Hypersensitivity pneumonitis
Neumonitis por Hipersensibilidad
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Hypersensitivity pneumonitis corresponds to 20% of all interstitial pathologies, its new classification of the ATS / ALAT / JRS / 2020 in inflammatory or fibrotic and identification of clinical criteria, radiological and pathological patterns allow us a greater identification and improve the subdiagnosis of the illness. Pneumonitis depends on a genetic predisposition, on the reaction against one or more antigens (organic, protein and inorganic) repeatedly, in a susceptible person, which leads to an immune response and will trigger according to time, duration and quantity of antigen exposure an inflammatory and subsequent fibrotic response in the small airway and lung parenchyma. Its incidence and prevalence are variable according to the region and the identification of the antigen. The clinical picture will depend on the acute or chronic exposure to the antigen, although some patients may develop the chronic form despite the suspension of the antigen. The diagnosis will be made with a complete, detailed clinical history, seeking, trying to find the antigen, the clinical picture and the inflammatory or fibrotic radiological and pathological patterns, associated with 20% lymphocytosis in the bronchoalveolar lavage and the help of a multidisciplinary group. Suspension of antigen exposure is the most important part of treatment. Pharmacological therapy is performed with immunosuppressants, steroids, mycophenolate, and azathioprine with low evidence, and antifibrotic drugs are indicated in the progressive fibrosing form.
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