Table 7.
Occupational Associations with Hypersensitivity Pneumonitis
| First Author, Year, Location (Reference) | Study Type | Cases (N) | Disease Definition | Exposure/Job Information | Comments | Occupational Burden (%) |
|---|---|---|---|---|---|---|
| Kawanami, 1983, USA (168) | Case series | 18 | Clinical, radiographic, physiologic, and laboratory data | History, clinical data, and serologic testing in 13 patients | 72.2% environmental; 27.7% unknown cause | 0 |
| Yoshida, 1995, Japan (169) | Case series | 835 | Criteria of the Japan Research Committee on Diffuse Pulmonary Disease for Hypersensitivity Pneumonitis | History, clinical data, and serologic testing | 79.4% environmental; 6.8% unknown cause | 13.8 |
| Yoshizawa, 1999, Japan (170) | Case series | 36 | Clinical and imaging criteria | History, clinical data, and serologic testing | 61.4% environmental; 13.9% unknown cause, series limited to chronic HP | 25.3 |
| Thomeer, 2001, Belgium (171) | Multicenter disease registry | 47 | A set of clinical and imaging criteria; data from the nationwide electronic register | Not clearly stated | 76.6% environmental; 23.4% unknown cause | 0 |
| Bang, 2006, USA (172) | Death certificate date | 814 | Death certificate coding | Occupationally related ICD codes for causes>100% due to multiple coded causes of HP | 38.4% occupational; 55.6% unknown cause | 40.5 |
| Hanak, 2007, USA (173) | Case series from a single center | 85 | Clinical and imaging criteria from the Mayo Clinic database | History, clinical data, and serologic testing | 64.7% environmental; 24.7% unknown cause | 10.6 |
| Olson, 2008, USA (174) | Case series from a single center | 4 | Retrospective case review; only cases with acute exacerbation of fibrotic HP | History, clinical data, and serologic testing; biopsy confirmation | 50% environmental; 50% unknown cause | 0 |
| Selman, 2010, multicountry (166) | Prospective multicenter cohort study | 199 | Clinical and imaging data, supported by the experts’ opinion | History, clinical data, and serologic testing | 76.9% environmental; 1.5% unknown cause | 21.6 |
| Cımrın, 2010, Turkey (175) | Review of published cases | 22 | Based on cases as defined in publications reviewed | Heterogeneous | 66.6% environmental; none of unknown cause | 33.3 |
| Caillaud, 2012, France (176) | Case series, multicenter | 139 | Clinical and imaging criteria | History, clinical data, and serologic testing | 18.7% environmental; none of unknown cause | 81.3 |
| Alhamad, 2013, Saudi Arabia (177) | Case series | 21 | A set of clinical and imaging criteria followed by expert review | Questionnaire | 42.9% environmental; 33.3% unknown cause | 23.8 |
| Castonguay, 2015, USA (178) | Case series | 40 | Clinical and imaging criteria | History, clinical data, and serologic testing; case overlap with Hanak et al., 2007 (173) | 55% environmental; 37.5% unknown cause | 7.5 |
| Millerick-May, 2016, USA (179) | Case series | 19 | ATS guidelines for the diagnosis of ILD | History, clinical data, and serologic testing | 51.9% environmental; none of unknown cause | 42.1 |
| Singh, 2017, India (180) | Prospective registry | 513 | Diagnostic criteria, expert review | Questionnaire | 69.4% environmental; 24.8% unknown cause | 5.8 |
| Cramer, 2016 Denmark (167) | Retrospective cohort study | 6,920 | Cases identified from records in Danish National Patient Register | Data on occupation were provided by Statistics Denmark | OR, 1.55 (95% CI, 1.40–1.72); cases exposed = 46% | 20.2 |
Definition of abbreviations: ATS = American Thoracic Society; CI = confidence interval; HP = hypersensitivity pneumonitis; ICD = International Classification of Diseases; ILD = interstitial lung disease; OR = odds ratio; USA = United States.
Occupational burden is derived from the proportion of occupationally attributed cases in the series or, in the case of Cramer and colleagues (167), derived from the OR and proportion of exposed cases. The overall burden of occupationally attributed HP is 19% (95% CI, 12–28%).