Skip to main content
SpringerLink
Log in

Exogen-allergische Alveolitis (Farmerlunge)

Extrinsic allergic alveolitis (hypersensitivity pneumonitis or farmer’s lung)

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die exogen-allergische Alveolitis (EAA) ist eine seltene interstitielle Lungenerkrankung, die durch Inhalation von Antigenen in Stäuben, Gasen oder Aerosolen entsteht. Pathogenetisch liegt eine immunkomplexvermittelte und eine zellvermittelte Immunreaktion zu Grunde. Die Kenntnis der verschiedenen Krankheitsbilder und Verlaufsformen sowie der potenziellen Antigenexposition ist für eine zeitgerechte Diagnosestellung und damit eine möglichst frühzeitige Antigenkarenz essenziell. Fortgesetzte Allergenexposition kann zu einer irreversiblen Fibrosierung des Lungenparenchyms führen oder auch zu einem Emphysem mit chronischer respiratorischer Insuffizienz. Im Folgenden wird ein Überblick über die Epidemiologie, ätiologische Faktoren, die Immunpathogenese, die Histopathologie und das klinische Erscheinungsbild gegeben. Darüber hinaus wird auf diagnostische Parameter wie Immunserologie, bronchoalveoläre Lavage sowie radiologische Merkmale eingegangen. Abschließend werden die derzeitigen therapeutischen Optionen sowie die Prognose, insbesondere im Hinblick auf die unterschiedlichen Verlaufsformen dargestellt.

Abstract

Extrinsic allergic alveolitis (or hypersensitivity pneumonitis) is a rare interstitial lung disease caused by inhaling antigens in dust, gases, or aerosols. The pathogenesis of extrinsic allergic alveolitis involves both type III and type IV hypersensitivity reactions that are mediated by immune complexes and TH1 T cells, respectively. Knowledge of the diverse clinical disease forms and the different courses of disease is important for discovering potential antigens. An early diagnosis with the possibility of allergen avoidance should always be pursued. Persistent antigen exposure can cause lung fibrosis and emphysema, leading to respiratory failure. This review focuses on the epidemiology, etiology, immunopathogenesis, pathology, and clinical features of extrinsic allergic alveolitis. In addition, diagnostic tools such as determination of precipitins, bronchoalveolar lavage, and radiologic techniques are discussed. An overview of current treatment options and the prognoses of different disease courses is given at the end.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Pepys J (1969) Hypersensitivity disease of the lungs due to fungi and organic dusts. In: Monographs in Allergy, vol. 4, Karger, New York

  2. Lopez M, Salvaggio JE (1987) Epidemiology of hypersensitivity pneumonitis/allergic alveolitis. Monogr Allergy 21:70–86

    PubMed  CAS  Google Scholar 

  3. Fink JN (1987) Epidemiologic aspects of hypersensitivity pneumonitis. Monogr Allergy 21:59–69

    PubMed  CAS  Google Scholar 

  4. Cormier Y, Bélanger J, Beaudovin J et al (1984) Abnormal bronchoalveolar lavage in asymptomatic dairy farmers: a study of lymphocytes. Am Rev Respir Dis 130:1046–1049

    PubMed  CAS  Google Scholar 

  5. Warren CPW (1977) Extrinsic allergic alveolitis: a disease commoner in non-smokers. Thorax 32:567–569

    Article  PubMed  CAS  Google Scholar 

  6. Israël-Assayag E, Dakhama A, Lavigne S et al (1999) Expression of costimulatory molecules on alveolar macrophages in hypersensitivity pneumonitis. Am J Respir Crit Care Med 159:1830–1834

    PubMed  Google Scholar 

  7. Droemann D, Goldmann T, Tiedje T et al (2005) Toll-like receptor 2 expression is decreased on alveolar macrophages in cigarette smokers and COPD patients. Respir Res 6:68

    Article  PubMed  CAS  Google Scholar 

  8. Koschel D, Sennekamp J, Schurz C, Müller-Wening D (2004) Zimmerspringbrunnen-Alveolitis. Pneumologie 58:666–669

    Article  PubMed  CAS  Google Scholar 

  9. Koschel D (2006) Atypische Mykobakterien als Ursache der Maschinenarbeiterlunge, der hot tub lung und der Schwimmbadalveolitis. Allergology 29:449–450

    Google Scholar 

  10. Mohr LC (2004) Hypersensitivity pneumonitis. Curr Opin Pulm Med 10:401–411

    Article  PubMed  Google Scholar 

  11. Schaaf BM, Seitzer U, Pravica V et al (2001) Tumor necrosis factor-α-308 promoter gene polymorphism and increased tumor necrosis factor serum bioactivity in farmers lung patients. Am J Respir Crit Care Med 163:379–382

    PubMed  CAS  Google Scholar 

  12. Droemann D, Goldmann T, Branscheid D et al (2003) Toll-like receptor 2 is expressed by alveolar epithelial cells type II and macrophages in the human lung. Histochem Cell Biol 119:103–108

    PubMed  CAS  Google Scholar 

  13. Hasday JD, Bascom R, Costa JJ et al (1999) Bacterial endotoxin is an active component of cigarette smoke. Chest 115:829–835

    Article  PubMed  CAS  Google Scholar 

  14. Suga M, Yamasaki H, Nakagawa K et al (1997) Mechanisms accounting for granulomatous responses in hypersensitivity pneumonitis. Sarcoidosis Vasc Diffuse Lung Dis 14:131–138

    PubMed  CAS  Google Scholar 

  15. Girard M, Israel-Assayag E, Cormier Y (2000) Pathogenesis of hypersensitivity pneumonitis. Curr Opin Pulm Med 6:420–423

    Article  Google Scholar 

  16. Takemura T, Akashi T, Ohtani Y et al (2008) Pathology of hypersensitivity pneumonitis. Curr Opin Pulm Med 14:440–454

    Article  PubMed  Google Scholar 

  17. Lacasse Y, Selman M, Costabel U et al (2003) Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med 168:952–958

    Article  PubMed  Google Scholar 

  18. Sennekamp J (2004) Extrinsic allergic alveolitis – hypersensitivity pneumonitis. Dustri, München

  19. Lee TH, Wraith DG, Bennett CO et al (1983) Budgerigar fancier’s lung. Clin Allergy 13:197–202

    Article  PubMed  CAS  Google Scholar 

  20. Kroidl RF (1994) Lungenemphysem, Endstadium der allergischen Alveolitis. Allergologie 17:74–75

    Google Scholar 

  21. Costabel U (1994) Atlas der bronchoalveolären Lavage. Thieme, Stuttgart

  22. Matar LD, McAdams HP, Sporn TA (2000) Hypersensitivity pneumonitis. AJR Am J Roentgenol 174:1061–1066

    PubMed  CAS  Google Scholar 

  23. Silva CI, Churg A, Müller NL (2007) Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings. AJR Am J Roentgenol 188:334–344

    Article  PubMed  Google Scholar 

  24. Sennekamp J, Müller-Wening D, Amthor M et al (2007) Empfehlungen zur Diagnostik der exogen-allergischen Alveolitis. Pneumologie 61:52–56

    Article  PubMed  CAS  Google Scholar 

  25. Monkare S (1983) Influence of corticosteroid treatment on the course of farmer’s lung. Eur J Respir Dis 64:283–293

    PubMed  CAS  Google Scholar 

  26. Bourke SJ, Banham SW, Carter R et al (1989) Longitudinal course of extrinsic allergic alveolitis in pigeon breeders. Thorax 44:415–418

    Article  PubMed  CAS  Google Scholar 

  27. Zacharisen MC, Schlueter DP, Fink JN et al (2002) The long-term outcome in acute, subacute, and chronic forms of pigeon breeder’s disease hypersensitivity pneumonitis. Ann Allergy Asthma Immunol 88:175–182

    Article  PubMed  Google Scholar 

  28. Cormier Y, Belanger J (1985) Long-term physiologic outcome after acute farmer’s lung. Chest 87:796–800

    Article  PubMed  CAS  Google Scholar 

  29. Ohtani Y, Saiki S, Sumi Y et al (2003) Clinical features of recurrent and insidious chronic bird fancier’s lung. Ann Allergy Asthma Immunol 90:604–610

    PubMed  Google Scholar 

  30. Cormier Y, Létourneau L, Racine G (2004) Significance of precipitins and asymptomatic lymphocytic alveolitis: a 20-year follow-up. Eur Respir J 23:523–525

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Medizinische Klinik, Forschungszentrum Borstel, Parkallee 35, 23845, Borstel, Deutschland

    H.-P. Hauber &  P. Zabel

Authors
  1. H.-P. Hauber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Zabel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Zabel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hauber, HP., Zabel, P. Exogen-allergische Alveolitis (Farmerlunge). Pneumologe 6, 287–296 (2009). https://doi.org/10.1007/s10405-008-0290-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10405-008-0290-0

Schlüsselwörter

Keywords

Search

Navigation