Allergic alveolit - it is immunological the mediated inflammatory reaction of respiratory bronchioles and alveoluses developing in response to intake of inhalation allergens. The symptomatology is characterized by mainly inspiratory short wind, cough, thorax pain, at a sharp current - a grippopodobny state. Diagnostics of an allergic alveolit is based on results of spirometry, a X-ray analysis and KT of a thorax, a research of a bronkhoalveolyarny unleavened wheat cake, bioptat of pulmonary fabric, level of antibodies in blood serum. Therapy of an allergic alveolit begins with allergen elimination, purpose of glucocorticosteroids is possible.
Exogenous allergic alveolit (a hypersensitivity pneumonitis) is the interstitsialny disease of lungs with localization of inflammatory process in terminal departments of airways (alveoluses, bronchioles) resulting from influence of external environmental factors. In practical pulmonology various forms of an allergic alveolit relating to professional pathology, and also not having connection with professional activity are considered. The first cases were described in 1932 among farmers ("the farmer's lung"), the second for frequency and the importance a form is the "lung of fans of birds" which is found at breeders of pigeons. The general frequency of incidence among the population makes 42:100000. Timely therapy of a pneumonitis of hypersensitivity allows to prevent development of fibrosis of lungs.
In all cases the inhalation allergens getting to an organism together with the inhaled air act as the reason of an allergic alveolit. At the same time for developing of a disease such factors as the size and concentration of the inhaled particles, features of anti-genes and the immune answer of the patient have the greatest value. It is known what in the presence in air of high concentration organic or chemicals exogenous allergic alveolit develops approximately at 5-15% of persons. It is also established that particles of dust with a diameter up to 5 microns are capable to get freely into alveoluses and to cause a sensitization. In pathogenesis of an allergic alveolit the large role is played by repeated inhalation of anti-genes.
Most often the disputes of mushrooms which are contained in hay, compost, wood bark, etc. act as allergens. The etiologichesky role of anti-genes of vegetable and house dust, proteinaceous anti-genes, bacterial spores, medicines (nitrofurans, penicillin, gold salts) is also proved. Among fungal anti-genes radiant fungi - thermophilic actinomycetes and aspergilla are most widespread. The first of them are associated with such forms of an allergic alveolit as "the farmer's lung", , "a lung of the persons using conditioners", "a lung of the persons which are growing up mushrooms". Various subspecies of Aspergillus are capable to cause "a malt lung", "the cheese maker's lung", , etc.
Proteinaceous anti-genes usually contain in excrement of birds (parrots, pigeons, canaries, etc.) and are tied "a lung of fans of birds" with a pneumonitis form. Professional forms of an allergic alveolit can arise at the faces, by the nature of the activity tied with production of polyurethane, the dyes and pitches contacting to vapors of the metals (cobalt) occupied in the woodworking and sherstepererabatyvayushchy industry.
Allergic alveolit - an immunopathological disease. In development of an allergic alveolit a fundamental role is played by hypersensitivity reactions III and IV types. In this case in response to repeated contact with inhalation allergen in blood there are specific pretsipitiruyushchy antibodies and the CEC, there is an infiltration of alveoluses lymphocytes, neutrophils, monocytes with development of a granulematozny inflammation. Intensive synthesis of collagen from the outcome in pulmonary fibrosis becomes result of long engagement with prichinno significant allergen or obliterating bronkhiolit.
Taking into account causal factors of the allergic alveolit and a source containing anti-genes distinguish the following syndromes:
- "the farmer's lung" - develops at contact with the mouldy hay containing thermophilic aktinimitseta
- "the lung of fans of birds" - occurs at the poultry breeders and persons who are looking after a bird; the bird's dung, down, secrets of skin glands, etc. is a source of anti-genes.
- - develops at contact with microfibres of a sugar cane
- – bark of a pith tree acts as an anti-gene source (a mold mushroom)
- "the malt lung" - develops at the persons contacting to barley dust
- "the lung of the persons using conditioners" - arises at frequent use of conditioners, heaters and humidifiers
- "the cheese maker's lung" - a source of an anti-gene acts a cheese mold
- "the lung of mushroom pickers" - develops at the persons which are growing up mushrooms; activators – the disputes of fungi which are contained in compost
- other professional allergic alveolita: "a lung producing cleaners", "a lung of laboratory workers", "a lung of the plastic occupied in production", etc.
The current of an allergic alveolit can be sharp, subsharp or chronic that finds the corresponding reflection in a clinical picture. The sharp form develops in 4-12 hours after contact with a massive dose of anti-genes; chronic – at a long ingalirovaniye of a low dose of anti-genes; subsharp – at a smaller exposition of anti-genes.
Symptoms of an allergic alveolit
The clinic of a sharp form of a disease is followed by grippopodobny symptoms: fever, mialgiya and artralgiya, headache. Several hours later after rise in temperature weight and thorax pain, cough with a poor mucous phlegm, short wind join. At an exception of contact with prichinno significant allergen all symptoms disappear within 1-3 days, however can come back again after a repeated ingalirovaniye of an anti-gene. The general weakness and short wind connected with physical activities remain on an extent of several weeks.
The subsharp form of an allergic alveolit is, as a rule, caused not by professional vrednost, but influence of anti-genes in house conditions. In a debut of a disease fever can be noted, however more often the symptomatology is limited to short wind at a physical tension, productive cough, increased fatigue. Chronic allergic alveolit can develop, as in the outcome of repeated episodes of sharp or subsharp process, and at once independently. The current of this form is characterized by the progressing inspiratory short wind, constant cough, an indisposition, decrease in body weight.
Emergence of a symptom of "drum sticks" - thickenings of phalanxes of fingers of hands indicates respiratory insufficiency and is an adverse predictive sign. As a natural outcome of a chronic form of an allergic alveolit serves development of interstitsialny fibrosis, pulmonary hypertensia, pulmonary heart, right ventricular heart failure. At the most part of patients in 10 and more years chronic bronchitis is formed, and the emfiyozema of lungs is diagnosed for a quarter.
On primary consultation of the pulmonologist the anamnesis, including professional, communication of displays of a disease with environment conditions is studied. Objectively at an allergic alveolit comes to light , cyanosis, auskultativno - a krepitation, especially in basal departments of lungs, the rattles sometimes whistling. The patient with an allergic alveolit also has to be consulted by the allergist-immunologist.
At a sharp pneumonitis the X-ray analysis of lungs allows to find small nodular or diffusion infiltration; according to spirometry decrease in ZhEL and violation of gas exchange comes to light. At a chronic form the radiological picture indicates development of a pneumosclerosis or "a cellular lung", and a research of function of external breath – existence of obstructive and restrictive violations. KT of lungs is more sensitive method in respect of early identification of changes in pulmonary fabric.
Laboratory data at an allergic alveolit are characterized by increase in the IgG and IgM levels, sometimes IgA, a rheumatoid factor. The greatest diagnostic value has detection of pretsipitiruyushchy antibodies to an estimated anti-gene. In the bronkhoalveolyarny washouts received by means of a bronkhoskopiya lymphocytes (T-cages) prevail, the maintenance of corpulent cages is increased. Provocative inhalation tests in response to which at patients with an allergic alveolit in several hours the specific answer develops can be used (weakness, , temperature increase, bronkhospastichesky reaction, etc.).
Because of bystry permission of symptomatology sharp allergic alveolit is diagnosed seldom or regarded as a SARS. At longer or recidivous current bronchial asthma, atypical pneumonia often mistakenly can be diagnosed (virus, mikoplazmenny), a pneumoconiosis, miliarny tuberculosis, aspergillomycosis, , idiopathic fibroziruyushchiya alveolit, other interstitsialny pulmonary diseases. For the purpose of differential diagnostics carrying out a biopsy of pulmonary fabric with a histologic research is possible.
Treatment of an allergic alveolit
The key moment of therapy of pathology is elimination of contact with prichinno significant anti-gene. At easy forms of a zaboleyovaniye of it happens enough for subsiding of all signs of an alveolit therefore in drug treatment there is no need. At the heavy course of a sharp pneumonitis or progressing of a chronic form purpose of glucocorticosteroids (Prednisolonum) is shown. At patients with forms of a disease, resistant to corticosteroids, positive responses to appointment D-penitsillamina and colchicine are received. Symptomatic therapy of an allergic alveolit is carried out by means of inhalation bronchodilators, bronchial spasmolytics, a kislorodoterapiya.
Forecast and prevention
The favorable outcome can be reached only on condition of timely elimination of allergen, if necessary – active treatment of an allergic alveolit. In case of a recurrence of a pneumonitis of hypersensitivity, development of warm and pulmonary insufficiency the forecast rather adverse. Primary prevention consists in elimination of harmful professional and household factors (observance of occupational health, use of protective clothes, airing of production rooms, care of conditioners and so forth), performing periodic medical examinations of the persons having the increased risk of development of an allergic alveolit. The termination of contact with allergen, if necessary – change of professional activity belongs to measures of secondary prevention.