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24.5: Hypersensitivity Pneumonitis and Summary

  • Page ID
    152354
    • Ying Liu, Serena Chang, Grace Murphy, Esther Ajayi-Akinsulire, Isobel Ardren, Izabella Guy, Kai Johnston, Saskia Lee, and Lauren Russell
    • City College of San Francisco

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    Learning Objectives
    • Explain why hypersensitivity pneumonitis is considered an occupational disease.
    • Summarize the similarities and differences among different types of hypersensitivity.

    Hypersensitivity Pneumonitis

    Some disease caused by hypersensitivities are not caused exclusively by one type. For example, hypersensitivity pneumonitis (HP), which is often an occupational or environmental disease, occurs when the lungs become inflamed due to an allergic reaction to inhaled dust, endospores, bird feathers, bird droppings, molds, or chemicals. HP goes by many different names associated with various forms of exposure (Figure \(\PageIndex{9}\)). HP associated with bird droppings is sometimes called pigeon fancier’s lung or poultry worker’s lung—both common in bird breeders and handlers. Cheese handler’s disease, farmer’s lung, sauna takers' disease, and hot-tub lung are other names for HP associated with exposure to molds in various environments.

    Pathology associated with HP can be due to both type III (mediated by immune complexes) and type IV (mediated by TH1 cells and macrophages) hypersensitivities. Repeated exposure to allergens can cause alveolitis due to the formation of immune complexes in the alveolar wall of the lung accompanied by fluid accumulation, and the formation of granulomas and other lesions in the lung as a result of TH1-mediated macrophage activation. Alveolitis with fluid and granuloma formation results in poor oxygen perfusion in the alveoli, which, in turn, can cause symptoms such as coughing, dyspnea, chills, fever, sweating, myalgias, headache, and nausea. Symptoms may occur as quickly as 2 hours after exposure and can persist for weeks if left untreated.

    A) Photo of chickens in a coop. b) Photo of a worker in a warehouse.
    Figure \(\PageIndex{9}\): Occupational exposure to dust, mold, and other allergens can result in hypersensitivity pneumonitis. (a) People exposed daily to large numbers of birds may be susceptible to poultry worker’s lung. (b) Workers in a cheese factory may become sensitized to different types of molds and develop cheese handler’s disease. (credit a: modification of work by The Global Orphan Project)

    Figure \(\PageIndex{10}\) summarizes the mechanisms and effects of each type of hypersensitivity discussed in this section.

    Table summarizing four types of hypersensitivities. Type I uses immune reactant IgE and a soluble antigen. The mechanism of activation is: Allergen-specific IgE antibodies bind to mast cells via their Fc receptor. When the specific allergen binds to the IgE, cross-linking of IgE induces degranulation of mast cells. Examples of hypersensitive reactions include: Local and systemic anaphylaxis, seasonal hay fever, food allergies, and drug allergies. Type II uses immune reactant IgG or IgM and a cell-bound antigen. The mechanism of activation is: IgG or IgM antibody binds to cellular antigen, leading to complement activation and cell lysis. IgG can also mediate ADCC with cytotoxic T cells, natural killer cells, macrophages, and neutrophils. Examples of hypersensitive reactions include: Red blood cell destruction after transfusion with mismatched blood types or during hemolytic disease of the newborn. Type III uses immune reactant IgG or IgM and a soluble antigen. The mechanism of activation is: Antigen-antibody complexes are deposited in tissues. Complement activation provides inflammatory mediators and recruits neutrophils. Enzymes released from neutrophils damage tissue. Examples of hypersensitive reactions include: Local and systemic Post-streptococcal glomerulonephritis, rheumatoid arthritis, and systemic lupus erythematosus. Type IV uses immune reactant T cells and a soluble or cell-bound antigen. The mechanism of activation is: TH1 cells secreete cytokines, which activate macrophages and cytotoxic T cells.. Examples of hypersensitive reactions include: Contact dermatitis, type I diabetes mellitus, and multiple sclerosis.
    Figure \(\PageIndex{10}\): Components of the immune system cause four types of hypersensitivities. Notice that types I–III are B-cell/antibody-mediated hypersensitivities, whereas type IV hypersensitivity is exclusively a T-cell phenomenon.

    Query \(\PageIndex{1}\)

     


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