Test Id : BHYPS
Hypersensitivity Pneumonitis Panel, Immunoglobulin G, Serum
Useful For
Suggests clinical disorders or settings where the test may be helpful
Evaluation of patients suspected of having hypersensitivity pneumonitis induced by exposure to Alternaria tenuis/alternata, Aspergillus fumigatus, Aureobasidium pullulans, Laceyella sacchari, Micropolyspora faeni, Penicillium chrysogenum/notatum, Phoma betae, and Trichoderma viride
Method Name
A short description of the method used to perform the test
Fluorescence Enzyme Immunoassay (FEIA)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Allergic Lung Serology
Aeroallergen
Allergic bronchopulmonary aspergillosis
ABPA
Alternaria alternata
Alternaria tenuis
Alternaria tenuis/alternata
Aspergilloma
Aspergillosis
Aspergillus fumigatus
Asthma
Aureobasidium pullulans
Bagassosis
Chronic pulmonary aspergillosis
Dematiaceous fungus
Farmer's Lung Antibody
Farmer's Lung Disease
Fumigatus
Fungal sensitizer
Air conditioner lung
Hay fever
Hot tub lung
Humidifier lung
Hypersensitivity pneumonitis
Laceyella sacchari
Micropolyspora faeni
Neocamarosporium betae
non-tuberculous mycobacteria (NTM)
Penicillium chrysogenum
Penicillium notatum
Phoma betae
Saccharopolyspora rectivirgula
Saprophyte
Saprophytic fungus
Trichoderma viride
Specimen Type
Describes the specimen type validated for testing
Serum
Ordering Guidance
This is a panel of tests which includes serology for: Alternaria tenuis/alternata, Aspergillus fumigatus, Aureobasidium pullulans, Laceyella sacchari, Micropolyspora faeni, Penicillium chrysogenum/notatum, Phoma betae, and Trichoderma viride. If only Aspergillus fumigatus is requested, order SASP / Aspergillus fumigatus, IgG Antibodies, Serum.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Container/Tube: Sarstedt Aliquot Tube, 5 mL (T914)
Preferred: Serum gel
Acceptable: Red top
Specimen Volume: 0.5 mL Serum
Collection Information: Centrifuge and aliquot serum into a plastic vial.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
Serum: 0.3 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Evaluation of patients suspected of having hypersensitivity pneumonitis induced by exposure to Alternaria tenuis/alternata, Aspergillus fumigatus, Aureobasidium pullulans, Laceyella sacchari, Micropolyspora faeni, Penicillium chrysogenum/notatum, Phoma betae, and Trichoderma viride
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Hypersensitivity pneumonitis (HP) is a complex inflammatory lung disease triggered by repeated inhalation of various organic and inorganic antigens in susceptible individuals.(1-3) The condition presents significant diagnostic challenges due to its diverse clinical presentations, variable disease progression, and overlap with other interstitial lung diseases.(1,3-5) The 2020 American Thoracic Society and Japanese Respiratory Society, and Asociacion Latinoamericana del Torax (ATS/JRS/ALAT) Clinical Practice Guideline emphasizes that HP diagnosis requires a comprehensive multidisciplinary approach integrating clinical history, exposure assessment, radiological findings, and when necessary, histopathological examination.(1,5) Currently, no single test is sufficient for definitive diagnosis of HP.
Serum IgG testing serves as one component of the diagnostic workup for HP, particularly in identifying specific antigenic exposures. However, studies demonstrate significant limitations in the diagnostic performance of serum IgG testing alone.(1,3,4) The clinical validity of HP antibody assays is enhanced when used within a structured diagnostic framework.(1) Multidisciplinary team meetings have shown improved diagnostic agreement in diffuse parenchymal lung diseases, highlighting the importance of integrating serological findings with other clinical data rather than relying on laboratory results in isolation.(2) Contemporary understanding of HP recognizes an expanding spectrum of causative agents beyond traditional organic dust. Occupational causes encompass diverse antigens including microbial agents, animal proteins, and chemical compounds.(6,7). The use of multi-analyte antibody panels can help identify specific antigenic exposures, particularly in occupational settings, though the absence of detectable antibodies does not exclude HP diagnosis.
Recent research has identified distinct clinical phenotypes in HP that may influence the interpretation of serological testing.(8) The relationship between specific exposures and clinical presentations varies considerably, with some patients developing disease despite minimal apparent exposure while others with significant exposure remain asymptomatic. The pathogenesis of HP involves complex immune mechanisms beyond simple antibody-mediated responses, including T-cell activation and inflammatory cascades.(1,3) This complexity underscores why serological testing alone cannot be used to establish or exclude the diagnosis of HP.(3, 4) In addition, reference intervals for the analytes tested do vary between laboratories, even when the same instrument and reagents are used.(9-10)
The panel's clinical validity is established through its ability to identify specific antigenic exposures and immune responses associated with HP, while requiring integration with comprehensive clinical assessment for optimal diagnostic accuracy. Healthcare professionals should utilize these assays as one component of a comprehensive diagnostic evaluation, maintaining awareness of their limitations while leveraging their potential to identify relevant exposures and guide further clinical investigation.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Alternaria alternata, IgG antibody: < or =19.0 mg/L
Aspergillus fumigatus, IgG antibody: < or =102.0 mg/L
Aureobasidium pullulans, IgG antibody: < or =16.0 mg/L
Laceyella sacchari, IgG antibody: < or =45.0 mg/L
Micropolyspora faeni, IgG antibody: < or =6.0 mg/L
Penicillium chrysogenum, IgG antibody: < or =94.0 mg/L
Phoma betae, IgG antibody: < or =16.0 mg/L
Trichoderma viride, IgG antibody: < or =16.0 mg/L
Interpretation
Provides information to assist in interpretation of the test results
Antibody levels greater than the reference range indicate that the patient has been immunologically sensitized to the antigen or a related antigen. The significance of an elevated antibody response is dependent on a combination of patient's clinical history, HRCT (high-resolution computed tomography) scan findings, pathological examination, and certain risk factors (eg, environmental and occupational determinants). Results must be interpreted as a component of a comprehensive diagnostic evaluation and known limitations of hypersensitivity tests.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
IgG antibodies to Alternaria tenuis/alternata, Aspergillus fumigatus, Aureobasidium pullulans, Laceyella sacchari, Micropolyspora faeni, Penicillium chrysogenum/notatum, Phoma betae, and Trichoderma viride may be found in sera from healthy individuals; the presence of these specific antibodies is not sufficient to establish the diagnosis of hypersensitivity pneumonitis.
Elevated concentration of antibodies to Aspergillus fumigatus may be also found in patients with invasive aspergillosis and cavitary lung disease.
The concentrations of antibodies to these antigens may decrease following treatment, although elevated concentrations may persist in treated patients.
The test method utilizes the fluorescence enzyme immunoassay (FEIA) on Phadia ImmunoCAP 250. Values obtained using the same test system or different assay methods cannot be used interchangeably. Alternative reference values established utilizing the same reagents or test system may be influenced by the characteristics of the local cohorts and environmental exposures.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. 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
2. Walsh SLF, Wells AU, Desai SR, et al. Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study. Lancet Respir Med. 2016;4(7):557-565
3. Barnes H, Troy L, Lee CT, Sperling A, Strek M, Glaspole I. Hypersensitivity pneumonitis: Current concepts in pathogenesis, diagnosis, and treatment. Allergy. 2022;77(2):442-453
4. Jenkins AR, Chua A, Chami H, et al. Questionnaires or Serum Immunoglobulin G Testing in the Diagnosis of Hypersensitivity Pneumonitis among Patients with Interstitial Lung Disease. Ann Am Thorac Soc. 2021;18(1):130-147
5. Johannson KA, Barnes H, Bellanger AP, et al. Exposure Assessment Tools for Hypersensitivity Pneumonitis. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2020:17(12):1501-1509
6. Kongsupon N, Walters GI, Sadhra SS. Occupational causes of hypersensitivity pneumonitis: a systematic review and compendium. Occup Med (Lond). 2021;71(6-7):255-259
7. Calaras D, David A, Vasarmidi E, Antoniou K, Corlateanu A. Hypersensitivity Pneumonitis: Challenges of a Complex Disease. Can Resp J. 2024;2024:4919951
8. 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
9. Raulf, M, et al. Update of reference values for IgG antibodies against typical antigens of hypersensitivity pneumonitis: Data of a German multicentre study. Allergo Jour Int. 2019;28(6):192-203
10. Lozier B, Martins T, Slev P, Saadalla A. Determination of Positivity Cutoff for an Automated Aspergillus fumigatus-Specific Immunoglobulin-G Assay in a National Reference Laboratory. J Appl Lab Med. 2025;10(3): 619-628
Method Description
Describes how the test is performed and provides a method-specific reference
The Phadia ImmunoCAP System-specific IgG-fluorescence enzyme immunoassay (FEIA) provides an in vitro method for measuring the levels of circulating specific IgG antibodies in human blood samples. Specific IgG from the patient's serum reacts with the antigen of interest, which is covalently coupled to an ImmunoCAP. After washing away nonspecific IgG, enzyme-labeled anti-IgG antibodies are added to form a complex. After incubation, unbound enzyme anti-IgG is washed away and the bound complex is then incubated with a developing agent. After stopping the reaction, the fluorescence of the eluate is measured. The fluorescence is proportional to the amount of specific IgG that is present in the patient's sample (ie, the higher the fluorescence value, the more specific IgG antibody is present).(Package insert: Phadia AB, Uppsala, Sweden 2009)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
86001 x 8
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| BHYPS | Hypersensitivity Pheum Panel,IgG, S | 35577-6 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| BH01 | Alternaria alternata, IgG Ab | 26951-4 |
| BH02 | Aspergillus fumigatus, IgG Ab | 26954-8 |
| BH03 | Aureobasidium pullulans, IgG Ab | 26955-5 |
| BH04 | Laceyella sacchari, IgG Ab | 105270-3 |
| BH05 | Micropolyspora faeni, IgG Ab | 26948-0 |
| BH06 | Penicillium chrysogenum, IgG Ab | 26957-1 |
| BH07 | Phoma betae, IgG Ab | 35551-1 |
| BH08 | Trichoderma viride, IgG Ab | 49687-7 |
| BH09 | Hypersensitivity Interpretation | 69048-7 |