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Other Respiratory Tract Disorders
Hypersensitivity Pneumonitis
Idiopathic Intersitial Lung Disease

Idiopathic Interstitial Lung Disease

Welcome to a web page dedicated to aiding both the patient and physician in the diagnosis and long-term management of interstitial disorders that may be caused by inhalation of organic antigens in closed environments.


This site may be useful to an individual desiring to understand better methods of management of homes and workplaces to prevent contaminations.


Since this is an evolving area this site will be continually growing as new data are collected, tests and procedures improved, and different situations and circumstances are described.


  • Our area of the world is semi-arid South Texas. Life-styles, climate, building techniques and materials, and home management will differ to a degree between countries and regions of countries.


Definition: A group of disorders affecting the alveolar (air sacs) walls with inflammation (pneumonia) resulting in scar tissue deposition (fibrosis) of unknown cause that vary by symptomatic presentation, blood tests, patterns on lung biopsy, and morbidity and mortality.


Below is a classification of idiopathic interstitial lung diseases as discussed in the International Consensus Statement published in the Am J Respir Crit Care Med. 161;2000:646-64.


  • Idiopathic Interstitial lung Disease
  • Acute Interstitial Pneumonia (AIP)
  • Bronchiolitis Obliterans-Organizing Pneumonia (BOOP)
  • Idiopathic Pulmonary Fibrosis (IPF)
  • Usual Interstitial Pneumonia (UIP)
  • Non-specific Interstitial Pneumonia (NSIP)
  • Related Interstitial Lung Diseases
  • Hypersensitivity Pneumonia(HP)
  • Chronic Eosinophilic Pneumonia (CEP)
  • Pulmonary Infiltrate with Eosinophilia (PIE)
  • Desquamative Interstitial Pneumonia (DIP)
  • Respiratory Bronchiolitis-associated Interstitial Lung Disease (RBILD)
  • Lymphoid Interstitial Lung Disease (LIP)
  • Pulmonary Histiocytosis X
  • Sarcoid


Many of the types of idiopathic interstitial pneumonia/ fibrosis listed above can be shown to be caused by prolonged exposure to an organic antigen that is causative in the pathology of the disease. Remediation of, or avoidance of, the antigen leads to stability or non-progression of the disorder and, often, obviates the need for any long-term medication treatment.


Histopathological types of organic antigen-induced lung disease reported or evaluated by our facility:

  • Hypersensitivity Pneumonia (HP)
  • Non-specific Interstitial Pneumonia (NSIP)
  • Bronchiolitis Obliterans-Organizing Pneumonia (BOOP)
  • Usual Interstitial Pneumonia (UIP)
  • Chronic Eosinophilic Pneumonia (CEP)
  • Pulmonary Infiltrate with Eosinophilia (PIE)
  • Non-classified (NC)
  • Non-biopsied (NB)


We have described a cohort of patients seen sequentially with idiopathic interstitial lung disease at the time of referral. We evaluated all these patients from an immunological and environmental viewpoint and present that data as the basis for our opinion that we must change the way these patients are managed by both the pulmonologist and the allergist.


We propose that the diagnosis of Hypersensitivity Pneumonitis (HP) be expanded to include several different categories including:


  • Hypersensitivity Pneumonia: Granulomata Histopathologic Presentation
  • Hypersensitivity Pneumonia: NSIP Histopathologic Presentation
  • Hypersensitivity Pneumonia: CEP Histopathologic Presentation
  • Hypersensitivity Pneumonia: PIE Histopathologic Presentation
  • Hypersensitivity Pneumonia: UIP/IPF Histopathologic Presentation
  • Hypersensitivity Pneumonia: BOOP Histopathologic Presentation
  • Hypersensitivity Pneumonia: Nonclassified Histopathologic Presentation
  • Hypersensitivity Pneumonia: Non-biopsied Presentation
  • Hypersensitivity Pneumonia: AIP Histopathologic Presentation
  • Hypersensitivity Pneumonia: RBILD Histopathologic Presentation

We propose that all these patients be managed by a team of the PCP, pulmonary physician, and the allergist. We feel the primary care provider (PCP) should quickly refer these patients to the pulmonologist for advanced diagnostic procedures.The pulmonologist quickly refers to the allergist who must determine if an environmental cause is playing a role. The onus is on the allergist to work with the patient, investigators, and contractors to remediate the causative problems and confirm effectiveness. Long-term management is a shared responsibility between all three specialities if the patient is to do well.