (L. acidophilus) ache L-92 (L-92) may be able for the analysis of Japanese cedar-pollen allergy. Added analysis is bare to affirm these results.

L. acidophilus may be difficult to abide if allergic to dairy articles absolute L. acidophilus. Abstain with history of an abrasion or affliction of the abdominal wall, immune-disease, or affection valve surgery. Abstain with decree drugs, such as corticosteroids, because of the accident of infection. Use carefully with affection murmurs. Antibiotics or booze may abort L. acidophilus. Therefore, it is recommended that L. acidophilus be taken three hours afterwards demography antibiotics or bubbler alcohol. Some individuals may use antacids, such as famotidine (Pepcid©) and esomeprazole (Nexium©), to abatement the bulk of acerbic in the abdomen one hour afore demography L. acidophilus.

L-carnitine

: Currently there is bereft affirmation to abutment the use of carnitine for respiratory distress.

Avoid with accepted abhorrence or hypersensitivity to carnitine. Use carefully with borderline vascular disease, hypertension (high claret pressure), alcohol-induced alarmist cirrhosis, or diabetes. Use carefully in low bearing weight breed and individuals on hemodialysis. Use carefully if demography anticoagulants (blood thinners), beta-blockers, or calcium approach blockers. Abstain if abundant or breastfeeding.

Licorice

: Abounding medical altitude are apparent by inflammation. Because licorice can affect the metabolism of steroids, licorice is sometimes acclimated to advice abatement inflammation. Added abstraction is bare to accomplish a conclusion.

Avoid with a accepted abhorrence to licorice, any basic of licorice, or any affiliate of the Fabaceae (Leguminosae) bulb family. Abstain with congestive affection failure, coronary affection disease, branch or alarmist disease, aqueous retention, top claret pressure, hormonal abnormalities or if demography diuretics. Licorice can could could could could cause abnormally low testosterone levels in men or top prolactin or estrogen levels in women. This may accomplish it difficult to become abundant and may could could could could cause menstrual abnormalities.

Lutein

: Lutein is begin in top levels in foods such as blooming vegetables, egg yolk, kiwi fruit, grapes, orange juice, zucchini, squash, and corn. For some commercially accessible supplements, lutein is extracted from marigold petals.

There is aboriginal affirmation of a role of carotenoids in lung action and severity of respiratory infections. Added analysis is bare to accomplish a conclusion.

Avoid if allergic or acute to lutein or zeaxanthin. Use carefully if at accident for cardiovascular ache or cancer. Abstain if abundant or breastfeeding.

Onion

: Aboriginal analysis shows that contemporary appliance of an alcoholic onion abstract decidedly bargain responses to allergies, such as wheals (hives) and flares. Added analysis is needed.

Avoid if allergic or acute to onion (Allium cepa), its constituents, or associates of the Lilaceae family. Use carefully with hematologic (blood) disorders, diabetes, hypoglycemia (low claret sugar), and hypotension (low claret pressure). Use carefully if demography anticoagulants or antiplatelets (blood thinners). Abstain alleviative doses if abundant or breastfeeding.

Perilla

: Preliminary affirmation suggests some account of perilla abstract for melancholia allergies. Added analytic trials are appropriate afore abstracts can be made.

Avoid if allergic/hypersensitive to perilla or associates of the Lamiaciae/Labiatae family. Use carefully with cancer, low HDL-cholesterol, and allowed disorders. Use carefully if demography NSAIDS or barbiturates. Abstain if abundant or breastfeeding.

Physical therapy

: Lung hyperinflation is a address acclimated by physiotherapists to activate and abolish balance lung secretions, reinflate areas of pulmonary collapse, and advance oxygenation. Added analysis is bare to bigger accept the capability of concrete analysis for pulmonary conditions.

Not all concrete analysis programs are ill-fitted for everyone, and patients should altercate their medical history with their able healthcare professionals afore alpha any treatments. Based on the accessible literature, concrete analysis appears about safe if accomplished by a able concrete therapist; however, complications are possible. Persistent affliction and fractures of alien agent accept been reported. Concrete analysis may access the continuance of affliction or could could could could cause limitation of motion. Affliction and all-overs may action during the rehabilitation of patients with burns. Both morning acerbity and cartilage abrasion accept been arise in the concrete analysis literature, although agent is unclear. Erectile dysfunction has aswell been reported. All therapies during abundance and breastfeeding should be discussed with a accountant obstetrician/gynecologist afore initiation.

Probiotics

: Abandoned a few types and combinations of probiotics accept been advised as a accessible abhorrence treatment. They accept been advised mostly in children, teenagers, and adolescent adults. Added analysis is all-important afore a close cessation can be made.

Probiotics are about advised safe and able-bodied tolerated. Abstain if allergic or acute to probiotics. Use carefully if lactose intolerant.

Thymus extract

: Thymus abstract may abate abhorrence affection due to its abeyant allowed aesthetic effects. Added analytic trials are appropriate afore recommendations can be fabricated involving thymus abstract for this use.

Avoid if allergic or acute to thymus extracts. Use bovine thymus abstract supplements carefully due to abeyant for acknowledgment to the virus that causes “mad cow disease.” Abstain use with an agency displace or added forms of allografts or xenografts. Abstain if accepting immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), basic hypothyroidism, or if demography hormonal therapy. Abstain if abundant or breastfeeding; thymic abstract increases beastly agent action and progression.

Turmeric

: Turmeric is a abiding bulb built-in to India and Indonesia, and it is about acclimated as a aroma in cooking. Class and beastly studies appearance action adjoin deepening for turmeric and its basic curcumin. Reliable beastly analysis is lacking.

Avoid if allergic or acute to turmeric (curcumin), chicken aliment colorings or plants acceptance to the Curcuma or Zingiberaceae (ginger) families. Use carefully with history of bleeding disorders, allowed arrangement deficiencies, alarmist ache or gallstones. Use carefully with blood-thinners (e.g. warfarin). Use carefully if abundant or breastfeeding.

Yerba santa

: Chumash Built-in Americans and added California tribes accept acclimated yerba santa (Eriodictyon californicum) and added accompanying breed (Eriodictyon crassifolium, Eriodictyon trichocalyx) for abounding centuries in the analysis of pulmonary conditions, saliva production, and to stop bleeding of accessory cuts and scrapes. There is aswell analytic history of the use of Eriodictyon extracts in influenza, bacterial pneumonia, asthma, bronchitis, and tuberculosis. However, added abstraction is needed.

Avoid if allergic or acute to Eriodictyon species. Use carefully in children. Abstain if abundant or breastfeeding.

PREVENTION

Avoid acknowledgment to accepted allergens.

Properly dry and abundance acreage articles to abatement the accident of developing hypersensitivity pneumonitis.

Individuals who may be apparent to allergens should plan in aerial areas and use respiratory aegis (masks).

AUTHOR INFORMATION

This advice has been edited and peer-reviewed by contributors to the Natural Standard Analysis Collaboration (www.naturalstandard.com).

  • American Lung Association. Hypersensitivity Pneumonitis. www.lungusa.org. Accessed May 14, 2009.
  • Lung Blight Frontiers. Hypersensitivity Pneumonitis. www.lungcancerfrontiers.org. Accessed May 14, 2009.
  • MedlinePlus. Hypersensitivity pneumonitis. www.nlm.nih.gov. Accessed May 14, 2009.
  • Natural Standard: The Authority on Commutual Medicine. www.naturalstandard.com. Copyright © 2009.
  • University of Pennsylvania Health System. Hypersensitivity Pneumonitis. http://pennhealth.com. Accessed May 14, 2009.

Copyright © 2011 Natural Standard (www.naturalstandard.com)

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