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Article Dans Une Revue American journal of respiratory and critical care medicine Année : 2020

Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline.

Martina Vasakova
  • Fonction : Auteur
Jonathan H. Chung
  • Fonction : Auteur
Bridget F. Collins
  • Fonction : Auteur
Hassan A. Chami
  • Fonction : Auteur
Abigail T. Chua
  • Fonction : Auteur
Javier Diaz-Mendoza
  • Fonction : Auteur
Abhijit Duggal
  • Fonction : Auteur
Ryoko Egashira
  • Fonction : Auteur
Thomas Ewing
  • Fonction : Auteur
Mridu Gulati
  • Fonction : Auteur
Yoshikazu Inoue
  • Fonction : Auteur
Alex R. Jenkins
  • Fonction : Auteur
Maximiliano Tamae-Kakazu
  • Fonction : Auteur
Masanori Kitaichi
  • Fonction : Auteur
Shandra L. Knight
  • Fonction : Auteur
Dirk Koschel
  • Fonction : Auteur
David J. Lederer
  • Fonction : Auteur
Yolanda Mageto
  • Fonction : Auteur
Lisa A. Maier
  • Fonction : Auteur
Carlos Matiz
  • Fonction : Auteur
Setu Patolia
  • Fonction : Auteur
Carlos A. Pereira
  • Fonction : Auteur
Elisabetta A. Renzoni
  • Fonction : Auteur
Margaret L. Salisbury
  • Fonction : Auteur
Moises Selman
  • Fonction : Auteur

Résumé

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.

Dates et versions

hal-04357603 , version 1 (21-12-2023)

Identifiants

Citer

Ganesh Raghu, Martine Remy, Christopher J. Ryerson, Jeffrey L. Myers, Michael Kreuter, et al.. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline.. American journal of respiratory and critical care medicine, 2020, American Journal of Respiratory and Critical Care Medicine, 202, pp.e36-e69. ⟨10.1164/rccm.202005-2032ST⟩. ⟨hal-04357603⟩

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