General Guideline Principles for Hypersensitivity Pneumonitis

(HP) for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Hypersensitivity Pneumonitis (HP).

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Hypersensitivity Pneumonitis (HP) of Occupational Interstitial Lung Disease

Hypersensitivity Pneumonitis (HP), also known as extrinsic allergic alveolitis, can be brought on by breathing in organic dust that has antigenic qualities or by being exposed to substances with low molecular weights that can trigger sensitization.

Condition Considerations

HP is a broad category of immune response disorders that are frequently linked to granulomatous pathological alterations. HPs frequently exhibit strong occupational or environmental specificity.

Inhaled causative agents include:

  • Animal proteins

  • Plant proteins

  • Bacteria

  • Fungi

  • Diisocyanates.

  • Paints

  • Trimellitic anhydride

  • Epoxy resins

  • “Bordeaux combination,” a copper sulfate-based insecticide applied to vineyards

These dusts arise from:

  • Renovation of structures (particularly destruction or the exposure of wet internal walls), contact with contaminated water, or prolonged exposure to moist environments (such as humidifiers, hot tubs, saunas, and unventilated showers)

  • Handling birds

  • Occasionally from animal sensitization (like farmer’s lung)

  • Amoebae; • Insects (such as miller’s lung, whose antigen is a wheat weevil protein); (humidifier lung)

  • Powdered pesticide (pyrethrum HP)

  • A thermophilic actinomycete bacteria’s spores cause furrier’s lung disease

  • Dusts made from grains, animals, or mould spores.

Airway blockage and wheeze are frequent precursors to HP. If left untreated and uncontrolled, it could develop into severe impairment and respiratory insufficiency. Contrary to most hypersensitivity pneumonitides, the pigeon breeders’ lung is infamously connected to clubbing.

Latency of Hypersensitivity Pneumonitis (HP)

In HP, sensitization may start to develop after a few weeks of exposure, but in some cases it may take months or years.A sensitized person has the acute, primary airway symptoms of HP over a period of days to weeks.

Over the course of weeks, these symptoms may progress to interstitial inflammation and, eventually, fibrosis. In rare cases, it may also be hyperacute or rapid in start, like some eosinophilic pneumonias or some drug-induced pneumonitis.

Differential Diagnosis of Hypersensitivity Pneumonitis (HP)

An acute influenza-like illness or febrile disease in a patient with a history of exposure to inhaled antigens should be differentially diagnosed with HP.

Infection (mycoplasma, Legionella spp., or diffuse mycosis) or rheumatological or autoimmune lung illness may also be implicated as a contributing factor in interstitial disease, the latter of which is particularly true in hosts with weakened immune systems. A history of bird exposure should suggest the risk of further illnesses, such as psittacosis.

Personal and familial vulnerability may be a factor in the development of HP even though there are no known risk factors.

What our office can do if you have workers compensation injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

We are orthopedic surgeons and do not treat chest diseases. We will refer you to someone in your area who does treat respiratory symptoms.

Disclaimer

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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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