Internal illnesses. Exogenous allergic alveolitis (most important)

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Internal illnesses. Exogenous allergic alveolitis (most important)

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38. EXOGENOUS ALLERGIC ALVEOLITIS

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.

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

Etiology. 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 medications.

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

Clinic. The 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 can be heard in the lungs (pneumonia-like syndrome), there may be a dry non-productive cough with expiratory shortness of breath and dry scattered wheezing (bronchitis syndrome), upon repeated contact with the allergen, symptoms may recur with a subacute (intermittent) course.

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

Diagnostic research. 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. X-ray examination is being carried out.

Differential diagnosis. In the acute stage 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, with the ineffectiveness of hormone therapy, immunosuppressors, with fibrosis D-penicillamine (cuprenil). Extracorporeal methods are used: plasmapheresis, hemosorption.

Flow. Prolonged, progressive.

Forecast. Relatively favorable.

Prevention. Primary prevention: development of technological processes of production, restriction of work in hazardous industries with bronchopulmonary diseases. Secondary prevention: dispensary observation.

Author: Myshkina A.K.

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