Moldy Hazelnut Husk and Shell Related Hypersensitivity Pneumonitis: A Possible Novel Occupational Causative Agent
Keywords:hypersensitivity pneumonitis; hazelnut husk and leaves; molds
Hypersensitivity pneumonitis (HP) is a complex immune-mediated interstitial lung disease (ILD) triggered by inhalation exposure to environmental or occupational antigens in genetically susceptible individuals. Novel exposure sources and antigens are frequently identified. However, the causative agent remains unidentified in nearly half of HP cases. Early diagnosis for nonfibrotic-HP and quitting the exposure may prevent the disease progression to fibrotic forms and related complications. Here, we present two cases of HP associated with mold exposure in hazelnut husks, leaves, and shells in hazelnut agriculture.
Walters GI, Huntley CC. Novel occupational causes of hypersensitivity pneumonitis. Curr Opin Allergy Clin Immunol.2023;23(2):85-91. Doi: 10.1097/aci.0000000000000894
Raghu G, Remy-Jardin M, Ryerson CJ, et al. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202(3):e36-e69. Doi: 10.1164/rccm.202005-2032ST
Fernández Pérez ER, Kong AM, Raimundo K, Koelsch TL, Kulkarni R, Cole AL. Epidemiology of Hypersensitivity Pneumonitis among an Insured Population in the United States: A Claims-based Cohort Analysis. Ann Am Thorac Soc. 2018;15(4):460-469. Doi: 10.1513/AnnalsATS.201704-288OC
Kongsupon N, Walters GI, Sadhra SS. Occupational causes of hypersensitivity pneumonitis: a systematic review and compendium. Occup Med. 2021;71(6-7):255-259. Doi: 10.1093/occmed/kqab082
Cormier Y, Laviolette M. Farmer's lung. 1993, Thieme Medical Publishers, Inc.; 1993:31-37.
Fernández Pérez ER, Travis WD, Lynch DA, et al. Executive Summary: Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report. Chest. 2021;160(2):595-615. Doi:10.1016/j.chest.2021.03.067
Hamblin M, Prosch H, Vašáková M. Diagnosis, course and management of hypersensitivity pneumonitis. Eur Respir Rev. 2022;31(163).
Castro NR, Swart J. Building a roundtable for a sustainable hazelnut supply chain. J Clean Prod. 2017;168:1398-1412.
Erkan F, Baur X, Kiliçaslan Z, et al. [Exogenous allergic alveolitis caused by mouldy hazel nut leaves]. Exogene allergische Alveolitis durch schimmelige Haselnusshüllblätter. Pneumologie. 1992;46(1):32-5.
Arbak P, Karatas N, Balbay EG, et al. Respiratory symptoms and pulmonary functions in hazelnut workers. Health Med. 2011:165.
Moran-Mendoza O, Aldhaheri S, Black CJ, Clements-Baker M, Khalil M, Boag A. Mold in Foam Pillows and Mattresses: A Novel Cause of Hypersensitivity Pneumonitis. Chest. 2021;160(3):e259-e263.
Barnes H, Lu J, Glaspole I, Collard HR, Johannson KA. Exposures and associations with clinical phenotypes in hypersensitivity pneumonitis: a scoping review. Respir Med. 2021;184:106444.
Pscheidt J, Heckert S, Wiseman M, Jones L. Fungi associated with and influence of moisture on development of kernel mold of hazelnut. Plant Dis. 2019;103(5):922-928.
Barranco P, Moreno-Ancillo A, Robles MLM, et al. Hypersensitivity pneumonitis in a worker exposed to tiger nut dust. J Allergy Clin Immunol. 1999;104(2):500-501.
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