Hypersensitivity Pneumonitis: Challenges of a Complex Disease

Table 3

Face-to-face recommendations on the same diagnostic tools given by the guidelines [6, 8].

Diagnostic tools	Chest guideline	ATS/JRS/ALAT guideline
History of exposure	Thorough clinical history of exposures	Thorough history to identify potential exposures ± questionnaires
	Role of occupational medicine specialist and an environmental hygienist	—
	Clinical improvement after exposure avoidance—support diagnosis	—
	Serum-specific IgG, IgA testing	Serum-specific IgG testing
HRCT role	HRCT integrated with clinical findings	HRCT essential role
BAL	Not routinely recommended	BAL for lymphocyte count recommended for non-fibrotic HP and suggested for fibrotic HP (adding TBB increases the diagnostic yield)
Lung biopsy	Indicated when clinical, laboratory, HRCT, and BAL do not yield the diagnosis	TBB for non-fibrotic HP
	Integrating biopsy with clinical and HRCT	TBLC for fibrotic HP
	No recommendation regarding the preferred methods	SLB suggested only after alternative diagnostic options have been exhausted
MDT	For deciding the need for lung biopsy	For deciding the need for TBLC or SLB
	For diagnostic decision-making	For diagnostic decision-making

BAL: bronchoalveolar lavage, HRCT: high-resolution computer tomography, MDT: multidisciplinary team, TBB: transbronchial biopsy, TBLC: transbronchial cryo-biopsy, and SLB: surgical lung biopsy.