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Hypersensitivity Pneumonitis in Adults

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2 Key Points ➤ Hypersensitivity pneumonitis (HP) must be considered in the differential diagnosis for patients with newly identified interstitial lung disease (ILD). ➤ This guideline committee categorized HP into two clinical phenotypes—nonfibrotic and fibrotic HP—and made separate recommendations for each. • For patients with clinical and radiographic manifestations suggestive of nonfibrotic HP (i.e., patients without radiological and/or histopathological evidence of fibrosis), the guideline committee: ▶ makes no recommendation or suggestion for or against the use of a questionnaire to identify potential HP inciting agents and sources. Instead, the guideline committee recommends development and validation of a questionnaire. Remark: Pending the availability of a validated questionnaire, the guideline committee advocates that clinicians take a thorough history to identify potential exposures and sources in the patient's environment that are known to be associated with HP. ▶ suggests performing serum IgG testing that targets potential antigens associated with HP (suggestion, very low confidence in the estimated effects). ▶ recommends obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis (recommendation, very low confidence in the estimated effects). ▶ suggests transbronchial forceps lung biopsy (suggestion, very low confidence in the estimated effects). ▶ makes no recommendation or suggestion for or against transbronchial lung cryobiopsy. ▶ suggests surgical lung biopsy only when all other diagnostic testing has not yielded a diagnosis (suggestion, very low confidence in the estimated effects). • For patients with clinical and radiographic manifestations suggestive of fibrotic HP (i.e., patients with radiological and/or histopathological evidence of fibrosis), the guideline committee: ▶ makes no recommendation or suggestion for or against the use of a questionnaire to identify potential HP inciting agents and sources. Instead, the guideline committee recommends development and validation of a questionnaire. Remark: Pending the availability of a validated questionnaire, the guideline committee advocates that clinicians take a thorough history to identify potential exposures and sources in the patient's environment that are known to be associated with HP. ▶ suggests performing serum IgG testing that targets potential antigens associated with HP (suggestion, very low confidence in the estimated effects). ▶ suggests obtaining BAL fluid for lymphocyte cellular analysis (suggestion, very low confidence in the estimated effects). ▶ makes no recommendation or suggestion for or against transbronchial forceps lung biopsy. Suggests transbronchial lung cryobiopsy (suggestion, very low confidence in the estimated effects). ▶ suggests surgical lung biopsy; this recommendation is intended to apply when all other diagnostic testing has not yielded a diagnosis (suggestion, very low confidence in the estimated effects).

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