Hypersensitivity pneumonitis in children
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Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Poland
Department of Paediatrics, Paediatric and Social Nursing, Institute of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
Maria Wawszczak   

Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 63A, 02-091, Warsaw, Poland
Hypersensitivity pneumonitis (HP) is one of the most common forms of interstitial lung disease in children. Due to its common association with occupational environment, it used to be considered an exclusively adult disease; however, hypersensitivity pneumonitis also affects the paediatric population, and is often associated with exposure to antigens in the home environment and with the pastime activities of children.

The aim of the study is to present the current state of knowledge on hypersensitivity pneumonitis in children with a focus on the peculiarities of diagnostic investigation and management of the disease in this age group. The study includes a case report of the disease in a child.

State of knowledge:
In children, the most common factors causing HP are avian and fungal antigens present in the home environment. Diagnosis is based on the co-occurrence of characteristic clinical presentation, radiographic and pulmonary function tests findings, and a history of exposure to a potential triggering antigen. The main strategy in the management of HP is to eliminate the trigger factor with the use of a systemic corticosteroids therapy in severe or advanced cases.

Due to the risk of irreversible changes in the respiratory tract, an early diagnosis is very important. A quick identification of the trigger factor and its elimination from the patient’s environment makes it possible to apply a less aggressive treatment, and to improve the patient’s prognosis. Unfortunately, due to its infrequent occurrence, hypersensitivity pneumonitis is often not taken into account in a differential diagnosis of respiratory diseases in children, which leads to a delayed diagnosis despite the characteristic clinical presentation of the disease.

Griese M. Chronic interstitial lung disease in children. Eur Respir Rev. 2018 Feb 7; 27(147). pii: 170100.
Buchvald F, Petersen BL, Damgaard K, Deterding R, Langston C, Fan LL, et al. Frequency, treatment, and functional outcome in children with hypersensitivity pneumonitis. Pediatr Pulmonol. 2011 Nov; 46(11): 1098–107.
Wanin S, Malka-Ruimy C, Deschildre A, Nathan N, Reboux G, Reix P, et al. Usefulness of bronchoalveolar lavage in a French pediatric cohort with hypersensitivity pneumonitis. Pediatr Pulmonol. 2019 Oct 20.
Griese M, Haug M, Hartl D, Teusch V, Glöckner-Pagel J, Brasch F; National EAA Study Group. Hypersensitivity pneumonitis: lessons for diagnosis and treatment of a rare entity in children. Orphanet J Rare Dis. 2013; 8: 121.
Quirce S, Vandenplas O, Campo P, Cruz MJ, de Baly F, Koschel D,et al. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016; 71(6): 765–79.
Riario Sforza GG, Marinou A. Hypersensitivity pneumonitis: a complex lung disease. Clin Mol Allergy. 2017; 15: 6.
Soumagne T, Dalphin ML, Dalphin JC. Hypersensitivity pneumonitis in children. Rev Mal Respir. 2019; 36(4): 495–507.
Nathan N, Berdah L, Borensztajn K, Clement A. Chronic interstitial lung diseases in children: diagnosis approaches. Expert Rev Respir Med. 2018; 12(12): 1051–1060.
Magon P. Reversible lung disease due to abundant use of talcum powder. Indian J Pediatr. 2012; 79(10): 1383.
Aebischer CC, Frey U, Schöni MH. Hypersensitivity pneumonitis in a five-year-old boy: an unusual antigen source. Pediatr Pulmonol. 2002; 33(1): 77–8.
Kristiansen JD, Lahoz AX. Riding-school lung? Allergic alveolitis in an 11-year-old girl. Acta Paediatr Scand. 1991; 80(3): 386–8.
Fracchia MS, El Saleeby CM, Murali MR, Sagar P, Mino-Kenudson M. Case records of the Massachusetts General Hospital. Case 9–2013. A 9-year-old boy with fever, cough, respiratory distress, and chest pain. N Engl J Med. 2013; 368(12): 1141–50.
Ando A, Hagiya H, Nada T, Kimura K, Waseda K, Rai K, et al. Hypersensitivity Pneumonitis Caused by a Home Ultrasonic Humidifier Contaminated with Candida guilliermondii. Intern Med. 2017; 56(22): 3109–3112.
Selman M. Immunopathology, diagnosis, and management of hypersensitivity pneumonitis. Semin Respir Crit Care Med. 2012; 33(5): 543–54.
Asai N, Kaneko N, Ohkuni Y, Aoshima M, Kawamura Y. Familial Summer-type hypersensitivity Pneumonitis: A Review of 25 Families and 50 Cases in Japan. Intern Med. 2016; 55(3): 279–83.
Tsanglao WR, Nandan D, Chandelia S, Bhardwaj M. Chronic Hypersensitivity Pneumonia due to Pigeon Breeders Disease. Indian Pediatr. 2017; 54(1): 55–57.
Cardoso J, Carvalho I. The value of family history in the diagnosis of hypersensitivity pneumonitis in children. J Bras Pneumol. 2014; 40(2): 183–7.
Habra B, AbdulWahab A. A Rare Pediatric Case of Severe Bird Fancier’s Lung Presented with Viral Pneumonitis-Like Picture. Children (Basel) 2018; 5(11): 149.
Jordan LE, Guy E. Paediatric feather duvet hypersensitivity pneumonitis. BMJ Case Rep. 2015; 2015.pii: bcr2014207956.
Vergez M, Honjoya S, Guérin S, Delacourt C, Benoist G. Hot tub lung: A case report. Arch Pediatr. 2017; 24(12): 1271–1274.
Naqibullah M, Shaker SB, Bach KS, Bendstrup E. Rituximab-induced interstitial lung disease: five case reports. Eur Clin Respir J. 2015;2.
Fragoulis GE, Conway R, Nikiphorou E. Methotrexate and interstitial lung disease: controversies and questions. A narrative review of the literature. Rheumatology (Oxford). 2019; 58(11): 1900–1906.
Lee IH, Kang GW, Kim KC. Hypersensitivity pneumonitis associated with azathioprine therapy in a patient with granulomatosis with polyangiitis. Rheumatol Int. 2016; 36(7): 1027–32.
Virdee G, Bleasdale J, Ikramullah M, Graham-Clarke E. Sertraline-induced hypersensitivity pneumonitis. BMJ Case Rep. 2019; 12(12). pii: e230724.
Sommerfeld CG, Weiner DJ, Nowalk A, Larkin A. Hypersensitivity Pneumonitis and Acute Respiratory Distress Syndrome From E-Cigarette Use. Pediatrics. 2018; 141(6). pii: e20163927.
Nair N, Hurley M, Gates S, Davies P, Chen IL, Todd I, et al. Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes. Arch Dis Child. 2019; pii: archdischild-2019-317889.
Selman M, Pardo A, King TE. Jr. Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med. 2012; 186(4): 314–24.
Greenberger PA. Hypersensitivity pneumonitis: A fibrosing alveolitis produced by inhalation of diverse antigens. J Allergy Clin Immunol. 2019; 143(4): 1295–1301.
Spagnolo P, Rossi G, Cavazza A, Bonifazi M, Paladini I, Bonella F, et al. Hypersensitivity Pneumonitis: A Comprehensive Review. J Investig Allergol Clin Immunol. 2015; 25(4): 237–50; quiz follow 250.
Soumagne T, Dalphin JC. Current and emerging techniques for the diagnosis of hypersensitivity pneumonitis. Expert Rev Respir Med. 2018; 12(6): 493–507.
Falfán-Valencia R, Camarena A, Pineda CL, Montaño M, Juárez A, Buendía-Roldán I, et al. Genetic susceptibility to multicase hypersensitivity pneumonitis is associated with the TNF-238 GG genotype of the promoter region and HLA-DRB1*04 bearing HLA haplotypes. Respir Med. 2014; 108(1): 211–7.
Peiffer G, Underner M, Perriot J. The respiratory effects of smoking. Rev Pneumol Clin. 2018; 74(3): 133–144.
Vasakova M, Morell F, Walsh S, Leslie K, Raghu G. Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management. Am J Respir Crit Care Med. 2017; 196(6): 680–689.
Fan LL. Hypersensitivity pneumonitis in children. Curr Opin Pediatr. 2002; 14(3): 323–6.
Walsh SLF, Richeldi L. Demystifying fibrotic hypersensitivity pneumonitis diagnosis: it’s all about shades of grey. Eur Respir J. 2019; 54(1). pii: 1900906.
Semple TR, Ashworth MT, Owens CM. Interstitial Lung Disease in Children Made Easier…Well, Almost. Radiographics. 2017; 37(6): 1679–1703.
Bush A, Cunningham S, de Blic J, Barbato A, Clement A, Epaud R, et al. chILD-EU Collaboration. European protocols for the diagnosis and initial treatment of interstitial lung disease in children. Thorax. 2015; 70(11): 1078–84.
Ratjen F, Bredendiek M, Zheng L, Brendel M, Costabel U. Lymphocyte subsets in bronchoalveolar lavage fluid of children without bronchopulmonary disease. Am J Respir Crit Care Med. 1995; 152: 174–178.
Churg A, Bilawich A, Wright JL. Pathology of Chronic Hypersensitivity Pneumonitis What Is It? What Are the Diagnostic Criteria? Why Do We Care? Arch Pathol Lab Med. 2018; 142(1): 109–119.
Miller R, Allen TC, Barrios RJ, Beasley MB, Burke L, Cagle PT, et al. Hypersensitivity Pneumonitis A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med. 2018; 142(1): 120–126.
Carlsen KH, Leegaard J, Lund OD, Skjaervik H. Allergic alveolitis in a 12-year-old boy – treatment with budesonide nebulizing solution. Pediatr Pulmonol. 1992, 12(4): 257–259.
Fiddler CA, Simler N, Thillai M, Parfrey H. Use of mycophenolate mofetil and azathioprine for the treatment of chronic hypersensitivity pneumonitis-A single-centre experience. Clin Respir J. 2019; 13(12): 791–794.
Sisman Y, Buchvald F, Blyme AK, Mortensen J, Nielsen KG. Pulmonary function and fitness years after treatment for hypersensitivity pneumonitis during childhood. Pediatr Pulmonol. 2016; 51(8): 830–7.