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Related Concept Videos

Hypersensitivities01:30

Hypersensitivities

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Hypersensitivity, also known as a hypersensitivity reaction or allergic reaction, is a condition where the body's immune system reacts abnormally to a foreign substance. Such substances, that cause hypersensitivity are referred to as an allergen, could be something typically harmless to most people, like pollen or certain foods.
Types of Hypersensitivities
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Pneumonia is an acute respiratory infection that targets the lungs, specifically the alveoli. These tiny air sacs, essential for oxygen exchange, become engorged with pus and fluid, severely hindering breathing, decreasing oxygen absorption, and causing significant pain and discomfort during respiration.
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Assessment of the Cytotoxic and Immunomodulatory Effects of Substances in Human Precision-cut Lung Slices
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Hypersensitivity pneumonitis: new concepts and classifications.

Andrew Churg1,2

  • 1Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada. achurg@mail.ubc.ca.

Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc
|September 17, 2021
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Summary

Diagnosing hypersensitivity pneumonitis (HP) is challenging due to varied definitions. Current guidelines classify HP as nonfibrotic or fibrotic, with distinct pathological and clinical features guiding diagnosis and treatment.

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Area of Science:

  • Pulmonary Medicine
  • Pathology
  • Radiology

Background:

  • Conflicting definitions complicate hypersensitivity pneumonitis (HP) diagnosis.
  • Recent guidelines propose classifying HP as nonfibrotic or fibrotic.
  • Pathological and clinical distinctions between HP subtypes and other interstitial lung diseases remain debated.

Purpose of the Study:

  • To clarify diagnostic criteria for nonfibrotic and fibrotic hypersensitivity pneumonitis.
  • To review key pathological and clinical features aiding HP diagnosis.
  • To discuss the implications of accurate HP diagnosis for treatment strategies.

Main Methods:

  • Review of existing literature and diagnostic guidelines for hypersensitivity pneumonitis.
  • Analysis of pathological findings, including granulomas, giant cells, and metaplasia.
  • Evaluation of clinical and CT imaging features suggestive of fibrotic HP.

Main Results:

  • Nonfibrotic HP typically shows bronchiolocentric inflammation; fibrotic HP can mimic other interstitial pneumonias.
  • Pathological features like extensive peribronchiolar metaplasia and specific CT findings (e.g., air-trapping) support fibrotic HP.
  • No reliable molecular tests currently distinguish fibrotic HP from other interstitial lung diseases.

Conclusions:

  • Accurate differentiation of fibrotic HP from usual interstitial pneumonia is critical for current treatment, though future approaches may unify management.
  • Clinical and CT findings are essential for diagnosing HP, especially the fibrotic form.
  • Ongoing research is needed to refine diagnostic criteria and develop targeted therapies for hypersensitivity pneumonitis.