Barnes Hayley, Lu Jesse, Glaspole Ian, Collard Harold R, Johannson Kerri A
Department of Medicine, University of California, San Francisco, USA; Central Clinical School, Monash University, Melbourne, Australia; Department of Respiratory Medicine, Alfred Health, Melbourne, Australia.
Department of Medicine, University of Toronto, Toronto, Canada.
Respir Med. 2021 Aug;184:106444. doi: 10.1016/j.rmed.2021.106444. Epub 2021 May 6.
Antigen identification is important for establishing a confident diagnosis of hypersensitivity pneumonitis (HP). There are no systematically curated lists of HP-associated exposures that inform clinical relevance or disease phenotype. We sought to systematically identify all reported causes of HP in the literature and evaluate their clinical relevance. A scoping review was performed to identify all publications describing HP cases and their associated exposures (even if unknown) from Jan 1990-June 2020. Frequencies of exposures and meta-analysis of proportions for registry-based studies were determined for specific exposure categories, and associations with fibrotic and non-fibrotic HP were assessed. 24,138 publications were identified, with 967 publications included in the final analysis, representing 62 unique exposures associated with HP. Certain exposures were more frequently reported than others, including birds (comprising 32% of HP cases in registry-based studies) and mould (17% registry study HP cases). Antigen-indeterminate HP comprised 15-24% of registry-based studies. Limited data found contaminated metal-working fluids, isocyanate exposure, and hot tub lung were rarely associated with fibrotic features, whereas antigen-indeterminate HP cases were more frequently associated with fibrosis. There was heterogeneity in HP case definition and how causative exposures were identified. We identified 62 unique exposures associated with HP, with specific exposures associated with clinical phenotypes. These data may inform clinical assessment and the development of questionnaires to identify antigens in the diagnostic evaluation of suspected HP. OPEN SCIENCES FRAMEWORK REGISTRATION: osf.io/4aq5m.
抗原鉴定对于确诊过敏性肺炎（HP）至关重要。目前尚无系统整理的与HP相关暴露因素清单来指导临床相关性或疾病表型。我们试图系统地识别文献中所有报道的HP病因，并评估其临床相关性。进行了一项范围综述，以识别1990年1月至2020年6月期间描述HP病例及其相关暴露因素（即使未知）的所有出版物。确定了特定暴露类别基于登记研究的暴露频率和比例的荟萃分析，并评估了与纤维化和非纤维化HP的关联。共识别出24,138篇出版物，最终分析纳入967篇出版物，代表62种与HP相关的独特暴露因素。某些暴露因素的报道频率高于其他因素，包括鸟类（在基于登记研究的HP病例中占32%）和霉菌（登记研究HP病例的17%）。抗原未明确的HP占基于登记研究的15 - 24%。有限的数据发现，受污染的金属加工液、异氰酸酯暴露和热水浴缸肺很少与纤维化特征相关，而抗原未明确的HP病例更常与纤维化相关。HP病例定义以及如何识别致病暴露因素存在异质性。我们识别出62种与HP相关的独特暴露因素，特定暴露因素与临床表型相关。这些数据可为临床评估以及在疑似HP诊断评估中识别抗原的问卷开发提供参考。开放科学框架注册：osf.io/4aq5m。
