Diagnosis of Hypersensitivity Pneumonitis in Adults An Official ATS/JRS/ALAT Clinical Practice Guideline
Raghu G, Document S, Remy-Jardin M, Ryerson CJ, Myers JL, Kreuter M, Vasakova M, Bargagli E, Chung JH, Collins BF, Bendstrup E, Chami HA, Chua AT, Corte TJ, Dalphin JC, Danoff SK, Diaz-Mendoza J, Duggal A, Egashira R, Ewing T, Gulati M, Inoue Y, Jenkins AR, Johannson KA, Johkoh T, Tamae-Kakazu M, Kitaichi M, Knight SL, Koschel D, Lederer DJ, Mageto Y, Maier LA, Matiz C, Morell F, Nicholson AG, Patolia S, Pereira CA, Renzoni EA, Salisbury ML, Selman M, Walsh SLF, Wuyts WA, and Wilson KC. Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2020.
American journal of respiratory and critical care medicine
BACKGROUND: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort between the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax.
METHODS: Systematic reviews were performed for six questions. The evidence was discussed and then recommendations formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and hypersensitivity pneumonitis (HP) using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS: The guideline committee defined HP and clinical, radiographic, and pathologic features were described. HP was classified into non-fibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed upon. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with non-fibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage fluid for lymphocyte cellular analysis, as well as suggestions for transbronchial lung biopsy and surgical lung biopsy. For patients with fibrotic HP, suggestions were made in favor of obtaining bronchoalveolar lavage fluid for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions.
CONCLUSIONS: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.
ePub ahead of print