Allergic alveolit at children – the immunoinflammatory pathology caused by inhalation of the small organic particles which are anti-genes, and followed by violation of structure of alveolar and interstitsialny tissue of lung. The clinic includes unproductive cough, short wind, temperature increase of a body against the background of the expressed inflammation. Diagnostics means carrying out a X-ray analysis of bodies of a thorax, a bacteriological research of a phlegm, all-clinical analyses, demands consultation of the pulmonologist and the allergist. Therapy consists in elimination of contact with allergen, decrease in expressiveness of symptoms due to reception of resolvents.
Allergic alveolit at children
Allergic alveolit at children (an inhalation pnevmopatiya, a hyper sensitive pneumonitis) – the name of group of allergic diseases of the lungs which are formed against the background of continuous and intensive inhalations of a certain irritant. Is the sharp or chronic inflammatory process affecting an alveolus and interstition. Functional violations are not specific and similar to those at other damages of lungs. At children the hyper sensitive pneumonitis arises in the wide age range – from 2nd to 16 years. Prevalence of a disease — about 42 cases on 100 thousand of the population. Pathologies are subject girls and boys to the same extent.
The reasons of an allergic alveolit at children
The small inhalation particles getting to the lower departments of respiratory system act as the Etiologichesky factor. It is proved that organic and inorganic dust with a diameter up to 5 microns can freely get to alveoluses and cause allergic inflammatory reaction. In the development mechanism the large role is played by repeated inhalation of anti-genes. Microscopic organisms and products of their metabolism (the bacteria or fungi producing specific enzymes, proteinaceous structures, toxins), biological substances (wood sawdust, hair of animals, bird's protein), low-molecular substances (salts of heavy metals, toluol connections), inhalation or powder medicines (hormones, antibacterial medicines) are among allergens.
For a cause of illness judge specific changes in lungs. At the child, according to the standard classification of allergic alveolit, the so-called "lung of pigeon breeders" or "a lung of fans of wavy parrots" as the contact with birds is most probable is most often formed – parrots are got as pets. Other types of a disease (, a malt lung) are more characteristic of the adult patients occupied in agriculture and at the industrial enterprises, but their emergence in children is also not excluded.
The main condition of development of an inhalation pnevmopatiya is frequent inhalation of allergen in sufficient concentration. Also influence of endogenous factors is not excluded (heredities, features of immunity), however their role at the moment is completely not studied. Allergic alveolit treats allergic reactions of the third and fourth type (on Gella-Koombs's classification).
The third type – immunocomplex option of reaction of hypersensitivity. Production of M and G immunoglobulins is its cornerstone. The specified proteinaceous elements enter a direct connection with allergens. As a result of connection reaction an antibody + the anti-gene is formed the immune complex circulating in an organism. It activates system of a complement, increases permeability of small vessels, increases quantity of neutrophils and macrophages in blood. The last allocate inflammation mediators, release a histamine.
This moment joins the fourth type of an allergy – reaction of hypersensitivity of the slowed-down type, or the T-mediated inflammatory process. The inflammation mediators released during immunocomplex damage attract T-lymphocytes. They, in turn, allocate tsitokina: interleykina, interferona, tumor necrosis factor. Inflammatory process amplifies, the structure of pulmonary fabric is broken.
Symptoms of an allergic alveolit at children
In pediatrics distinguish three clinical forms of an alveolit: sharp, subsharp and chronic. The clinic of an acute inflammation arises in several hours after long contact with high concentration of allergen. The beginning of a disease is similar to a SARS: the child complains of a fever, headaches, a general malaise, temperature increase is noted. A bit later changes from lungs are defined: dry cough, the accruing short wind. After the termination of contact with an irritant the state is stabilized, the symptomatology regresses, reception of anti-histamines in rare instances is required.
The subsharp form differs in terms of improvement of health, usually on elimination of signs of an inflammation several weeks or month leave. However and the clinical picture is expressed to a lesser extent, from all complaints there are only small cough and short wind. Signs of deterioration in the general state in the form of the increased body temperature, a fever and an indisposition are absent.
The chronic type of an alveolit is characterized by productive cough with office of a mucous phlegm, short wind. Against the background of a hypoxia of fabrics at the child trailer phalanxes of fingers as "drum sticks" change, at physical activity cyanosis of an integument appears. The clinical picture is supplemented with increased fatigue, decrease or total absence of appetite.
Progressing of allergic inflammatory process, formation of interstitsialny fibrosis and gradual violation of blood supply of fabrics results in stagnation of blood in a small circle of blood circulation, pulmonary hypertensia. Similar changes come to an end with development of the chronic pulmonary heart (CPH) and respiratory insufficiency. HLS – a consequence of violation of haemo dynamics at which the progressing insufficiency of blood circulation is formed is broken a warm rhythm, and bodies suffer from oxygen starvation. When ignoring of the developing symptoms the lethal outcome is not excluded.
Statement of the exact diagnosis and passing of full inspection requires consultation of the pediatrician and children's allergist-immunologist. The anamnesis gathers, complaints are specified, the general inspection including a palpation, percussion and an auskultation is performed. The diagnosis of an allergic alveolit is made on the basis of the data obtained during the following methods of inspection:
- Estimates of objective signs. The symptomatology includes short wind, productive or dry cough. At a sharp current body temperature increases, the fever appears. At an auskultation of lungs the krepitation which was more expressed in the lower departments of lungs, sometimes – the whistling rattles is noted.
- Laboratory data. In the general blood test the number of neutrophils raises, SOE increases. At a biochemical immunological research of blue blood high concentration of IgG and IgM, S-jet protein are found.
- Functional tests. During spirometry decrease in pulmonary volumes, speeds of the forced exhalation comes to light. Functional tests demonstrate decrease in elasticity of fabrics, gas exchange malfunction. Carrying out FVD is possible only to children 5 years are more senior.
- Radiodiagnosis. The X-ray analysis of OGK diagnoses blackout of pulmonary fields, at chronic process multiple small focal shadows are defined. According to KT of lungs mesh reorganization of the pulmonary drawing is found, small focal shadows are visible.
Differential diagnostics is carried out with malignant new growths (a carcinoma, ), a fibroziruyushchy alveolit of not allergic nature, a granulematozama, system pathologies: vaskulita, nodular periarteriit, granulematozy Wegener. Sometimes at an uncertain clinical picture and indistinct results of inspection the biopsy of lungs is carried out.
Treatment of an allergic alveolit at children
For elimination of a kashlevy attack it is necessary to stop contact with the irritating agent then immediately to begin inhalation therapy with hormones. The only effective medicines suitable for elimination of a chronic form of an allergic alveolit, glucocorticosteroids are considered. Their dose is selected taking into account age of the child and severity of a disease.
For increase in passability of airways and elimination of a hypoxia of fabrics treatment is supplemented with a kislorodoterapiya, reception beta 2 - , antikholinergichesky means, metilksantin. At accession of a secondary infection antibiotics or antiviral medicines are written out. Oral antihistamines are not applied because of low therapeutic effect.
Forecast and prevention
Prevention of an inhalation pnevmopatiya consists in restriction of contact with an anti-gene and in timely treatment of a disease in order to avoid formation of chronic inflammatory process. The forecast depends on the speed of diagnosis, observance of medical recommendations, weight of pathology. At a sharp and subsharp form symptoms pass into nothingness, administration of drugs is not required. At chronic type of a disease full treatment is improbable, the inflammation progresses, however, by means of medicines perhaps achievement of long remission.