title: Occupational hypersensitivity pneumonitis: an EAACI position paper.
abstract: The aim of this document was to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis (OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non-IgE-mediated allergic reaction to a variety of organic materials or low molecular weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low molecular weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests to ascertain the work relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent.
authors.affiliation: Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Quirce
authors.affiliation: Department of Chest Medicine, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: O
authors.initials: O
authors.lastname: Vandenplas
authors.affiliation: Unidad de Gestión Clínica Allergy-IBIMA, Hospital Regional Universitario, Málaga, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Campo
authors.affiliation: Pulmonology Service, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.|CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cruz
authors.affiliation: Division of Asthma and Allergy, Department of Chest Diseases, University Hospital, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg University, Strasbourg, France.
authors.forename: F
authors.initials: F
authors.lastname: de Blay
authors.affiliation: Fachkrankenhaus Coswig GmbH Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thorax- und Gefäßchirurgie, Coswig, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Koschel
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Moscato
authors.affiliation: Occupational Physician's Division, Local Health Authority of Sassari, Sassari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pala
authors.affiliation: IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum, Bochum, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Raulf
authors.affiliation: Department of Allergy, Fundación Jiménez Díaz, and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sastre
authors.affiliation: Formerly Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Siracusa
authors.affiliation: Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Respiratory Division Toronto Western Hospital, Gage Occupational and Environmental Health Unit, St Michael's Hospital, Toronto, ON, Canada.
authors.forename: S M
authors.initials: SM
authors.lastname: Tarlo
authors.affiliation: Department of Occupational Diseases and Toxicology, Nofer Institute of Occupational Medicine, Lodz, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Walusiak-Skorupa
authors.affiliation: Centre de Pneumologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, QC, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Cormier
mesh_terms: D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D019468:Disease Management; D006801:Humans; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012129:Respiratory Function Tests; D012307:Risk Factors
keywords: diagnosis; extrinsic allergic alveolitis; hypersensitivity pneumonitis; occupational disease