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Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline

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Raghu, Ganesh, Remy-Jardin, Martine, Ryerson, Christopher J., Myers, Jeffrey L., Kreuter, Michael, Vasakova, Martina, Bargagli, Elena, Chung, Jonathan H., Collins, Bridget F., Bendstrup, Elisabeth, Chami, Hassan A., Chua, Abigail T., Corte, Tamera J., Dalphin, Jean-Charles, Danoff, Sonye K., Diaz-Mendoza, Javier, Duggal, Abhijit, Egashira, Ryoko, Ewing, Thomas, Gulati, Mridu, Inoue, Yoshikazu, Jenkins, Alex R., Johannson, Kerri A., Johkoh, Takeshi, Tamae-Kakazu, Maximiliano, Kitaichi, Masanori, Knight, Shandra L., Koschel, Dirk, Lederer, David J., Mageto, Yolanda, Maier, Lisa A., Matiz, Carlos, Morell, Ferran, Nicholson, Andrew G., Patolia, Setu, Pereira, Carlos A., Renzoni, Elisabetta A., Salisbury, Margaret L., Selman, Moises, Walsh, Simon L. F., Wuyts, Wim A., Wilson, Kevin C.·2020·American Journal of Respiratory and Critical Care Medicine
DOI 10.1164/rccm.202005-2032st
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Abstract

Abstract Background This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax. Methods Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Results The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions. Conclusions The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.

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Cited by

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Metadata

Authors
Raghu, G., Remy-Jardin, M., Ryerson, C. J., Myers, J. L., Kreuter, M., Vasakova, M., Bargagli, E., Chung, J. H., Collins, B. F., Bendstrup, E., Chami, H. A., Chua, A. T., Corte, T. J., Dalphin, J.-C., Danoff, S. K., Diaz-Mendoza, J., Duggal, A., Egashira, R., Ewing, T., Gulati, M., Inoue, Y., Jenkins, A. R., Johannson, K. A., Johkoh, T., Tamae-Kakazu, M., Kitaichi, M., Knight, S. L., Koschel, D., Lederer, D. J., Mageto, Y., Maier, L. A., Matiz, C., Morell, F., Nicholson, A. G., Patolia, S., Pereira, C. A., Renzoni, E. A., Salisbury, M. L., Selman, M., Walsh, S. L. F., Wuyts, W. A., & Wilson, K. C.
Venue
American Journal of Respiratory and Critical Care Medicine
Publisher
Oxford University Press (OUP)
Published
2020-08-01
Volume
202
Issue
3
Pages
e36-e69
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
DOI
10.1164/rccm.202005-2032st
OpenAlex
W3044046114
Cited by
1,047
References
195
FWCI
66.49
Type
journal article
Language
en
Update notices
Open access
hybrid
Licence
creativecommons.org/licenses/by-nc-nd/4.0/ (vor, 2041 d)

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This page
CoChat. (2026). Citation check: Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline. https://app.cochat.ai/papers/10.1164/rccm.202005-2032st
The paper
Raghu, G., Remy-Jardin, M., Ryerson, C. J., Myers, J. L., Kreuter, M., Vasakova, M., Bargagli, E., Chung, J. H., Collins, B. F., Bendstrup, E., Chami, H. A., Chua, A. T., Corte, T. J., Dalphin, J.-C., Danoff, S. K., Diaz-Mendoza, J., Duggal, A., Egashira, R., Ewing, T., . . . Wilson, K. C. (2020). Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.202005-2032st

Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.