Internal illnesses. Exogenous allergic alveolitis (lecture notes)

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Internal illnesses. Exogenous allergic alveolitis (lecture notes)

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LECTURE No. 33. Exogenous allergic alveolitis

Exogenous allergic alveolitis is a group of diseases caused by intense and prolonged inhalation of organic and inorganic dust antigens and characterized by allergic diffuse damage to the alveolar and interstitial structures of the lungs.

Common signs of the disease. The inflammatory process is localized in the alveoli and interstitium of the lungs, and not in the airways. The damaged areas consist of polynuclear and mononuclear infiltrates, sarcoid-like granulomas; in the later stages - the development of interstitial fibrosis. Types III and IV allergic reactions develop.

Etiology. Etiological factors are microorganisms (bacteria, fungi, protozoa) and their metabolic products (proteins, glyco- and lipoproteins, polysaccharides, enzymes, endotoxins), biologically active substances of animal and plant origin, low molecular weight compounds and drugs.

Pathogenesis. Type I pneumocytes are damaged, re-epithelialization of type II pneumocytes is disturbed, and the activity of suppressor T-lymphocytes decreases.

Clinic. Acute stage develops 4-12 hours after contact with the allergen. Chills, fever, cough, shortness of breath, nausea, myalgia and arthralgia (flu-like syndrome) appear, crepitus and moist rales (pneumonia-like syndrome) can be heard in the lungs, there may be a dry unproductive cough with expiratory shortness of breath and dry scattered wheezing (bronchitis syndrome). ), upon repeated contact with the allergen, the symptoms may recur with a subacute (intermittent) course.

In the chronic stage becomes a typical “Monday phenomenon”: acute manifestations are noted on days after rest, disappear by the end of the working week (this form is diagnosed more often), gradually respiratory failure progresses, asthenic syndrome, anorexia, weight loss with the formation of a chronic form, pulmonary hypertension and cor pulmonale are formed .

Additional diagnostic study. A general blood test is performed (neutrophilia, increased ESR, eosinophilia), an immunological blood test (the activity of all parts of the immune response), skin tests with allergens, an inhalation provocative test with an antigen are performed. An x-ray examination is carried out (changes that cannot be explained by other diseases), determination of the function of external respiration: destructive or obstructive types (bronchioloalveolitis) of respiratory failure and impaired diffuse ability leading to hypercapnia, examination of lung tissue biopsies.

Complications. Complications of the disease are respiratory failure, cor pulmonale.

Differential diagnostics. In the acute stage, it should be carried out with ARVI, influenza, acute pneumonia, acute bronchitis. In the chronic stage - with idiopathic fibrosing alveolitis, granulomatous processes in the lungs (tuberculosis, sarcoidosis, Wegener's granulomatosis).

Treatment. In the acute phase, mandatory hospitalization. Glucocorticoid hormones are shown: prednisolone 40-60 mg/day for 1-3 days, followed by a decrease within 3-4 weeks, if hormone therapy is ineffective, immunosuppressants - azathioprine at 150 mg/day for 1-1,5 months, then at 100 mg/day 4 -5 months, then 50 mg / day also 4-5 months, with fibrosis D-penicillamine (cuprenil) 150-200 mg per day for 4-6 months, followed by 100 mg / day for 2 years. Extracorporeal methods are used: plasmapheresis, hemosorption.

Flow. Prolonged, progressive.

Forecast. Relatively favorable.

Prevention. Measures of primary prevention: development of technological processes of production, restriction of work in hazardous industries for patients with bronchopulmonary diseases. Measures of secondary prevention: dispensary observation.

Author: Myshkina A.A.

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