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Table 3 Diagnostic criteria for HP in children (modified from [28])

From: Pediatric hypersensitivity pneumonitis: literature update and proposal of a diagnostic algorithm

Suggestive characteristics for HP:
1. Known exposure history to trigger antigen
a. positive aerobiological and microbiological environmental investigations
b. Sieric specific IgG levels [precipitins, ELISA, ImmunoCAP]
2. Compatible HRCT patternsa
3. Lymphocytosis at BAL (aspecific, not always necessary)
4. Positive inhalation challenge (only in selected patients)
• Environmental restatement
• Provocation test to the antigen
CONFIDENT HP without biopsy:
- Criteria 1 + 2 + 3: Histopathologic confirmation not necessary
- Criteria 1 + 2: BAL not necessary in case of clear exposition, typical HRCT, and response after antigen avoidance
- Criteria 1 (a or b) + 3; HRCT consistent with other lung diseases
- Criteria 2 + 3; no environmental exposure or serologic evidence
- Criteria 1 (a or b); HRCT consistent with other lung diseases; BAL not performed or without lymphocytosis
- Criteria 1 (a or b) + 2; BAL without lymphocytosis
  1. aHRCT patterns in acute HP: little centrilobular nodules predominantly in upper and middle lobes; ground-glass attenuation; reduced attenuation and vascularization lobular areas. HRCT patterns in chronic HP: upper and middle lobe or peribronchial-vascular fibrosis; honeycomb; air trapping; ground-glass attenuation; centrilobular nodules and relative sparing of the bases
  2. bLung biopsy appropriate for HP confirmation or identification of other diseases