Hypersensitivity pneumonitis medical therapy: Difference between revisions

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== Overview ==
== Overview ==
The best treatment is to avoid the provoking allergen, as chronic exposure can cause permanent damage. [[Corticosteroids]] such as [[Prednisolone]] may help to control [[Hypersensitivity pneumonitis history and symptoms|symptoms]] but may produce side-effects.
The best treatment is to avoid the provoking allergen, as chronic exposure can cause permanent damage. [[Corticosteroids]] such as [[Prednisolone]] may help to control [[Hypersensitivity pneumonitis history and symptoms|symptoms]] but may produce side-effects.
=== Antigen avoidance ===
If the responsible inhaled antigen can be identified, the most effective therapy is complete avoidance. Acute disease remits without specific therapy. This may prove difficult or impractical when a new home or new job would be required. When complete elimination or avoidance of the allergen exposure is not possible, exposure minimization with protective equipment or environmental treatment is a potential alternative. Respirators may provide satisfactory personal air purification for workplace environments. Alternatively, use of fungicides, dehumidification, mold removal or other remediation services may also sufficiently reduce ambient antigen burden. Patients with disease progression in the setting of ongoing exposure should still be strongly counseled on antigen avoidance even if drastic measures such as relocation to a new job or home are required.
=== Corticosteroid therapy ===
Corticosteroid therapy may be indicated for acute symptomatic relief and may accelerate the initial recovery in persons with severe disease.<sup> [[null 59]] </sup>In long-term prospective follow-up studies, however, prognosis was not affected.
Treatment regimens for hypersensitivity pneumonitis vary according to the prescriber. A conceivable initial empiric treatment dose is prednisone 0.5-1 mg/kg/day for 1-2 weeks in acute hypersensitivity pneumonitis or 4-8 weeks for subacute/chronic hypersensitivity pneumonitis followed by a gradual taper to off or maintenance dose of approximately 10 mg/day. Continued therapy should be guided by clinical response, pulmonary function, and radiographic improvement. Maintenance doses are not always required, particularly if the patient is removed from exposure.


==Medical Therapy==
==Medical Therapy==
* The mainstay of treatment for HP is:
* The mainstay of treatment for HP is:
** Environmental control  
** Environmental control/ Antigen exposure control  
** Antigen exposure control
** Corticosteroid therapy
* If the condition of the patient does not improve then medical therapy in the form of corticosteroid is used.
'''Antigen Control'''
'''Antigen Control'''
* Mainstay in treatment is complete control of exposure to antigen.   
* Mainstay in treatment is complete control of exposure to antigen.   
* If complete avoidance of antigen exposure cannot be done then the following can be done:
** Protective equipment can be used to minimize exposure. 
** Personal air purification can be achieved with the use of respirators. 
** Ambient antigen burden can be reduced using dehumidification, mold removal and fungicides. 
'''Corticosteroid therapy'''
* Corticosteroid therapy can be used to treat  acute symptoms.
* In severe disease, corticosteroid use can accelerate the initial recovery.
* Preferred regimen in acute HP: prednisone 0.5-1 mg/kg/day for 7-14 days.
* Preferred regimen in subacute HP: prednisone 0.5-1 mg/kg/day for 4-8 weeks.
* Preferred regimen for maintenance : prednisone 10 mg/day.
** Maintenance dose is only required if the patient cannot be removed from antigen exposure. 
*
Continued therapy should be guided by clinical response, pulmonary function, and radiographic improvement. Maintenance doses are not always required, particularly if the patient is removed from exposure.


==References==
==References==

Latest revision as of 03:16, 1 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The best treatment is to avoid the provoking allergen, as chronic exposure can cause permanent damage. Corticosteroids such as Prednisolone may help to control symptoms but may produce side-effects.

Medical Therapy

  • The mainstay of treatment for HP is:
    • Environmental control/ Antigen exposure control
    • Corticosteroid therapy

Antigen Control

  • Mainstay in treatment is complete control of exposure to antigen.
  • If complete avoidance of antigen exposure cannot be done then the following can be done:
    • Protective equipment can be used to minimize exposure.
    • Personal air purification can be achieved with the use of respirators.
    • Ambient antigen burden can be reduced using dehumidification, mold removal and fungicides.

Corticosteroid therapy

  • Corticosteroid therapy can be used to treat acute symptoms.
  • In severe disease, corticosteroid use can accelerate the initial recovery.
  • Preferred regimen in acute HP: prednisone 0.5-1 mg/kg/day for 7-14 days.
  • Preferred regimen in subacute HP: prednisone 0.5-1 mg/kg/day for 4-8 weeks.
  • Preferred regimen for maintenance : prednisone 10 mg/day.
    • Maintenance dose is only required if the patient cannot be removed from antigen exposure.

Continued therapy should be guided by clinical response, pulmonary function, and radiographic improvement. Maintenance doses are not always required, particularly if the patient is removed from exposure.

References

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