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Diagnosis of hypersensitivity pneumonitis in adults: an official ATS/JRS/ALAT clinical practice guideline

Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax.Methods: Systematic reviews were performed for six questions. Th...

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Main Authors: Raghu, Ganesh (Author) , Remy-Jardin, Martine (Author) , Ryerson, Christopher J. (Author) , Myers, Jeffrey L. (Author) , Kreuter, Michael (Author) , Vasakova, Martina (Author) , Bargagli, Elena (Author) , Chung, Jonathan H. (Author) , Collins, Bridget F. (Author) , Bendstrup, Elisabeth (Author) , Chami, Hassan A. (Author) , Chua, Abigail T. (Author) , Corte, Tamera J. (Author) , Dalphin, Jean-Charles (Author) , Danoff, Sonye K. (Author) , Diaz-Mendoza, Javier (Author) , Duggal, Abhijit (Author) , Egashira, Ryoko (Author) , Ewing, Thomas (Author) , Gulati, Mridu (Author) , Inoue, Yoshikazu (Author) , Jenkins, Alex R. (Author) , Johannson, Kerri A. (Author) , Johkoh, Takeshi (Author) , Tamae-Kakazu, Maximiliano (Author) , Kitaichi, Masanori (Author) , Knight, Shandra L. (Author) , Koschel, Dirk (Author) , Lederer, David J. (Author) , Mageto, Yolanda (Author) , Maier, Lisa A. (Author) , Matiz, Carlos (Author) , Morell, Ferran (Author) , Nicholson, Andrew G. (Author) , Patolia, Setu (Author) , Pereira, Carlos A. (Author) , Renzoni, Elisabetta A. (Author) , Salisbury, Margaret L. (Author) , Selman, Moises (Author) , Walsh, Simon L. F. (Author) , Wuyts, Wim A. (Author) , Wilson, Kevin C. (Author)
Format: Article (Journal)
Language:English
Published: August 1, 2020
In: American journal of respiratory and critical care medicine
Year: 2020, Volume: 202, Issue: 3, Pages: e36-e69
ISSN:1535-4970
DOI:10.1164/rccm.202005-2032ST
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1164/rccm.202005-2032ST
Verlag, lizenzpflichtig, Volltext: https://www.atsjournals.org/doi/full/10.1164/rccm.202005-2032ST
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Author Notes:Ganesh Raghu, Martine Remy-Jardin, Christopher J. Ryerson, Jeffrey L. Myers, Michael Kreuter, Martina Vasakova, Elena Bargagli, Jonathan H. Chung, Bridget F. Collins, Elisabeth Bendstrup, Hassan A. Chami, Abigail T. Chua, Tamera J. Corte, Jean-Charles Dalphin, Sonye K. Danoff, Javier Diaz-Mendoza, Abhijit Duggal, Ryoko Egashira, Thomas Ewing, Mridu Gulati, Yoshikazu Inoue, Alex R. Jenkins, Kerri A. Johannson, Takeshi Johkoh, Maximiliano Tamae-Kakazu, Masanori Kitaichi, Shandra L. Knight, Dirk Koschel, David J. Lederer, Yolanda Mageto, Lisa A. Maier, Carlos Matiz, Ferran Morell, Andrew G. Nicholson, Setu Patolia, Carlos A. Pereira, Elisabetta A. Renzoni, Margaret L. Salisbury, Moises Selman, Simon L.F. Walsh, Wim A. Wuyts, and Kevin C. Wilson; on behalf of the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax
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Summary:Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax.Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic 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 on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL 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.
Item Description:Gesehen am 20.10.2020
Physical Description:Online Resource
ISSN:1535-4970
DOI:10.1164/rccm.202005-2032ST

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