ORIGINAL ARTICLECauses and Presenting Features in 85 Consecutive Patients With Hypersensitivity Pneumonitis
Section snippets
PATIENTS AND METHODS
We conducted a computer-assisted search of the Mayo Clinic, Rochester, Minn, database to identify patients evaluated for HP at our medical center during a 6-year period from January 1, 1997, through December 31, 2002. Diagnostic criteria for HP included the following: (1) presence of episodic or persistent respiratory symptoms, (2) radiologic evidence of diffuse lung disease, (3) known exposure or a positive serum precipitin test result to an inciting antigen, and (4) no other identifiable
RESULTS
Demographic data and presenting clinical features of 85 consecutive patients with HP are summarized in Table 1. The mean ± SD age of the patients was 53±14 years (range, 13-90 years); 53 (62%) were women, and 32 (38%) were male. Only 2 patients (2%) were current smokers. Before the evaluation at our medical center, 23 patients (27%) had been diagnosed as having HP.
The most common presenting symptoms were dyspnea (93%) and cough (65%). Respiratory symptoms had been present for 4 months or more
DISCUSSION
Avian antigens (34%) and M avium complex associated with hot tub water (21%) were the most common causes of HP in this study cohort. Although controversy continues regarding the underlying pathophysiology of hot tub lung disease, the weight of evidence suggests HP rather than infection as the cause.8, 9 A wide array of potential antigens can cause HP, but it is noteworthy that farm-related antigens, house molds, avian antigens, and exposure to hot tub-related M avium complex accounted for all
CONCLUSION
Most patients with HP seen at this large tertiary care center in the Midwest region of the United States had chronic HP, and the most common causes included avian antigens and hot tub-related M avium complex. In 25% of patients, the presumptive antigen could not be identified. Additional research is needed to develop methods for identifying of-fending antigens, to formulate diagnostic criteria, and to define the natural history of and prognostic factors for HP.
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