Hypersensitivity pneumonitis

The lung is constantly exposed to a wide variety of environmental insults. In its defense against these environmental challenges, however, the lung responds through a limited number of pathophysiologic mechanisms. This is well illustrated by a group of diseases which are collectively referred to as hypersensitivity pneumonitis. This syndrome includes a very large number of different diseases. However, in the United States, only farmer's lung, bird-breeder's lung, and ventilation hypersensitivity pneumonitis occur with any significant frequency. Each of these is characterized by flu-like symptoms, in conjunction with a pneumonitis consisting of lymphocytic granulomatous infiltration of the alveoli and terminal bronchioles. This disease is caused by the inhalation of antigenic material which usually originates from the dusts of organic material. A host of different dusts and antigens have been described in conjunction with hypersensitivity pneumonitis but each leads to the same characteristic clinical syndrome. Thus, each of the diseases shares similar clinical features but differs primarily with respect to the nature of the exposure and causative antigens. The clinical features, pathogenesis, course, prognosis, and treatment of these related diseases are reviewed.