Allergic alveolitis (AZPP) is a disease whose diagnosis is often not easy. Diagnostic difficulties result primarily from non-specific symptoms that may be suggested, among others, by flu or flu-like infections. What tests are performed when AZPP is suspected and how is the disease treated?

Allergic alveolitis (AZPP)is a disease for whichis not easy to diagnose . The disease does not show any characteristic symptoms that would allow a quick diagnosis.

Allergic alveolitis (AZPP) can resemble a number of other lung diseases, such as pneumonia and bronchitis. The diagnostic problem is also often the chronic nature of the disease.

In connection with the above, the treatment of allergic alveolitis is undertaken in the advanced stage of the disease.

Allergic alveolitis (AZPP) is an inflammatory disease that develops in response to inhalation of various antigens of organic (e.g. fungi, bacteria, animal proteins) or chemical (e.g. diisocyanates, acid anhydrides) , copper sulfide).

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Exogenous (exogenous) allergic alveolitis belongs to the groupoccupational diseasesof the respiratory system, because farmers and livestock breeders, as well as people exposed to wood dust are most often exposed to its development (including carpenters), food industry workers, chemical industry workers.

It is estimated that the disease develops in 5-15 percent. people who have long been exposed to high levels of allergens. In Poland, it occurs with the frequency of 12.6 / 100 thousand. residents.

Allergic alveolitis (AZPP) is a disease whosesymptomsdepend on several factors, such as the intensity and duration of exposure to the allergen, the type of allergen, and the host's response. Accordingly, there are 3 forms of the disease: acute, subacute and chronic.

Allergic alveolitis (AZPP) - the forms and causes of the disease

Depending on the cause of the disease, there are several forms:

  • The farmer's lungis the most commona form of AZPP, which is usually diagnosed in farmers and livestock breeders. It is mainly caused by thermophilic actinomycetes (gram-positive bacteria) derived from rotting hay and grain, such as:Termoactinomyces vulgaris, T. viridis, T. candidus, T. lisko, T. koski, Saccharomyces rectivirgula, Aspergillus fumigatus.
  • Bird breeder's lung- found in breeders of pigeons and parrots. The factor causing an allergic reaction is the mucin present in the air - a substance excreted in bird droppings.
  • Sauna user's lung- bacteria such asMycobacterium avium-intracellulare complex and Aureobasidiumare responsible for the development of this form of the disease. pollute the water.
  • Lung with air conditioning and air humidifiers- in this case, too, contaminated water and moisturizing systems play a major role, which are the source of bacteria such asMycoplyspora foeni , Thermactinomyces vulgaris, Thermactinomyces candidus, Klebsiella oxytoca, Aspergillus fumigatus, Pullularia pullulans.

This group of diseases also includes the so-called laundress lung, tobacco grower's lung, carpenter's or carpenter's lung, m alt lung, mushroom processing lung, clone lumberjack lung, cheese washing lung, coffee processing lung, fish meal lung, brewers 'lung, manufacturers' lung wines, the lung of the pepper producers, the lung of the furriers and the lung of the tea collectors.

There are reports of allergic alveolitis being provoked by unusual exposures such as feather pillows or feather ornaments.

Some people may have a genetic predisposition that favors the development of the disease.

Allergic alveolitis (AZPP) and the Arthus phenomenon (reaction)

At the root of the disease is the Arthus phenomenon (reaction), i.e. a local inflammatory reaction occurring after contact with a given substance (antigen) of a person who is strongly allergic to it. In the case of AZPP, this substance is present in the air in high concentration, has the ability to cause an allergic reaction, an organic particle.

After getting into the respiratory system, it penetrates its peripheral parts and, under favorable conditions, initiates the disease process.

Allergic alveolitis (AZPP) - symptoms

1. Acute character

Develops within a few (usually 4-12) hours of exposure to a high concentration of allergen. Then there is a cough, shortness of breath, fever, chills, joint pain, malaise,rapid breathing, tachycardia, crackles at the base of the lungs. These symptoms usually disappear on their own after 24-36 hours after stopping contact with the allergen.

2. Subacute character

Develops as a result of less severe exposure, manifested by exertional dyspnea, cough, low-grade fever, and fatigue. These symptoms may recur after re-exposure to the allergen.

3. Chronic form

It is associated with long-term exposure to an even lower allergen and develops over many months. Symptoms of the chronic form are gradually increasing shortness of breath, cough, anorexia, weight loss, malaise, rales at the base of the lungs, and symptoms of chronic respiratory failure.

There is no typical fever or low-grade fever for this form of the disease. Often the chronic form is diagnosed at an advanced stage of development when pulmonary fibrosis has already occurred.

Allergic alveolitis (AZPP) - diagnosis

The basis for the diagnosis of AZPP is a detailed interview regarding the symptoms of the disease and allergens in the patient's environment. If AZPP is suspected, lung X-ray and high-resolution computed tomography (CTWR) are performed.

This type of examination shows the features of the acute form of the disease, i.e. mediastinal nodules, areas of frosted glass, features of mosaic perfusion, and features of the chronic form of the disease, i.e. irregular subpleural densities in connection with abnormalities in the lung architecture and the presence of the "honeycomb" image ".

The next step is bronchoalveolar lavage (BAL), which is the examination of the cellular composition of the bronchial fluid. Additionally, blood tests are performed to detect precipitins (a type of antibodies) in the serum (these are mainly found in the acute form of the disease).

If a chronic form of the disease is suspected, in order to assess the area of ​​pulmonary fibrosis, it is recommended to perform pulmonary function tests, such as spirometry.
In patients in whom the results of the prescribed non-invasive tests do not allow the diagnosis of AP , a lung biopsy is necessary to rule out other causes of interstitial disease.

Allergic alveolitis (AZPP) - treatment

In the case of acute disease, treatment with glucocorticosteroids and discontinuation of contact with the allergen is recommended. Then the patient can be protected against pulmonary fibrosis.

However, if there are irreversible changes in the lung tissue, which is usually the case in patients with chronic disease, the only thing left to do isdiscontinuation of contact with the allergen causing the symptoms of the disease and symptomatic treatment of respiratory failure.

Category:

Allergies