Hypersensitivity pneumonitis risk factors: Difference between revisions

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==Risk factors==
==Risk factors==
#'''Farmers and cattle workers:''' These workers develop the most common form of HP which is caused by the antigen thermophilic actinomycetes. It is important to note that while Farmer's lung is the most common cause of HP, it still must be distinguished from febrile toxic reactions to inhaled mold dusts (organic dust toxic syndrome, a nonimmunologic reaction) which occurs 30-50 times more often than HP.
* The most potent risk factor in the development of HP is exposure to organic antigens.  
#'''Poultry and other bird handlers:''' These workers are exposed to droppings, feathers, and serum proteins of pigeons and other birds.
* Certain occupations that are more at risk to these exposures are:
#'''Ventilation workers and those exposed to water-related contamination:''' These workers may be exposed to microorganisms thatcolonize humidifiers, forced-air systems, hot tubs, whirlpools, and spas. The putative antigens are derived from Thermoactinomyces or Cladosporium.
** Farmers and cattle workers
#'''Veterinarians and animal handlers:''' These workers obviously have daily contact with a large variety of animals and organic antigens.
** Poultry and other bird handlers<ref name="pmid5397797">{{cite journal |vauthors=Ahrer E, Philadelphy G, Bauer M |title=[Subcutaneous wire fixation of tibial torsion fractures] |language=German |journal=Hefte Unfallheilkd |volume=101 |issue= |pages=63–91 |year=1969 |pmid=5397797 |doi= |url=}}</ref>
#'''Grain and flour processors and loaders:''' These workers are exposed to grain. Grain can become colonized with a variety of microorganisms and their antigens.
*** These workers are exposed to droppings, feathers, and serum proteins of pigeons and other birds.
#'''Lumber mill workers and paper and wallboard manufacturers:''' These workers are exposed to wood which can become colonized with molds and then becomes aerosolized.
** Ventilation workers and those exposed to water-related contamination.
#'''Plastic manufacturers, painters, and electronics industry workers:''' These workers can be exposed to  diphenylmethane diisocyanate or toluene diisocyanate.
*** These workers may be exposed to microorganisms thatcolonize humidifiers, forced-air systems, hot tubs, whirlpools, and spas.  
#'''Textile workers''': These workers do develop lung injury but this is not a true form of HP. The injury is characterized by diffuse alveolar damage or airway dysfunction and includes diseases such as [[byssinosis]] and [[nylon worker's lung]].
** Veterinarians and animal handlers
Hypersensitivity Pneumonitis (HP) may also be called many different names, based on the provoking [[antigen]]. These include:
*** These workers obviously have daily contact with a large variety of animals and organic antigens.
# Bird-Breeder's Lung : Also called [[Bird fancier's lung]], Pigeon-Breeder's Lung, and Poultry-Worker's Lung. Caused by avian proteins. Exposure is from feathers and bird droppings.
** Grain and flour processors and loaders
; Farmer's Lung : Caused by the [[mold]]s ''Thermophilic [[actinomycetes]]'', ''[[Aspergillus]] species'', ''[[Saccharopolyspora rectivirgula]]'', and ''[[Micropolyspora faeni]]''. Exposure is generally from moldy hay but may be found elsewhere.
*** These workers are exposed to grain.
; Bagassosis : Caused by ''[[Thermophilic actinomycetes]]''. Exposure is from moldy bagasse (pressed sugarcane).
*** Grain can become colonized with a variety of microorganisms and their antigens.
; Malt Worker's Lung : Caused by ''Aspergillus clavatus''. Exposure is from moldy barley.
** Lumber mill workers and paper and wallboard manufacturers
; Humidifier Lung : Caused by the bacterias ''T. candidus'', ''Bacillus subtilis'', ''B. cereus'', and ''Klebsiella oxytoca''; the fungus ''[[Aureobasidium pullulans]]''; and the amoebae ''Naegleria gruberi'', ''Acanthamoeba polyhaga'', and ''Acanthamoeba castellani''. Exposure is from mist from standing water.
*** These workers are exposed to wood which can become colonized with molds and then becomes aerosolized.
; Mushroom Worker's Lung : Caused by ''Thermophilic actinomycetes''. Exposure is from mushroom compost.
** Plastic manufacturers, painters, and electronics industry workers
; Compost Lung : Caused by ''[[Aspergillus]]''. Exposure is from [[compost]].
*** These workers can be exposed to  diphenylmethane diisocyanate or toluene diisocyanate.
; Peat Moss Worker's Lung : Caused by ''Monocillium sp.'' and ''Penicillium citreonigrum''. Exposure if from peat moss.
** Textile workers
; Suberosis :  Caused by ''Penicillum frequentans''. Exposure is from moldy cork dust.
** Mushroom cultivators
; Japanese Summer-Type HP : Caused by ''[[Trichosporon cutaneum]]''. Exposure is from damp wood and [[Tatami|mats]].
** Wine makers
; Cheese-Washer's Lung : Caused by ''Pencillum casei'' or ''P.roqueforti''. Exposure is from [[cheese casings]].
; Metalworking Fluids HP : Caused by Nontuberculous Mycobacteria. Exposure is from mist from metalworking fluids.
; Hot Tub Lung : Caused by ''[[Mycobacterium avium]]'' complex. Exposure is from mist from [[hot tub]]s.
; Mollusc Shell HP : Caused by aquatic animal proteins. Exposure is from mollusc shell dust.
; Isocyanate HP : Caused by TDI, HDI, and MDI. Exposure is from paints, resins, and polyurethane foams.
; TMA HP : Caused by Trimellitic anhydride. Exposure is from plastics, resins, and paints.
; [[Berylliosis]]: Caused by [[Beryllium]]. Exposure in the electronics industry.
; Wine-grower's lung: From Botrytis cinerea mold on grapes.
Of these types, Farmer's Lung and Bird-Breeder's Lung are the most common. "Studies document 8-540 cases per 100,000 persons per year for farmers and 6000-21,000 cases per 100,000 persons per year for pigeon breeders. High attack rates are documented in sporadic outbreaks. Prevalence varies by region, climate, and farming practices. HP affects 0.4-7% of the farming population. Reported prevalence among bird fanciers is estimated to be 20-20,000 cases per 100,000 persons at risk."


==References==
==References==

Revision as of 21:44, 16 February 2018

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

Overview

The following is a partial list of occupations and major causative antigens that put a patient at risk of HP. Microbial agents like fungi or bacteria in humidifiers, heating systems, and air conditioners found in homes and offices. Exposure to certain chemicals, such as isocyanates or acid anhydrides, can also increase the risk of hypersensitivity pneumonitis in susceptible individuals.

Risk factors

  • The most potent risk factor in the development of HP is exposure to organic antigens.
  • Certain occupations that are more at risk to these exposures are:
    • Farmers and cattle workers
    • Poultry and other bird handlers[1]
      • These workers are exposed to droppings, feathers, and serum proteins of pigeons and other birds.
    • Ventilation workers and those exposed to water-related contamination.
      • These workers may be exposed to microorganisms thatcolonize humidifiers, forced-air systems, hot tubs, whirlpools, and spas.
    • Veterinarians and animal handlers
      • These workers obviously have daily contact with a large variety of animals and organic antigens.
    • Grain and flour processors and loaders
      • These workers are exposed to grain.
      • Grain can become colonized with a variety of microorganisms and their antigens.
    • Lumber mill workers and paper and wallboard manufacturers
      • These workers are exposed to wood which can become colonized with molds and then becomes aerosolized.
    • Plastic manufacturers, painters, and electronics industry workers
      • These workers can be exposed to diphenylmethane diisocyanate or toluene diisocyanate.
    • Textile workers
    • Mushroom cultivators
    • Wine makers

References

  1. ↑ Ahrer E, Philadelphy G, Bauer M (1969). "[Subcutaneous wire fixation of tibial torsion fractures]". Hefte Unfallheilkd (in German). 101: 63–91. PMID 5397797.

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