Tuesday, January 09, 2007

Hypersensitivity Pneumonitis

Anonymous M.D. asks if anyone knows of alternative immunotherapy for the treatment of chronic hypersensitivity pneumonitis in a patient who is not responding to steroids. Her FVC has remained in the mid 50% range regardless of predxnisone does (range 0 to 40 mg). The HRCT shows fairly extensive ground glass to indicate an active alveolitis. Of note, this patient has an open lung bx that was consistent with the diagnosis of HP).

4 comments - CLICK HERE to read & add your own!:

Anonymous said...

GGO may not be inflammatory the, but first - try higher doses of steroids first(60-80 mg or go IV then to oral), and then taper down - going much more slow taper at the lower doses (under 20 mgs - give scripts for 1 mg and 2.5 mg pills, and under 5 mg, perhaps substitute equivalent dose of hydrocortisone at that point, with ability to split dose AM and PM if nec). Send patient to a good allergist/immunologist for testing. Go over their history of exposures, drugs, supplements again. Get the home checked out - have them stay away from the home for a while if possible. Start introducing the other steroid-sparing immunomodulators when patient is around 20 mgs of pred. Immuran, Methotrexate, Cytoxan, Sirolimus. Close blood, pft and CXR monitoring for follow-up.

Baleeiro said...

My suggestion would be similar to the other comment and revisit the etiology/exposure of the HP.
I had a Pt back in Michigan who did not respond to steroids and was intolerant of MTx and Cytoxan and we anecdotally had a good response with Celcept and prednisone...

Anonymous said...

As a person who has suffered many years with HP I can offer what works for me when Prednisone does not. First, the dose of Pred should be much higher, I have been give as much as 300mg per day to start. Not fun. Try Benadryl 50-75 mg every 3-4 hours with Pred in the 80-120 mg range. You may also find that Siberian Ginseng and Licorrice Root extract have extremely strong results. Have the patient wear N-95 masks as many hours a day as possible. My HP is caudes by even the smallest amount of mold spores and also from the VOC's that mold makes. These vapors are often worse at inducing HP than the spores and pass through HEPA filters. Ventilate with clean air. Best wishes.

manoj said...

in hypersensitivity pneumonitis, there IS a cause of the allergic alveolitis. if you try to fine the offending factor, and the patient can avoid it, you will definately have a better response. Apart from the exposure to pigeons in good no. of my patients, patients also had HP due to old sofa foam, geyser used for hot water bath, cleaning aquarium. SO stretch your imagination and include the epatient in it. Best of Luck
Dr. Manoj Yadav, Vadodara, India