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[Physiopathology of extrinsic allergic alveolitis].

The extrinsic allergic alveolites classically represent the immunological reaction of type III of the lower respiratory tract. In fact, all immunological mechanisms and several non specific factors are involved in these affections. If delayed hypersensitivity (type I) is today considered as part of the disease, the mechanisms involving reagins (type I) are also probably part of it but it is not so evident for type II reactions. Non specific factors are numerous, often hypothetical, because they are still experimental and not all enumerated. The activation of alveolar macrophages, the triggering of the complement system by another way, the enzymes found in dust or the irritation produced by inhaled products are all important factors.

Allergens

[Extrinsic allergic alveolitis of drug origin].

Extrinsic allergic alveolitis of drug origin is now a better known branch of respiratory pathology. The symptoms and course of these cases resemble in many ways those of extrinsic allergic alveolitis in general with a few differences. The list of drugs responsible is longer every day, and it is important to be aware of it. The diagnosis of these diseases is not always easy, as there are certain similarities between them and other long diseases either iatrogenic or not, but not immuno-allergic. Our physiopathological knowledge is based on already known data concerning allergic alveolitis, but includes many theories which still have to be verified. It is important for the clinician to be aware of this new type of respiratory disease as the treatment includes withdrawal of the responsible drug as soon as possible, failing which irreversible pulmonary fibrosis develops.

Alveolitis, Extrinsic Allergic

Mechanical properties of the lung in extrinsic allergic alveolitis.

The lung function of 14 patients with extrinsic allergic alveolitis caused by exposure to mouldy hay (farmer's lung) or to birds (bird fancier's lung) was studied one week and four to six weeks after the last exposure to antigen. These data, together with lung mechanics measured four weeks after antigen exposure, were compared with measurements in 34 healthy non-smoking control subjects. Shortly after exposure to antigen there were reduction in lung volumes, increased elastic recoil (reduced compliance), and varied effects on expiratory flow and reduced gas transfer. With time, lung volumes and gas transfer improved, but expiratory flow often remained decreased. The data on lung mechanics showed that reduced compliance was often found, but this increased recoil did not always produce high airflow indicating increased upstream airways resistance. Patients with a longer duration of the illness tended to have increased compliance (reduced recoil) and low airflow. These results show that the described pathological changes of airway involvement, fibrosis, and emphysema in allergic alveolitis are manifest in the lung function of patients with the disease.

Adult

Extrinsic allergic alveolitis from bird exposure. Studies on the immediate hypersensitivity reaction.

Six patients with extrinsic allergic alveolitis had weak immediate and strong late reactions of intracutaneous injection of bird serum. Biopsy of the late reaction revealed vasculitis and immunoglobulin and complement deposition in one. The antibody responsible for the immediate hypersensitivity could be transferred in serum. It was short lasting (4 hr) and resistant to heat and 2-mercaptoethanol. No evidence of an immediate reaction in the lungs could be detected following inhalation challenge as judged by examination of spirometry, flow volume loops and single breath nitrogen washout curves.

Adolescent

Extrinsic allergic alveolitis: a disease commoner in non-smokers.

The smoking habits of 18 patients with extrinsic allergic alveolitis, 22 with cryptogenic fibrosing alveolitis, and 75 patients with sarcoidosis were compared with the smoking habits of the normal population of the Prairie Region for 1973. The patients were diagnosed at the same two hospitals over the four-year period November 1971--75 and were of comparable age. Non-smoking was significantly associated with allergic alveolitis in men and the three cases in women were all non-smokers. For the other two diseases, smoking habits were similar to those of the local population.

Adolescent

Extrinsic allergic alveolitis and contaminated cooling-water in a factory machine.

Symptoms and signs typical of extrinsic allergic alveolitis occurred in 24 workers in a stationery factory. The illness was caused by inhalation of a water aerosol contaminated by microorganisms, and although no specific organism has been incriminated, affected workers had serum precipitins to the contaminated water, and the illness could be reproduced by inhalation challenge tests.

Adult

Humidifier-associated extrinsic allergic alveolitis.

Three cases of allergic alveolitis due to indoor humdification systems are described. Thermoactinomyces vulgaris precipitins were detected in the serum of a 37-year-old female patient who had typical febrile attacks during exposure to cool-mist from a home humidifier. When the cause was detected and eliminated, the symptoms and signs disappeared and the woman's gas transfer factor improved from 56% to normal within six months. In a printing office a 60-year-old woman had had febrile attacks with cough for more than a year. The patient herself associated the respiratory disease with a cool-mist humidifier sometimes used at work. The water reservoir was heavily contaminated with amoebas (Amoeba proteus), which might have been the causative organisms in this case. Aspergillus fumigatus precipitins were found in the serum of a 53-year-old female printer with the clinical picture of occupational allergic alveolitis. The same organism was detected in the ambient air of the printing office.

Adult