Exogenous allergic alveolitis diagnostics. We recognize allergic lung alveolitis and treat it effectively. Examples of the formulation of the diagnosis

Shortness of breath, often with difficulty exhaling. At first, it occurs during physical exertion, as the disease progresses, it is also observed at rest.
Cough - often dry, sometimes with the release of a small amount of mucous sputum.
Chest pain - often bilateral, in the lower parts of the lungs, increases with deep inspiration.
Weight loss.
Increase in body temperature.
General weakness, fatigue, decreased performance.
Increased sweating.
Lack of appetite.
Cyanosis of the skin - with prolonged or acute course.
Change in the shape of the fingers - thickening due to bone growths, bulge of the nail plate (with a long course).

Forms

Acute form - develops 4-12 hours after contact with massive doses of antigen. It is characterized by a rapid increase and a significant severity of all symptoms: fever (up to 38 ° C and above), chills, cough, shortness of breath, chest pain, muscle and joint pain, headaches. When contact with the causative factor is stopped, the symptoms are quickly eliminated. With continued contact with the antigen, a transition to a chronic form is possible.
Subacute form - occurs with prolonged exposure of the body to relatively small doses of the antigen. Symptoms increase gradually.
Chronic form - associated with long-term contact with small doses of antigen. Symptoms develop slowly, leading to progressive shortness of breath. Gradually, there is a violation of the structure and loss of functionality of the lungs with the development of severe respiratory and heart failure.

The reasons

As a rule, the disease is of an occupational nature, since its development is due to contact with various antigens, mainly found at work or in the household. However, not all people who come into contact with these substances develop the disease.
This gives reason to believe that exogenous allergic alveolitis is formed in predisposed individuals (genetic predisposition, features of the body's immune response).

Causative factors may include:

Diagnostics

Collection of complaints (progressive shortness of breath, cough, chest pain, general weakness, weight loss).
Collecting an anamnesis (history of development) of the disease - asking about how the disease began and proceeded; clarification of the possible causes of the disease (contact with occupational hazards).
General examination (examination of the skin, chest, listening to the lungs with a phonendoscope).
Sputum analysis.
Complete blood count: in an acute course, it detects signs of inflammation (an increase in the number of leukocytes, an acceleration of ESR (erythrocyte sedimentation rate)), in a chronic form, an increase in the content of erythrocytes and hemoglobin is possible.
X-ray of the chest organs - allows you to detect changes in the lungs and suspect the disease.
High-resolution computed tomography (HRCT) - allows you to determine in more detail the nature of changes in the lungs.
Spirometry (spirography) is a study of the function of external respiration. Allows you to assess the airway patency and the ability of the lungs to expand.
Provocative tests - the function of external respiration is examined using spirometry, after which the patient is asked to inhale an aerosol containing a putative antigen. Then repeat spirometry. With a positive test, after about 4-6 hours, there is a deterioration in the general condition of the patient (cough, shortness of breath) and / or a decrease in respiratory function.
The study of the gas composition of the blood.
Bronchoscopy is a method that allows you to examine the condition of the bronchi from the inside using a special device (bronchoscope) inserted into the bronchi. During the procedure, swabs are taken from the walls of the bronchi and alveoli (breathing vesicles in which gas exchange takes place) for subsequent examination of the cellular composition. During the study, you can take a biopsy of the affected area.
Biopsy - obtaining a small piece of the affected tissue to study its cellular composition. The most informative open (surgical) biopsy of the affected area of lung tissue. The method is used in severe cases of the disease and the impossibility of making a diagnosis according to the above studies.
Consultation is also possible.

Treatment of exogenous allergic alveolitis

Exclusion of contact with the causative antigen is the key point of treatment.
Glucocorticosteroid hormones - to suppress inflammation.
It is possible to use antifibrotic drugs - to reduce the growth of connective tissue (the tissue that forms the supporting frame of all organs) in the lungs.
Bronchodilators (drugs that expand the bronchus) - to eliminate shortness of breath.
Oxygen therapy (oxygen inhalation).

Complications and consequences

Respiratory failure (lack of oxygen in the body).
Pulmonary hypertension is an increase in pressure in the pulmonary artery.
Chronic cor pulmonale (heart failure caused by a pathological process in the lungs).

Prevention of exogenous allergic alveolitis

Avoid prolonged contact with professional and household hazards (poultry feces and feathers, animal hair, bark, sawdust, wood, moldy hay, straw, various types of dust, flour, mold, confectionery ingredients, etc.).

Additionally

In the acute process and at the initial stages of the chronic course, the body reacts to the action of the antigen with an excessive immune response, expressed in the development of allergic inflammation, subsequently granulomas (clusters of cells involved in inflammation) form in the lungs.
With the long-term existence of the disease, a restructuring of the lung tissue is observed, its compaction and replacement with growing connective tissue. This stage is called the "honeycomb lung", because at this stage of the development of the disease, the lungs significantly change their structure and resemble a honeycomb in structure.
Such changes significantly disrupt the function of the respiratory system and cause severe respiratory failure (oxygen deficiency in the body).

Which doctors should you contact if you have Exogenous Allergic Alveolitis

What is exogenous allergic alveolitis

Exogenous allergic alveolitis includes diseases of the bronchi and lungs, in which the inhalation of organic dust causes hypersensitivity reactions with a primary lesion of the alveoli and bronchioles. The disease is especially widespread among people whose work is related to agriculture. During the rainy season, up to 8% of farmers in England and about 4% in the SSA fall ill with allergic alveolitis.

What provokes exogenous allergic alveolitis

The etiological factors of exogenous allergic alveolitis can be divided into several groups: 1) thermophilic actinomycetes; 2) mold (Aspergillus, Pemellium, Alternaria); 3) dust of plant and animal origin (wood and wool); 4) protein antigens (bird droppings and feathers, house dust, etc.); 5) food antigens (cheese, mushrooms, malt, flour, etc.); 6) medicines (penicillin, nitrofurans, gold salts, etc.). Based on the nature of inhaled particles leading to the development of exogenous allergic alveolitis, several diseases have been described: "farmer's lung", "bird lover's lung", "pigeon breeder's disease", "malt workers' lung", "mushroom pickers' lung", "washer's lung cheese", "miller's lung", "disease of workers of woodworking enterprises", "disease of wool sorters", etc. Allergic alveolitis has been described in persons working with air conditioning and humidifying installations, inhaling preparations obtained from the posterior lobe of the pituitary gland of pigs and cattle. Probably, hereditary predisposition to this disease can contribute to the development of exogenous allergic alveolitis.

Pathogenesis (what happens?) during exogenous allergic alveolitis

The pathogenesis of exogenous allergic alveolitis has not yet been studied enough. There are indications that precipitating antibodies to rotting hay antigens were found in the blood serum of 80% of patients with "farmer's lung". The pathogenic role of antibodies in patients with "farmer's lung" is currently disputed, since precipitating antibodies have also been found in a large percentage of apparently healthy farmers who have contact with rotten hay.

A number of studies have demonstrated the presence of type I and IV hypersensitivity reactions in patients with exogenous allergic alveolitis. It turned out that organic dust antigens can stimulate an alternative pathway of complement activation. In the experiment, participation in the pathogenesis of exogenous allergic alveolitis of reactions caused by activated alveolar macrophages was established.

Pathological changes depend on the stage of the disease and are characterized by changes of varying severity from an acute alveolar-interstitial reaction to diffuse pulmonary fibrosis. To clarify the diagnosis in individual patients, a provocative test is performed, during which the patient is placed in the environment in which he fell ill, and the resulting changes in the patient's condition are assessed. The need for such a sample is most obvious in cases where microflora found in air conditioning and humidifying installations is suspected as the cause of alveolitis. However, this test should be carried out only in individual cases and with great care, since it can lead to a deterioration in the patient's condition.

Differential diagnosis should be carried out with disseminated lung lesions (alveolar and metastatic cancer, miliary tuberculosis, sarcoidosis and other fibrosing alveolitis, aspergillosis, etc.).

Lung cancer differs from exogenous allergic alveolitis in the absence of a connection between the disease and exposure to an exogenous allergen, the steady progression and greater severity of the disease, the features of radiological signs of lung damage, and the absence of precipitating antibodies to any allergen in the blood serum.

Miliary pulmonary tuberculosis differs from exogenous allergic alveolitis in the absence of association with external antigens, a more pronounced severity and duration of the course of the disease, a feature of radiological manifestations, positive serological and skin reactions with tuberculosis antigen, and the absence of elevated titers of precipitating antibodies to any exoallergen in the blood serum. , which can lead to allergic alveolitis.

Sarcoidosis differs from exogenous allergic alveolitis, in addition to clinical, laboratory and radiological data, by an increase in hilar lymph nodes, changes in joints, eyes and other organs.

Distinctive features of fibrosing alveolitis in systemic lesions of the connective tissue are vasculitis and the multiorganism of the lesion. Bronchopulmonary aspergillosis differs from exogenous allergic alveolitis in severe eosinophilia and the predominance of obstructive bronchial changes with bronchospasm over restrictive changes.

In cases where the differential diagnosis is especially difficult, for example, in the chronic course of allergic alveolitis, a lung tissue biopsy is performed with a histological examination of the biopsy.

Treatment of exogenous allergic alveolitis

Treatment of exogenous allergic alveolitis begins with the elimination of the allergens that caused the disease from the environment of the patient, and the termination of the patient's contact with these allergens. In acute, severe and progressive course of the disease, glucocorticosteroids are prescribed at a dose of 1-1.5 mg of prednisolone per 1 kg of the patient's weight per day. Corticosteroid drugs are used for several weeks with a gradual decrease in dose until complete withdrawal. The duration of treatment with corticosteroid drugs is purely individual and depends on the clinical effect and how the patient tolerates these drugs. With a mild course of the disease, no drug therapy is required and the symptoms of the disease disappear after contact with the allergen is stopped.

The prognosis of allergic alveolitis depends on the timely, possibly more complete and early elimination of the etiological factors that cause alveolitis from the patient's environment, and the active treatment of this disease. With repeated recurrence of alveolitis and the appearance of complications from the lungs and heart, the prognosis becomes unfavorable.

Prevention of exogenous allergic alveolitis

Prevention. Primary prevention of alveolitis includes drying hay, using open silos, and well-ventilated work areas. The need to comply with hygiene standards applies to industrial and other premises in which animals and birds are kept. Careful maintenance of air conditioners and humidifiers is required.

Secondary prevention of exogenous allergic alveolitis is to stop contact with allergens of persons who have been treated for allergic alveolitis. In cases where the disease is associated with working conditions, a change of profession is necessary.

Exogenous allergic alveolitis (EAA) is an inflammation of a group of lung alveoli that develops as a result of the deposition of a kind of sediment in them, consisting of immunoglobulins and allergens of exogenous origin. But although the alveoli are the smallest structural units of the lungs and are located at the ends of the bronchioles, the bronchial tree itself remains unaffected in EAA.

Reasons for development

Previously, this disease was called "farmer's lung" and hypersensitivity interstitial pneumonitis. The disease received such a non-standard name due to the fact that the reason for its development is the regular inhalation of fine, complex dust, the components of which can be particles of various origins. That is, EAA is a consequence of exposure to the lungs of environmental pollutants, which, as a rule, enter the body during work in various industries, in particular, on farms and in other organizations related to agriculture. Although its relationship with domestic and environmental problems is also traced.

At the same time, allergic alveolitis in children is a fairly common disease that develops against the background of bronchial asthma. But if in adults the main cause of the formation of pathology is unfavorable working conditions, which consist in the saturation of regularly inhaled air with various proteins, then in children, house dust, which contains allergens, is of greater importance:

dust mites and other insects;
mold and yeast-like fungi;
spores of actinomycetes;
animal and vegetable proteins contained in waste products, feathers, pet fur;
washing powders, the components of which are enzymes;
food products, etc.

Symptoms

Allergic alveolitis of the lungs can occur in acute, subacute or chronic forms. In the acute course of the disease, by the end of the day after contact with the allergen, patients may experience:

elevated temperature;
shortness of breath even at rest;
chills;
weakness and malaise;
mild hyperemia (redness against the background of swelling) of the mucous membranes of the upper respiratory tract;
coughing fits;
blue skin and mucous membranes;
muffled rales in the lungs;
pain in the limbs.

Since the development of allergic alveolitis is accompanied by a deterioration in the purification of the bronchial tree, a few days after the onset of the first signs of the disease, symptoms of infectious and inflammatory processes in the lungs, for example, acute pneumonia or bronchitis, may join them.

Symptoms of a subacute course of the disease are:

shortness of breath accompanying physical activity;
cough with mucus sputum;
wheezing in the lungs.

Due to the fact that it is possible to talk about the subacute course of EAA only a few days after working in adverse conditions and inhaling large amounts of dust, most often the symptoms of allergic alveolitis remain ignored, since their appearance is usually associated with anything, but not with harmful working conditions.

Therefore, a person continues to work in the same place, and this aggravates the course of the disease and causes it to become chronic. A characteristic feature of this is the discrepancy between the intensity of the often occurring shortness of breath and the magnitude of the physical activity that provoked it. All other manifestations of the disease look blurred, and even wheezing in the lungs now occurs only periodically, and radiological data are very uncertain. Therefore, it is quite difficult to correctly diagnose chronic allergic alveolitis. However, it can be issued:

constant fatigue;
poor exercise tolerance;
loss of appetite and, accordingly, weight;
flattening of the chest;
the appearance of the "drumsticks" syndrome, that is, the thickening of the fingers and nails.

Syndrome of "drum sticks"

Diagnostics

Diagnosis is mainly based on:

clinical picture;
hematological disorders, expressed in the presence of leukocytosis, eosinophilia, increased ESR, etc.;
detection of serum precipitins to the expected antigens;
functional lung tests;
data on harmful production factors;
the presence of signs of fibrosis on x-rays;
data from a tracheobronchial biopsy, performed if other methods have not provided sufficient information for making a diagnosis, which allow us to judge the presence of pneumonitis.

Analysis of blood serum for specific antibodies

The analysis of serum precipitins to the expected allergens is one of the most important parts of the diagnosis, since they indicate the presence of an immunological reaction of the body to the influencing allergen. So, depending on the type of detected source of stimuli, there are:

Farm lung, the cause of which is thermophilic actinomycetes, contained in large quantities in moldy hay, silage, grain.
The lung of a bird lover, breeder or laborer. Such people often come into contact with the droppings of parrots, pigeons, turkeys, chickens and other poultry.
"Air-conditioned" lung. The reason for the development of this form of the disease is contaminated water in moisturizing aerosols, sprinklers or evaporators, in which there are thermophilic actinomycetes, amoebas, Aureobasidium pullulans, etc.
Lung forester. Formed by regular contact with oak, cedar dust and other types of wood.
Light sauna. It develops as a result of frequent inhalation of polluted steam in the sauna containing Aureobasidium pullulans, etc.
"Beetroot" light. It is observed in people working with contaminated beets, releasing thermophilic actinomycetes into the air.
"Coffee" light. It is considered an occupational disease of people working in the coffee industry.
Miller's lung. It develops due to damage to the alveoli by particles of flour weevil living in wheat flour.

There are many more varieties of EAA, but still only on the basis of the detection of specific precipitating antibodies in the blood serum, that is, precipitating certain antigens, it is impossible to talk about the presence of allergic alveolitis, since a similar picture is observed in many people. Thus, the analysis of blood serum allows only to judge the type and amount of the allergen that has entered the body, which, after confirming the diagnosis, helps to determine the cause of the development of the disease.

Functional lung tests

With any form of EAA, patients are found:

decrease in lung volume;
violation of their diffusion ability;
decrease in elasticity;
insufficient saturation of the blood with oxygen during physical exertion.

Initially, functional changes are minor, but as the disease progresses, they worsen. Therefore, in chronic exogenous allergic alveolitis, airway obstruction is often observed.

Differential Diagnosis

EAA requires differential diagnosis with:

sarcoidosis;
idiopathic pulmonary fibrosis;
lung damage in DBST;
medical damage to the lungs;
eosinophilic pneumonia;
allergic bronchopulmonary aspergillosis;
"pulmonary mycotoxicosis";
atypical "farmer's lung";
infectious lesions.

Treatment

Treatment of exogenous allergic alveolitis in general consists in eliminating contact with the harmful substances that caused the development of the disease. If you recognize and stop interacting with the source of allergens in time, this may be enough for a complete recovery without the use of any special medicines. Therefore, patients are often advised to radically change the type of work activity or get rid of pets. If, for one reason or another, this is not possible, for example, house dust is the source of allergens, it is worth considering buying special air purifiers, etc.

In cases where the symptoms of the disease cause significant discomfort to the patient or do not go away for a long time, it may be necessary to prescribe:

Antihistamines, for example, Claritin, Zyrtec, Ebastine. Preparations of this particular group are used more often than others to eliminate signs of pathology.
Glucocorticoids. They are indicated in the presence of acute and subacute forms of the disease. The most preferable is the use of Medrol, less - Prednisolone. Initially, they are prescribed in the form of an initiating course lasting 10 days, the purpose of which is to relieve acute reactions. If, after this period, it is not possible to cope with the disease with Medrol-based drugs, doctors may decide to extend therapy to 2 weeks or more. After elimination of acute manifestations of EAA from the respiratory organs, they switch to an alternative treatment regimen, in which Medrol is taken in the same doses, but every other day, and with further improvement in the patient's condition, the drug is gradually canceled by reducing the dose by 5 mg per week.
Penicillin antibiotics or macrolides. They are indicated in the presence of a large number of bacteria in the inhaled dust and an increase in temperature in the patient.
β 2 -sympathomimetics, for example, Salbutamol or Berotek. The drugs of this group are used in the presence of an obstructive syndrome, accompanied by paroxysmal shortness of breath or cough.

Also, to facilitate breathing and eliminate coughing, patients are recommended to take Lazolvan and a complex of vitamins A, C, E. If they have abnormal immunograms, in such cases, immunorehabilitation therapy may be offered.

With the right approach to the problem and timely elimination of the allergen, EAA, which occurs in an acute form, completely disappears after 3-4 weeks, but in the presence of a chronic disease, doctors cannot even guarantee the safety of the patient's life, since it can lead to the development of pulmonary and cardiac decompensation and thus increase the likelihood of death.

What is exogenous allergic alveolitis

What provokes exogenous allergic alveolitis

Pathogenesis (what happens?) during exogenous allergic alveolitis

Differential diagnosis should be carried out with disseminated lung lesions (alveolar and metastatic cancer, miliary tuberculosis, sarcoidosis and other fibrosing alveolitis, aspergillosis, etc.).

Sarcoidosis differs from exogenous allergic alveolitis, in addition to clinical, laboratory and radiological data, by an increase in hilar lymph nodes, changes in joints, eyes and other organs.

Treatment of exogenous allergic alveolitis

Prevention of exogenous allergic alveolitis

Which doctors should you contact if you have Exogenous Allergic Alveolitis

pulmonologist

Therapist

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What is this disease?

Exogenous allergic alveolitis is provoked by external stimuli, an allergic reaction appears, and then inflammation of the alveoli occurs (these are the air sacs inside the lungs).

The etiology of the development of this disease are small particles that enter directly into the lungs, bypassing the trachea.

The source could be:

bird protein;
Mold;
Any dust;
Fungal spores.

Toxic-allergic alveolitis

It develops due to the influence of toxic substances on the lungs.

It is caused by certain substances:

Chemical compounds with chlorine.
Ground talc.
Immunosuppressants.
Zinc.
Sulfonamides.

The reasons

The following are distinguished:

Medicines;
Certain foodstuffs;
Climate feature;
Microorganisms;
Chemical substances;
conditions of professional activity.

Depending on the factors of occurrence, exogenous allergic alveolitis is divided into types:

Bagassose - An irritant is sugar cane.
Suberosis - the source of the antigen is the cork tree.
Barn flour - dirty flour negatively affects.
Lycoperdinosis - a manifestation of the disease causes a raincoat fungus.
The lung of threshers is a grain with a fungus.
Lung furriers - particles of hair, dried urine of mice.
The disease of sauna lovers is the source in the mold of damp wood.

The list can be continued indefinitely. For people prone to this disease, there is always and everywhere a source of antigen.

Disease pathogenesis

This form of allergic alveolitis is still being studied and there is no exact data on the processes occurring during the illness.

A pathological process occurs that affects the tissues of the lungs. The development of the reaction depends on the characteristics of external allergens and the body's response.

Hypersensitivity causes damage to the bronchioles, which leads to the manifestation of the corresponding symptoms.

Granulomas form in the lungs at the initial stage of the disease. Then the lungs change structure: the connective tissue becomes the main one.

Symptoms

The clinical picture of the disease depends on the stage in which the pathology process is located.

Acute stage

It develops a few hours after the penetration of the allergen into the body. This stage is characterized by rapid development.

A person has:

Chills;
Dyspnea;
The temperature rises;
The cough is usually dry;
Joints and muscles begin to ache.

Interruption of contact with the antigen leads to the disappearance of all symptoms without treatment.

subacute stage

Occurs with regular intake of antigen into the body. The disease develops slowly, which is the reason for the rare visit to the doctor.

This form appears:

Cough with phlegm;
shortness of breath;
Loss of appetite;
Rise in temperature.

Repeated contact with the irritant exacerbates the symptoms.

chronic stage

It is characterized by a combination of immune, infectious and inflammatory processes. The functionality of the lungs is impaired, which causes heart failure.

There is a distinctive sign of the disease in people of certain professions. It's called the Monday symptom.

In a person during the working week, the disease manifests itself very clearly, but over the weekend, the symptoms are significantly reduced. The state of health improves significantly, but at the beginning of labor activity, the symptoms increase again.

In children

This disease occurs rarely, mainly at school age. The cause is dust and pets.

If the disease begins to progress, children experience symptoms:

Fast fatiguability;
Decreased body weight;
slow growth;
The shape of the nails changes.

Diagnostics

The treatment of exogenous allergic alveolitis is carried out by a therapist, a pulmonologist, and, if necessary, an allergist.

The diagnosis is made after a comprehensive examination, which is as follows:

History is being collected.
The patient's complaints are analyzed.
Auscultation of the lungs is performed.
Chest x-ray.
Bronchoscopy.
Determination of the level of erythrocytes.
provocative tests. By inhalation, an aerosol with an antigen is injected and then spirometry is done.

If there is not enough data to make an accurate diagnosis, then a lung biopsy is done.

Differential Diagnosis

This disease must be differentiated from tuberculosis, lymphogranulomatosis and other similar diseases.

Some of them:

Sarcoidosis;
eosinophilic pneumonia;
infectious inflammation;
Pulmonary mycotoxicosis.

Differentiation will allow to exclude diseases with similar symptoms.

Treatment

Therapy of exogenous allergic alveolitis must necessarily be complex and last for a long time.

The main principles of therapy are:

Removal of contact with the pathogen.
It is necessary to stop the inflammatory process.
Respiratory failure should be compensated.

The following drugs are usually used:

Hormonal remedies

Cytostatics - stop cell division and slow down the development of the reaction.

Sometimes the blood is purified from the antigen. For this, plasmapheresis is used - an effective way to help when toxic-allergic alveolitis manifests itself.

The acute stage of the disease is treated with hormones for a month. If there is a strong cough, hormones are replaced with bronchodilators.

If the pathology is detected in a timely manner, then the prognosis is quite favorable.

Complications

The disease has its own characteristics and is fraught with serious complications, especially in children.

This is due to the increased susceptibility of the lungs to external factors and weak immunity. In such people, an acute form of the disease almost instantly develops, the signs are pronounced and the danger of infectious complications is high.

Possible consequences:

Oxygen deficiency causes respiratory failure;
Pulmonary hypertension;
Lung pathology can cause heart failure.

Preventive measures

Prevention plays an important role in preventing this disease:

Hygiene standards must be maintained in production facilities.
During work, it is advisable to wear respirators and special clothing.
If the disease develops due to taking medications, then before treatment it is necessary to take into account the allergic history.
Some patients need to change jobs.

You should be regularly examined by a pulmonologist. By changing working conditions and adjusting lifestyle, you can prevent the development of allergic alveolitis.

With adequate treatment, exogenous allergic alveolitis should disappear in a month. But if the disease has become chronic, then doctors cannot guarantee a favorable outcome. Pulmonary decompensation may occur, which can be fatal.

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Kinds

Considering the etiological factors, we can distinguish the following types of alveolitis:

Fibrosing idiopathic - a feature is that
which manifests itself against the background of unknown factors, but it is known that its development is influenced by genetics and lifestyle.
Exogenous allergic is a type of alveolitis, which occurs due to the penetration of antigens into the body through the respiratory system.
Toxic alveolitis - manifested as a result of exposure to chemical components. It is very easy to get rid of this form, since it is enough to stop interacting with chemical agents.

Depending on the time of the course of the disease, the following types of alveolitis are distinguished:

Chronic - the course passes gradually, as a result of which, the diagnosis is carried out late at the moment when the disease can no longer be cured. The aggravation is accompanied by a long period of retreat.
Acute - the first signs of this form occur in the period from 4 to 12 hours.

Causes of lung alveolitis

Each type of lung alveolitis implies its own causes. To date, experts have not been able to determine the factors that contribute to the development of the disease. It is generally accepted that the basis of the origin of the disease is precisely the virus. Among the main causes of alveolitis can be identified:

Viruses - hepatitis C, cytomegalovirus, herpevirus, HIV. Interacting with the immune system, they destroy it, as a result of which the body easily succumbs to external stimuli.
Heredity. There is no exact information on the influence of heredity, but despite this, experts are confident in the influence of genes on the development of alveolitis.
External stimulus
autoimmune factor.

External irritants include chemicals and natural components, such as bird droppings or feathers, bark, fur, raincoat fungus spores, rotten hay, sawdust, certain types of cheese, rotten coffee.

Alveolitis can manifest itself with constant interaction with an irritant. In the case of natural origin, it contributes to allergic diseases, if toxic components - toxic diseases.

Symptoms

Depending on the stage of the disease, there are various symptoms of lung alveolitis. For the acute form of the disease, the following symptoms are characteristic:

Wet cough
Elevated temperature
Dyspnea
Runny nose.

In the case of a correct treatment process, this form of the disease disappears instantly.

For the chronic form of pulmonary alveolitis, the following symptoms are characteristic:

Gradually onset shortness of breath
Dry cough
Discomfort while breathing
Bloody cough.

If you do not carry out treatment, there is an increase in shortness of breath, pressure in the small circle increases, as a result of which the person dies. This disease has common symptoms with other respiratory diseases, which can lead the patient to a different diagnosis, as a result of which self-medication will be in vain.

In addition, this disease is characterized by fatigue, rapid weight loss, pallor of the skin, thickening of the fingertips, a feeling of "goosebumps" throughout the body, wheezing and pain in the chest area.

With the fibrous form of the disease, all the most striking symptoms can appear, since it is the final stage in the development of the disease.

Symptoms of fibrosing alveolitis:

Shortness of breath, which manifests itself as a result of heavy physical exertion, and after a while, can be observed even with little activity.
Cough with little or no sputum.
Edema
Rapid weight loss
Significant fatigue
Skin may have a blue tint
muscle weakness
Elevated temperature.

Allergic alveolitis has the following symptoms:

Inability to take a deep breath
Severe pain in the chest area
Cough with phlegm
Decreased appetite resulting in weight loss
Finger deformity
Chills
Temperature rise
Strong headache.

Diagnosis of the disease

Often, patients do not notice the symptoms of alveolitis present and confuse it with completely different diseases.

As a result, the diagnosis of alveolitis is based on a number of different procedures - a detailed conversation with the patient about the complaints present, determining the time of manifestation of symptoms, reviewing the clinical history of the patient by the doctor, searching for the causes of the disease, based on the living and working conditions of the patient. The main components of the diagnosis are gas, biochemical, complete blood count, examination of sputum that occurs during a cough.

Hardware diagnostics consists of:

Chest x-ray, which will provide information about lung disorders.
Spirometry - a study of the patient's respiratory function
HRCT - a thorough examination of changes in the lungs
Biopsy - a small area of damaged tissue is taken for microscopic experiments.
Bronchoscopy is a way to determine the internal structure of the bronchi.

Complications

If alveolitis of the lungs is not treated, serious complications can occur, including pulmonary edema, cor pulmonale, and developing respiratory failure. The liquid part of the blood penetrates into the lung tissue, resulting in changes in gas exchange. In such a situation, the patient should immediately receive medical attention to prevent death. Pulmonary edema can be of different forms:

Acute - manifests itself over several
hours and cause death.
Lightning - develops instantly, the patient's condition worsens instantly and can end in death.
Protracted - this is the most popular form of edema in alveolitis, which is formed within 12-24 hours.
Subacute - this form is characterized by an alternation of amplification and weakening of symptoms.

In addition, a progressive disease can provoke an increase in pressure in the arteries of the lungs, heart failure, chronic bronchitis, emphysema.

Alveolitis treatment

Treatment of alveolitis is carried out under the constant supervision of a specialist. Certain treatments are prescribed depending on the type of disease. In the case of toxic or allergic alveolitis, in addition to the use of drugs, it is worth eliminating the external irritant, due to which the disease progresses.

In the case of fibrosing alveolitis, glucocorticoids are used. With this type of disease, treatment should be started quickly, since the rapid replacement of epithelial tissue with fibrous tissue causes the alveoli to cease activity during breathing, which can be fatal. In case of ineffectiveness of glucocorticoids, immunosuppressants and penicillins are prescribed.

In the treatment of toxic or allergic alveolitis, glucocorticosteroids are used. Initially, you should eliminate the external stimulus that contributes to the progression of the disease. Allergic alveolitis contributes to fibrosis. In order for the treatment to be effective, in addition to medications, a course of vitamins, certain physical exercises and breathing exercises are prescribed.

Folk methods of treatment

Therapy with folk remedies has little effectiveness in the battle with this disease.

Eucalyptus
Chamomile and mint
Oregano and lungwort
Plantain and nettle
Motherwort and hawthorn
Ground pepper and cinnamon
Coriander
Dill and ginger.

It is herbal decoctions that help to calm irritated airways, promote expectoration and eliminate inflammation, reduce cough and shortness of breath. To achieve the desired result, you should follow a simple diet:

Drink plenty of fluids, more than two liters per day
Eat broth from lean meats and fish
Eat plenty of dairy products
All meals must be boiled, oven-baked or steamed.
Eat plenty of fresh vegetables and dried fruits.

Prevention of lung alveolitis implies compliance with the norms of working with toxic components, getting rid of the irritant that provokes allergies. It is prevention that will save people from possible lung problems that can be fatal.

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Pathogenetic features of EAA

EAA belongs to the type of immunopathological diseases. The leading role in the entire pathological process is assigned to allergic reactions of 3-4 types. But there are also non-immune forms.

In addition to immune reactions, allergic alveolitis also manifests itself in the form of toxic changes in the lung tissue.

Clinical manifestations

EAA is divided into three types:

Spicy;
Subacute;
Chronic.

Each form of alveolitis depends on the duration of contact with the pathogen (antigen).

The acute form of EAA is characterized by:

temperature rise;
chills;
cough;
malaise;
dyspnea.

Very often, the complex of these symptoms misleads doctors who make a diagnosis of the flu.

The acute form of EAA can also lead to the development of a pneumo-like condition, when shortness of breath becomes pronounced, and wheezing and crepitus begin to be heard in the lungs. This condition is cured by simply limiting the patient's contact with the antigen.

Sometimes an asthmatic variant of the course develops. It manifests itself as a symptomatic asthmatic complex that occurs approximately 10-20 minutes after contact with the allergen. Asthmoid exogenous allergic alveolitis of the lungs manifests itself in the form of suffocation, wheezing in the lungs, serous sputum.

Exogenous allergic lung alveolitis in any form, it has one disease-defining symptom, called the “Monday symptom”. This symptom appears like this. After working five weekdays, the patient has the above symptoms all the time, but after the weekend they are largely leveled, and the person feels better. With the onset of the working week, the symptoms are activated again. And so it continues weekly.

The subacute form proceeds latently for several weeks and lasts until a person's breathing is disturbed and cyanosis appears. This condition requires rapid hospitalization of the patient.

It happens that the subacute form replaces the acute form.

Both in subacute and acute forms of EAA, the symptoms of the disease disappear after a few days or months after cessation of contact with the allergen. But, if nothing is done during this period, these forms can become chronic.

The chronic form often presents with interstitial lung disease with cough, dyspnea from exertion, and weight loss. When listening to the lungs, medium and small bubbling moist rales, weakened breathing are heard. Percussion is represented by a boxed tone of sound. On the fingers develop "drum sticks" (thickening of the phalanges). This comes from malnutrition of the periosteum and innervation. Subsequently, patients develop cor pulmonale with actively developing circulatory failure.

There are several variants of exogenous allergic alveolitis: "amiodarone lung" and "methotrexate lung". Amiodarone, for example, has the property of having a long half-life (5-13 months). Amiodarone-induced EAA begins insidiously and proceeds slowly after discontinuation of the drug, but abrupt withdrawal can also cause a relapse of symptoms. Pulmonary pathologies develop in the interval from several weeks to several years, and accompany the drug.

Methotrexate also causes the development of the disease at any duration of administration. Although the main risk period falls on the first year of use. Inflammation of the lungs associated with methotrexate is characterized by subacute and less often acute and chronic course.

The differential diagnosis of "methotrexate lung" shows us that:

shortness of breath begins to progress;
the temperature rises above 38 ° C;
tachypnea is present (more than 29 per minute);
radiography shows signs of interstitial changes;
leukocytosis occurs;
the lungs have reduced diffusing capacity.

Diagnosis of "exogenous allergic alveolitis"

There are certain grounds on the basis of which exogenous allergic lung alveolitis:

Indication of working conditions in the sanitary and hygienic characteristics (contact with a certain antigen during the work process);
Episodic shortness of breath, which is accompanied by a dry cough, malaise, fever above 38 ° C, which develops after several hours of contact with the antigen, and disappears after a certain period of time after the termination of contact;
The presence of auscultatory and objective data, as well as listening to bilateral crepitus over the lungs;
On information from such specialists as: allergist, pulmonologist and occupational pathologist;
On the collected laboratory data: elevated levels of interleukin-8, increased levels of TNF-b, increased ESR, C-reactive protein, plus, determined rheumatoid factor. In rare cases, eosinophilia is observed. Elevated IgG and IgM are also present;
On the data of instrumental studies.

In addition, a study of external respiration is carried out, which reveals a decrease in lung volume and a restrictive type of ventilation disorders.

Forced expiration indicators decrease, hypoxemia is fixed with any physical activity, positive scarification tests are observed. Positive results of the provocative inhalation test. X-ray shows a significant darkening of the lung field, and later a retico-nodular lesion or multiple small-focal shadows, which disappear quite quickly when the contact is removed.

Acute and subacute forms are marked on x-rays by reduced transparency of the lung fields (“frosted glass”), fuzzy spots, separate or diffuse nodular infiltrates.

In the chronic form, pleural effusion, hilar adenopathy or induration is noted, a network of continuous nodular infiltrates appears.

Necessary alveolitis treatment in all forms and at all stages of development.

On CT, multiple small focal shadows are visible against the background of a rearranged mesh pattern of the lungs, a “ground glass” zone and nodular opacities. Bullous swelling of the lung parenchyma and honeycombed lung are often described. Sometimes an "air cushion" symptom is seen.

Scintigraphy in the diagnosis of EAA is rarely used, as it does not provide correct information.

Bronchoalveolar lavage is also used, in which a five-fold increase in T-lymphocytes is detected. During this procedure, foamy macrophages are visible on the amiodarone lung.

A lung biopsy is resorted to if the above diagnostic data are not enough.

EAA often develops peribronchial inflammatory infiltrates and bronchiolitis obliterans. In general, alveolitis, granulomatosis and bronchiolitis constitute a triad of morphological signs of EAA.

Differential diagnosis of EAA

The radiological picture of exogenous allergic alveolitis is very similar to bronchioloalveolar cancer, carcinomatosis, leukemia and pulmonary lymphogranulomatosis. Also, when conducting differential diagnosis, it is necessary to check for the exclusion of fibrosing alveolitis and pulmonary granulomatosis, systemic vasculitis and angiitis.

Treatment of exogenous allergic alveolitis

Mainly alveolitis treatment aimed at eliminating the antigen.

The main, and in fact the only treatment for EAA are systemic glucocorticosteroids (GCS). They are canceled immediately after the improvement. If, after the abolition of GCS, deterioration occurs, then their use should be resumed.

If the disease does not respond to corticosteroids, colchicine and D-penicillamine are prescribed.

With hyperreactivity of breathing, bronchodilating drugs, b2-agonists, anticholinergics, and less often methylxanthines are prescribed.

Complications require the use of symptomatic therapy, and this is long-term oxygen therapy, antibiotics, diuretics, etc.

EAA forecast

The prognosis depends on the stage and extent of the disease. In acute and subacute forms, excluding the antigen, the disease disappears without a trace after a few days.

Chronic forms in the vast majority of cases do not carry any favorable prognosis. But it also happens that the disease can continue to progress even after contact with the antigen has ceased.

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Causes and possible allergens

The main provoking negative factor in the appearance of allergic alveolitis is the ingress of various allergens into the respiratory tract of a person (even a very small particle can lead to a violent reaction of the immune system). AA is a consequence of severe environmental pollution.

The most susceptible to the disease are people working in a variety of industries, including organizations related to agriculture. Experts trace the relationship of the disease with environmental, domestic problems.

Allergic alveolitis in children develops against the background of the course of bronchial asthma. Adults suffer from severe allergic reactions as a result of constant work in hazardous enterprises, inhalation of huge amounts of dust particles saturated with various proteins (allergens).

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Depending on the specific factor that causes a violent reaction of the immune system, experts have identified several forms of the disease:

bagassosis - the disease occurs against the background of human inhalation of sugar cane microfiber;
"farmer's lung" - is formed during prolonged contact with rotten hay;
suberosis - the bark of the cork tree acts as an allergen;
“lung of bird lovers” - from the name it is clear that the disease is caused by small particles of bird feathers, their droppings, fluff, skin secretions;
"malt lung" - pathology occurs against the background of constant inhalation of barley dust;
"Mushroom picker's lung" - manifests itself in mushroom pickers who inhale fungal spores;
"lung of a laboratory worker" - noted by doctors who are constantly in contact with various chemicals;
“lung of an air conditioner lover” - people who often use air humidifiers and heaters suffer;
"Cheesemaker's lung" - cheese mold acts as an allergen.

Modern medicine knows about 350 types of allergic alveolitis, each has its own name, but the mechanism of the disease is the same.

Symptoms and forms of the disease

The clinical picture of the pathology resembles a cold. Often, doctors do not immediately make the correct diagnosis, which leads to a deterioration in the patient's well-being. With the help of modern equipment, specialists have learned how to quickly identify a specific allergen, and to stop the unpleasant symptoms of an allergic reaction in a short period of time.

Allergic alveolitis occurs in three forms:

acute. Symptoms appear several hours after contact with a large dose of the allergen. The pathological condition is accompanied by severe headaches, fever, fever. The patient complains of breathing problems, sometimes there is a slight sputum production. After a few days, the symptoms disappear. With constant contact with the allergen, the acute form becomes chronic, causing a lot of inconvenience to a person;
subacute. Manifested after contact with a small amount of the allergen, accompanied by a mild allergic cough, shortness of breath, very rarely - fever. The clinical picture, in this case, mild, passes within a day without the use of any means;
chronic. It occurs against the background of regular contact with a large number of harmful particles, accompanied by a decrease in appetite, constant shortness of breath, wet cough. The pathological condition is progressive in nature, can lead to pulmonary hypertension, heart failure. In most cases, ten years later, patients are diagnosed with pulmonary emphysema, chronic bronchitis.

Diagnostics

It is quite difficult to identify allergic alveolitis, given the symptoms similar to various ailments. To make a correct diagnosis, research is carried out in several stages:

the doctor studies the clinical picture of the patient, without fail takes into account the place of work of the person;
blood, sputum, urine are taken for analysis;
the physician examines the victim's breathing (characteristic wheezing in the lungs may indicate allergic alveolitis);
patient's chest x-ray;
in severe cases, a biopsy is required.

Methods and directions of therapy

The basis of the treatment of allergic alveolitis is the elimination of contact with the allergen., which causes a negative reaction from the patient's immune system. In some cases, with the timely implementation of this recommendation, the disease goes away on its own without the use of any means.

Depending on the specific allergen, the useful recommendations of doctors differ significantly in each individual case:

some doctors recommend radically changing the type of work activity, eliminating contact with harmful particles;
animals that cause allergic reactions should be disposed of immediately;
if you have an allergic reaction to house dust, purchase special air purifiers, often carry out wet cleaning.

The chronic course of allergic alveolitis requires the use of special medications:

antihistamines are used to relieve unpleasant symptoms (Suprastin, Claritin);
corticosteroids. They are prescribed for the relief of symptoms of the disease in the acute and subacute phase. In severe cases, a course of ten days is recommended;
penicillin antibiotics are used at elevated body temperature, a large number of inhaled allergens.

The patient can ease breathing with the help of Lazolvan, regular use of vitamins A, C, B. Deviations in the immune system require immediate immunorehabilitation therapy.

Folk remedies are used only as an adjuvant therapy, show poor results. If you have serious health problems, contact an experienced specialist, follow his recommendations, give up self-medication.

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Allergic alveolitis in children

Allergic alveolitis in babies is caused by regular exposure to the body of various allergens. Often, pet hair, poor environmental conditions, contact with toxic chemicals act as a provoking factor.

As a treatment for an ailment in children, Prednisolone is used, which is prescribed for a long course (up to 30 days). Special gymnastics, exercise therapy helps to facilitate the breathing process. The difficulty in treating children is caused by weak immunity. The earlier a pathological process is detected, the less likely there are deviations in the physical, mental, mental development of the child.

Complications and prognosis

With timely treatment of allergic alveolitis, the prognosis for patients is favorable. Negligent attitude to one's health, lack of medical care leads to the development of complications, including lung cancer, death.

Specific preventive recommendations have not been developed. It is impossible to predict which allergen the human immune system will react to. The only way out is to lead a healthy lifestyle, harden the body, increasing its resistance to the negative effects of the environment.

Video. TV program "Live healthy" about the symptoms and features of the treatment of allergic alveolitis of the lungs:

Alveolitis is one of the most common inflammatory diseases affecting the respiratory parts of the respiratory tract. Despite the fact that they can act as separate pathologies, as well as symptomatic manifestations of other diseases, alveolitis is characterized by some unique features. Thus, inflammation in this case does not have a clear localization and over time leads to the formation of connective tissue in place of the lung - fibrosis. To independent species include toxic, fibrosing and exogenous allergic alveolitis. The latter is being discovered more and more often, so it deserves more detailed consideration.

There are a lot of pathogens that can provoke exogenous allergic alveolitis. Mostly they enter the body with the inhaled air. It can be:

fungal spores, most of which are found in damp hay or maple bark;
particles of plants, animals and birds (often pigeons and parrots);
house dust;
medical preparations;
microparticles of household chemicals;
dust particles exfoliated from some food products (flour, coffee, malt, and others).

After the allergen enters the respiratory system, the body starts active production of antibodies. The so-called immune complex is formed, which accumulates in the alveolar walls, the smallest branches of the bronchial tree and capillaries. When a certain concentration is reached, an inflammatory process begins, accompanied by the release of a large amount of serotonin and histamine from the blood cells. In addition, eosinophils and neutrophils are activated, increasing inflammation.

If the causative agents are fungal spores, granulomas begin to form in the alveoli, eventually leading to the growth of connective tissue and replacing it with lung tissue. Sometimes, due to the inflammatory process, fluid is released from the blood vessels in the tissues and cavities of the lungs, causing the destruction of their individual sections, which in the future is fraught with the development of emphysema.

Symptoms

Depending on the type of pathogen, exogenous allergic alveolitis can occur in three forms with different symptoms:

Acute. It mainly manifests itself 5-6 hours after the allergen enters the body. Patients complain of shortness of breath, cough, headache, general malaise. This form is often accompanied by fever and chills. In people suffering from other allergic diseases, the condition may worsen after 10 minutes. In this case, spasmodic contraction of the muscles of the bronchial wall occurs, making breathing difficult.
Subacute. Here, the symptoms are a little blurry, and it is more difficult to establish the specific pathogen that caused allergic alveolitis. Patients have shortness of breath, cough, lethargy, weight loss, often there are signs of bronchitis.
Chronic. Occurs with constant penetration into the lungs of an allergen over a long period. It is characterized by a wet cough, severe shortness of breath (sometimes even at rest), muscle pain, lethargy, lack of appetite, weight loss. If there is no timely treatment, this form of exogenous alveolitis causes emphysema.

The acute form of alveolitis usually resolves after elimination of the pathogen. But sometimes, due to stagnation of sputum, an infection can occur that has symptoms of bronchitis or pneumonia. Then recovery will not come until the secondary inflammation is cured.

Diagnostics

When diagnosing exogenous alveolitis, it is primarily assumed that it develops in people who do not suffer from allergic diseases. The following studies are carried out:

X-ray. The acute form is characterized by small darkened foci, with subacute focal fibrosis. If the alveolitis is chronic, areas of overgrown connective tissue become clearly visible.
Blood analysis . At the same time, moderate leukocytosis is detected with an increase in neutrophilic granulocytes. Since the symptoms of subacute and chronic forms do not give a clear idea of the nature of the pathogen, a blood test for serology helps here.
Allergic tests. Most often, intradermal is done, although this method sometimes gives a false positive result, and a slight excess of the dose of the allergen can adversely affect the patient's health.
Differential Studies. To do this, it is necessary to exclude fibrosing and toxic alveolitis, sarcoidosis of the lungs, infectious pneumonia, tuberculosis, which has multiple foci.

Treatment

First of all, the treatment of exogenous alveolitis should begin with the elimination of the very cause that caused it. That is, the patient must in every possible way avoid contact with the pathogen. To restore the normal functioning of the body in acute and subacute forms, corticosteroid therapy (Prednisolone) is prescribed. If the alveolitis is chronic, antihistamines and restorative drugs are additionally prescribed. Also, Kuprenil has proven itself well, contributing to the rapid destruction of immune complexes.

Features in children

Allergic alveolitis often occurs in children, and is observed in a fairly wide age range (1.5 - 16 years). Almost half of the patients are schoolchildren. Since, unlike adults, the cause of the disease here is not related to professional activity, most patients are residents of rural areas.

It should be noted that there have been repeated cases of people falling ill after moving to another apartment located in an area rich in pathogens (for example, not far from the elevator). Also, allergic alveolitis can provoke an abundance of woolen carpets or dampness in a living room - a favorable environment for the formation of mold.

Treatment of this disease in children has the same specifics as in adults, differing only in the dosage of drugs. In addition to medicines, courses of physiotherapy exercises and massage are recommended for a speedy recovery.

In acute and subacute forms, the disease has a favorable prognosis, but when it becomes chronic, it can lead to serious complications. For example, in older people there have been cases of enlargement and expansion of the right heart, sometimes leading to death. Therefore, if allergic alveolitis is suspected, all necessary measures must be taken immediately to eliminate it.