Diagnosis and Evaluation of Hypersensitivity Pneumonitis (HP)
Publication Date: April 12, 2021
Last Updated: March 14, 2022
Recommendations
1. In patients with suspected hypersensitivity pneumonitis (HP), we suggest gathering a thorough clinical history of exposures focused on establishing the type, extent, and temporal relationship of exposure(s) to symptoms. (GPR, )
658
2. In patients with suspected HP, if the inciting antigen (IA) is thought to be related to an occupational exposure, we suggest considering the inclusion of an occupational medicine specialist and an environmental hygienist during the multidisciplinary diagnostic workup, especially when the source of exposure is obscure or unverified. (GPR, )
658
3. In patients with suspected HP, we suggest classifying patients based on the likelihood of an occupational or environmental inciting antigen exposure. (W - Weak, VL - Very Low)
658
4. For patients with either newly diagnosed or a working diagnosis of HP, we suggest classifying the disease as fibrotic or nonfibrotic based on the presence or absence of fibrosis on high-resolution CT (HRCT) of the chest. (W - Weak, VL - Very Low)
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5. In patients with suspected HP, if an IA exposure is identified and then completely avoided, we suggest using clinical improvement with antigen avoidance to support the diagnosis of HP, but not relying solely on the lack of clinical improvement with antigen avoidance to rule out the diagnosis of HP. (W - Weak, VL - Very Low)
658
6. For patients with suspected HP, we suggest not relying solely on clinical improvement with medical therapy to confirm a diagnosis of HP or on the lack of clinical improvement with medical therapy alone to rule out the diagnosis of HP. (W - Weak, VL - Very Low)
658
7. For patients with suspected HP, we suggest not relying solely on serum antigen-specific immunoglobulin G (IgG) or immunoglobulin A (IgA) testing to confirm or rule out the diagnosis of HP. (W - Weak, VL - Very Low)
658
8. For patients with suspected HP, we suggest not performing antigen-specific inhalation challenge testing to support the diagnosis of HP. (W - Weak, VL - Very Low)
658
9. For patients with suspected HP, we suggest not performing antigen-specific lymphocyte proliferation testing to support the diagnosis of HP. (W - Weak, VL - Very Low)
658
10. For patients with suspected HP, we suggest the integration of HRCT findings characteristic of HP with clinical findings to support the diagnosis of HP, but not using the CT findings in isolation to make a definite diagnosis. (W - Weak, VL - Very Low)
658
11. For patients with suspected HP, we suggest using a multidisciplinary discussion (MDD) for diagnostic decision-making. (W - Weak, VL - Very Low)
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12. For patients with suspected HP who have a compelling exposure history within the appropriate clinical context and a chest HRCT pattern typical for HP, we suggest not routinely using BAL fluid analysis to confirm a diagnosis of HP. (W - Weak, VL - Very Low)
658
13. In patients with suspected HP, we suggest considering histological lung biopsy for additional diagnostic evaluation when all available data such as clinical, laboratory, and radiologic findings along with bronchoscopic results do not yield a confident diagnosis and results may help guide management. (W - Weak, VL - Very Low)
658
14. For patients with suspected HP, we suggest integrating biopsy findings with clinical and radiological findings to support the diagnosis of HP in the context of the MDD. (W - Weak, VL - Very Low)
658
Recommendation Grading
Overview
Title
Diagnosis and Evaluation of Hypersensitivity Pneumonitis (HP)
Authoring Organization
American College of Chest Physicians
Publication Month/Year
April 12, 2021
Last Updated Month/Year
April 1, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Physician, nurse practitioner, nurse, physician assistant
Scope
Assessment and screening, Diagnosis
Diseases/Conditions (MeSH)
D006967 - Hypersensitivity
Keywords
interstitial lung disease, evidence-based medicine, Guidelines, hypersensitivity pneumonitis
Source Citation
Fernández Pérez ER, Travis WD, Lynch DA, Brown KK, Johannson KA, Selman M, Ryu JH, Wells AU, Tony Huang YC, Pereira CAC, Scholand MB, Villar A, Inase N, Evans RB, Mette SA, Frazer-Green L. Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report. Chest. 2021 Aug;160(2):e97-e156. doi: 10.1016/j.chest.2021.03.066. Epub 2021 Apr 20. PMID: 33861992.
Supplemental Methodology Resources
Methodology
Number of Source Documents
230
Literature Search Start Date
February 28, 2018
Literature Search End Date
April 30, 2020