• Ashutosh Sharma, Vincent Ferraro, Elisabetta A Renzoni, and Julie Morisset.
• Interstitial Lung Disease Unit, Royal Brompton Hospital.
• Curr Opin Pulm Med. 2021 Sep 1; 27 (5): 414-421.

Purpose Of ReviewEstablishing a diagnosis of hypersensitivity pneumonitis (HP) and distinguishing it from other forms of interstitial lung diseases represents a common challenge in clinical practice. This review summarizes the latest literature and guidelines on HP while integrating some real-life conundrums.Recent FindingsAdvances in the understanding of the pathobiology of fibrotic HP and other progressive pulmonary fibrosis have changed how we approach the diagnosis and treatment of interstitial lung disease. Classifications now embrace distinguishing two clinical phenotypes: nonfibrotic and fibrotic HP because of distinct disease behavior and prognosis implications. International guidelines on HP were recently published and proposed a framework and algorithm to guide the diagnostic process.SummaryThe diagnosis of HP relies on the integration of multiples domains: clinical assessment of exposure, imaging, bronchoalveolar lavage lymphocytosis and histopathological findings. These features are reviewed in multidisciplinary discussion and lead to an estimation of the degree of confidence for HP diagnosis. Further research is warranted to improve knowledge on the pathophysiology of HP and ultimately improve its diagnostic approaches.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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