Immunologic evaluation of environmental lung disease

Environmental lung disease is any respiratory ailment that results from inhalation of airborne substances, either particulate or gaseous. Some forms of environmental lung disease such as reactive airways dysfunction syndrome are not immunologically mediated, and no immunologic workup is indicated. However, if a patient has a history compatible with an immunologically mediated disease such as asthma or hypersensitivity pneumonitis, appropriate immunologic evaluation should be performed. With the identification, preparation, and characterization of the putative antigen(s), a variety of tests can be used to evaluate the immune mechanism. However, these tests are corroborative only and are to be used in conjunction with a compatible clinical history and other appropriate clinical evaluations such as pulmonary function tests and chest films. Once a diagnosis is established, corticosteroids or other medications may be useful in the management of the acute disease, but the definitive treatment is avoidance of the antigen.