Chest
Original ResearchDiffuse Lung DiseaseIdentifying an Inciting Antigen Is Associated With Improved Survival in Patients With Chronic Hypersensitivity Pneumonitis
Section snippets
Materials and Methods
From our longitudinal ILD database, as described previously,1 we identified 142 consecutive adult patients with clinical-radiologic-pathologic chronic HP evaluated in our multidisciplinary ILD and occupational medicine program between January 1, 1982, and January 1, 2008. Data from some of these patients were included in two previously published studies.1, 2 We reviewed the complete medical records of included subjects and abstracted data pertaining to the following: demographics, smoking
Results
Of 142 subjects (mean age, 58 ± 12 years; 67 women), 67 (47%) had an IA, and 75 (53%) had no IA. The most common IAs were avian (n = 24, 41%) or mold (n = 16, 27%). Median follow-up for the cohort was 7.8 years. Table 1 displays the clinical characteristics of subjects stratified on survival. At diagnosis, compared with survivors, subjects who died were older, had lower total lung capacity % and Dlco%, had higher severity of dyspnea, were more likely to have fibrosis on HRCT scan and in
Discussion
We identified 142 subjects with well-defined HP evaluated in our program between 1982 and 2008 and evaluated the effect of identifying an IA on prognosis. The main findings of this study were the following: (1) IAs were identified in only 47% of the cohort; (2) IAs were significantly more likely to be identified among survivors than among subjects who died; (3) avian antigens were the most commonly identified IA; (4) inability to identify an IA was a significant predictor of shortened survival,
Acknowledgments
Author contributions: Dr Fernández Pérez is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article.
Dr Fernández Pérez: contributed to conception and design of the study, data collection and analysis, and drafting the manuscript for important intellectual content.
Dr Swigris: contributed to design of the study, data collection and analysis, and drafting the manuscript for important intellectual content.
Ms Forssén:
References (27)
- et al.
The effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis
Am J Med
(2004) - et al.
Chronic hypersensitivity pneumonitis in Japan: a nationwide epidemiologic survey
J Allergy Clin Immunol
(1999) - et al.
Hypersensitivity pneumonitis: current concepts and future questions
J Allergy Clin Immunol
(2001) - et al.
High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis
Chest
(2008) - et al.
Causes and presenting features in 85 consecutive patients with hypersensitivity pneumonitis
Mayo Clin Proc
(2007) - et al.
Use of co-immunoelectrodiffusion to detect presumed disease-associated precipitating antibodies, and time-course value of specific isotypes in bird-breeder's disease
J Immunol Methods
(2003) - et al.
Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival
Radiology
(2007) - et al.
A clinical, radiographic, and physiologic scoring system for the longitudinal assessment of patients with idiopathic pulmonary fibrosis
Am Rev Respir Dis
(1986) - et al.
Needs and opportunities for research in hypersensitivity pneumonitis
Am J Respir Crit Care Med
(2005) - et al.
Bird antigen persistence in the home environment after removal of the bird
Ann Allergy
(1992)
Experimental hypersensitivity pneumonitis: lack of tolerance
Am Rev Respir Dis
Spontaneous regression in murine hypersensitivity pneumonitis: lack of immunological tolerance
Int Arch Allergy Appl Immunol
Longitudinal course of extrinsic allergic alveolitis in pigeon breeders
Thorax
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Funding/Support: Dr Swigris receives funding via a National Institutes of Health K23 Career Development Award [Grant K23 HL092227].
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