306 Ch 305. Hypersensitivity Pneumonitis and Eosinophilic Pulmonary Disease

Hypersensitivity pneumonitis (HP) = 過敏性肺炎，inhaled antigen 誘發的免疫介導 ILD；分 fibrotic (chronic) vs non-fibrotic (acute / subacute)；常見抗原：bird antigens (bird fancier’s lung)、thermophilic actinomycetes (farmer’s lung)、moldy hay、hot tub molds、isocyanates；診斷靠 antigen exposure + HRCT (mosaic attenuation, ground-glass, fibrosis) + BAL lymphocytosis (CD4/CD8 < 1)；治療 = antigen avoidance + steroids + nintedanib / pirfenidone for fibrotic HP；eosinophilic pulmonary diseases：(1) acute eosinophilic pneumonia (AEP)；(2) chronic eosinophilic pneumonia (CEP)；(3) ABPA (allergic bronchopulmonary aspergillosis)；(4) EGPA (Churg-Strauss)；(5) DRESS；(6) parasitic (Loeffler, schistosoma)；(7) idiopathic hypereosinophilic syndrome (HES)；治療多以 corticosteroids 為主；dupilumab + mepolizumab 在 eosinophilic conditions 有 emerging role；ABPA 用 itraconazole + steroids + dupilumab for refractory。