Diagnosis and management of hypersensitivity pneumonitis in adults: A position statement from the Thoracic Society of Australia and New Zealand

Hayley Barnes; Tamera J Corte; Gregory Keir; Yet H Khor; Sandhya Limaye; Jeremy P Wrobel; Elizabeth Veitch; John Harrington; Leona Dowman; Lutz Beckert; David Milne; Rebekah De Losa; Wendy A Cooper; Peter T Bell; Pradeep Balakrishnan; Lauren K Troy

doi:10.1111/resp.14847

Diagnosis and management of hypersensitivity pneumonitis in adults: A position statement from the Thoracic Society of Australia and New Zealand

Respirology. 2024 Oct 28. doi: 10.1111/resp.14847. Online ahead of print.

Authors

Hayley Barnes^{1

2

3}, Tamera J Corte^{4

5

6

7}, Gregory Keir^{8

9}, Yet H Khor^{2

10

11

12}, Sandhya Limaye^{5

13}, Jeremy P Wrobel^{14

15}, Elizabeth Veitch^{16

17}, John Harrington^{18

19}, Leona Dowman^{2

10

11}, Lutz Beckert^{20

21}, David Milne²², Rebekah De Losa²³, Wendy A Cooper^{5

7

24

25}, Peter T Bell^{9

26}, Pradeep Balakrishnan^{27

28}, Lauren K Troy^{4

5

6

7}

Affiliations

¹ Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
² Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
³ Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁵ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁶ NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia.
⁷ Institute for Academic Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁸ Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁹ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.
¹¹ Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.
¹² Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
¹³ Department of Immunology, Concord Hospital, Concord, New South Wales, Australia.
¹⁴ Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia.
¹⁵ School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia.
¹⁶ Respiratory Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia.
¹⁷ Faculty of Medicine, Macquarie University, Macquarie Park, New South Wales, Australia.
¹⁸ Asthma and Breathing Research Program, The Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.
¹⁹ Department of Sleep and Respiratory Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
²⁰ Department of Respiratory Medicine, Te Whatu Ora, Panui Canterbury, New Zealand.
²¹ Department of Medicine, University of Otago, Christchurch, New Zealand.
²² Department of Radiology, Te Toka Tumai, Auckland, New Zealand.
²³ Respiratory Medicine, Northern Hospital, Epping, Victoria, Australia.
²⁴ Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
²⁵ School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
²⁶ Department of Respiratory and Sleep Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
²⁷ Department of Medicine, St John of God Midland Public Hospital, Perth, Western Australia, Australia.
²⁸ UWA Medical School, Division of Internal Medicine, University of Western Australia, Perth, Western Australia, Australia.

PMID: 39467777
DOI: 10.1111/resp.14847

Abstract

Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) relating to specific occupational, environmental or medication exposures. Disease behaviour is influenced by the nature of exposure and the host response, with varying degrees of lung inflammation and fibrosis seen within individuals. The differentiation of HP from other ILDs is important due to distinct causes, pathophysiology, prognosis and management implications. This Thoracic Society of Australia and New Zealand (TSANZ) position statement aims to provide an up-to-date summary of the evidence for clinicians relating to the diagnosis and management of HP in adults, in the Australian and New Zealand context. This document highlights recent relevant findings and gaps in the literature for which further research is required.

Keywords: clinical respiratory medicine; environmental and occupational health and epidemiology; hypersensitivity pneumonitis; inflammation; interstitial lung disease; pulmonary fibrosis.