Allergic pneumonia

　　Allergic pneumonia is a group of non-asthmatic allergic pulmonary diseases caused by different allergens, with a low incidence in children. The allergen is organic dust particles containing fungal spores, bacterial products, animal proteins, or insect antigens. According to statistics, the known organic dust that can cause allergic pneumonia is at least40 or more.

　　The occurrence of allergic pneumonia is mainly due to organic dust as an immunogen. The particles should be less than5The acute form often occurs after exposure to the antigen.6μm. Because particles larger than this diameter are mostly deposited in the upper respiratory tract or large bronchi, only when the allergen enters the small airways and alveoli and then enters the surrounding lung tissue can it cause alveolitis. When the amount of allergen particles reaching the alveoli reaches a certain level, the lung tissue produces a strong immune response, causing allergic alveolitis.

　　Patients with late-stage allergic pneumonia may develop honeycomb lung. Honeycomb lung is a pulmonary change characterized by honeycomb-like features in various late-stage pulmonary diseases. The lesions often involve the middle and lower lung fields, forming cysts with a diameter of about1Cysts of about cm in diameter, arranged one by one, resembling the appearance of a honeycomb or beehive. Symptoms are manifested as pulmonary function failure, characterized by decreased ventilation function, hypoxia, and asphyxia. X-ray manifestations show thickening and disorder of pulmonary vessels, presenting as linear, filamentous, or multiple annular radiolucent shadows. Due to the shrinkage of the lower lobe, the intercostal space often becomes narrow and the diaphragm elevated, which may be accompanied by displacement of the mediastinum, trachea, or hilum.

　　After inhaling allergens, a few children with allergic pneumonia may have prodromal symptoms such as wheezing and runny nose.3The acute form often occurs after exposure to the antigen.6After a few hours, symptoms begin to appear, characterized by fever, dry cough, rapid breathing, chest pain, hypoxia, cyanosis of the lips, fingers, and toes, and so on.6The acute form often occurs after exposure to the antigen.8The symptoms mentioned above reach their peak after a few hours.24The symptoms basically disappear after a few hours. During the attack, the pulmonary signs are different from those of asthma, with few wheezing sounds, mainly wet rales.

　　急性型常在接触抗原后4The acute form often occurs after exposure to the antigen.8～

　　How to prevent allergic pneumonia?

　　1Summer is the peak period for allergic pneumonia because the air in summer is relatively dry and turbid. Nowadays, air pollution is serious, and people who have lived in such an environment for a long time are prone to upper respiratory tract diseases, among which allergic pneumonia is a common one.

　　2The best preventive measure for allergic pneumonia in summer is to prevent and treat early, and to leave the environment of allergens early. If exposure to allergens can be avoided in time, symptoms such as fever, cough, and shortness of breath can disappear within a week.

　　3It is necessary to strengthen indoor ventilation and air exchange, adjust the environment, to reduce the invasion of allergens into the respiratory tract.

　　4For fever, alcohol baths and other physical methods of cooling can be used, and cough can be treated with cough suppressants. In addition, corticosteroids and aminophylline have a certain therapeutic effect on the disease, while the use of antibiotics is futile.

　　5At the same time, the use of antiallergic drugs can be combined, which can have a good effect.

　　6The patient's diet should be warm, light, and soft, with small and frequent meals. Eat more fruits, vegetables, beans, and high-fiber foods, and avoid allergenic and irritant foods such as fish, shrimp, chili, strong tea, coffee, and alcohol.

　　Although it was previously believed that a positive serum precipitation antibody could clearly diagnose allergic pneumonia, the presence of serum antibodies is neither sensitive nor specific. The diagnosis is based on a history of environmental exposure, relevant clinical characteristics, chest X-ray, pulmonary function tests, and fiberoptic bronchoscopy. The history of exposure can provide clues (such as individuals exposed to antigens at work may be asymptomatic, or symptoms may occur after re-exposure).48appears again after hours). The history of exposure to the causative antigen is not easy to find out, especially for 'air conditioning lung' (humidifier lung). Environmental investigations by experts for difficult cases are helpful for diagnosis. For patients who are difficult to diagnose or have no history of environmental exposure, lung biopsy can be performed.

　　1Imaging

　　The chest X-ray examination may be normal or show diffuse interstitial fibrosis. Bilateral plaques or nodular infiltrates, thickening of bronchopulmonary markings, or small acinar changes may suggest pulmonary edema. Lymph node enlargement at the hilum and pleural effusion are rare. CT, especially high-resolution CT, is valuable for determining the type and extent of the lesion.

　　(1) The CT manifestations of acute allergic pneumonia include double lung ground-glass changes; widespread patchy, mass-like, and cloud-like lung consolidation shadows, with blurred edges, uneven density and distribution, more common in the middle and lower lungs, with rapid changes in lesion location and migratory characteristics. The pathological basis of the imaging manifestations of acute allergic pneumonia is the infiltration of neutrophils and eosinophils in the lung parenchyma and the inflammation of small blood vessels, causing diffuse lung congestion and edema, and the exudation of protein fluid in the alveoli.

　　(2) The CT manifestations of acute allergic pneumonia include double lung ground-glass changes; widespread patchy, mass-like, and cloud-like lung consolidation shadows, with blurred edges, uneven density and distribution, more common in the middle and lower lungs, with rapid changes in lesion location and migratory characteristics. The pathological basis of the imaging manifestations of acute allergic pneumonia is the infiltration of neutrophils and eosinophils in the lung parenchyma and the inflammation of small blood vessels, causing diffuse lung congestion and edema, and the exudation of protein fluid in the alveoli.

　　(3The CT manifestations of chronic allergic pneumonia are reticular and honeycomb-like fibrous shadow, indicating lung interstitial fibrosis; in severe cases, atelectasis, emphysema, and pleural thickening can be seen. The CT manifestations of subacute allergic pneumonia include diffused small lobular central nodular shadows, unclear edges; patchy ground-glass shadows; air trapping signs and lung cystic changes. The pathological basis of the imaging manifestations of subacute allergic pneumonia: small lobular central nodular shadows are the manifestation of cellular bronchitis; ground-glass shadows are the manifestation of diffuse lymphocytic interstitial pneumonia; air trapping signs and lung cystic changes are the result of bronchial inflammation and obstruction. Small lobular central nodular shadows and ground-glass changes are characteristic changes of allergic pneumonia, while small lobular central nodular shadows are characteristic changes of subacute allergic pneumonia.

　　2Lung function

　　Mostly restrictive, lung volume reduction, decreased carbon monoxide diffusion, ventilation/Abnormal blood flow ratio and hypoxemia. Acute cases are not common, but chronic cases can occur. Eosinophils are normal.

　　3Bronchoscope

　　Bronchoalveolar lavage is a sensitive method to determine the presence of alveolitis. Lymphocytes are generally visible, especially an increase in T cells, with CD8+(Inhibitory cell toxicity) T cell subsets are mainly involved. The value of bronchoscope biopsy is very limited due to the small amount of specimens, which can cause misdiagnosis.

　　Allergic pneumonia patients should eat more fresh fruits and vegetables, eat more foods rich in vitamin C, such as oranges, strawberries, kiwi, etc., eat more foods rich in vitamin A, such as fatty fish and eggs, which is very important for maintaining the health of the tracheal membrane. Avoid eating high sugar foods, high protein diets, spicy foods, etc. Allergic pneumonia food therapy (the following information is for reference only, detailed information needs to be consulted with a doctor):

　　1Jasmine Tofu Soup: Fresh jasmine roots120 grams, tofu250 grams. Put fresh jasmine roots and tofu in a pot, add water and boil.

　　2Pumpkin Beef Soup: Lean beef250 grams, ginger6grams. Boil beef until 80% done, then add peeled pumpkin500 grams, boil together until cooked, season with salt and MSG.

　　3Chrysanthemum Honey Drink: Chrysanthemum leaves150 grams, honey30 grams. Cut the chrysanthemum leaves into pieces, then boil with water.10minutes later, filter the residue and extract the juice, add honey, and boil for a moment. Every day1剂，分3times, drink it all at once, and take it consecutively.5dosis.

　　4Honeyed Radish: White radish250 grams, molasses3tablespoons. Peel and slice the white radish, place in a bowl, and add molasses.3tablespoons, mix well and leave overnight.

　　5Silver and Tangerine Mung Bean Porridge: Silver dew30 grams, mung beans50 grams, glutinous rice150 grams, dried tangerine peel15grams, fresh lotus leaves25grams, fresh bamboo leaves20 grams, sugar to taste. Cut lotus leaves, bamboo leaves, and dried tangerine peel into pieces, then boil with water.10minutes, filter the residue and take the juice. Put the mung bean and glutinous rice in the pot, add water and boil with high heat, then cook with low heat, add silver flower dew, medicine juice, sugar, boil for a moment. Every day1剂，分2times服完，连服5dosis.

　　6、Fischherba shepherd's purse tea: Fischherba50g, sugar as needed. Boil the money grass and shepherd's purse with water10minutes, add sugar.

　　7、Braised pork with chestnuts: Chestnuts250g, lean pork500g, salt, ginger, black bean sauce each a little. Remove the chestnut skin, cut the pork into pieces, add salt and other spices, add water in moderation and braised, cook until tender.

　　8、Yami lily soup: Yami200g, lily50g. Βάλτε τα δύο υλικά στην κατσαρόλα, προσθέστε νερό5Bowl, boil into3Bowl, take three times, finish in one day.

　　9、Fischherba αυγά: Fischherba1Βάλτε, αυγά αρκετά. Ζεσταίνετε τα αυγά και φάγετε για αρκετές ημέρες και θα ιαθείτε.

　　Η θεραπεία της αλλεργικής πνευμονίας πρέπει πρώτα να απομακρυνθεί το αλλεργιογόνο, η αιφνίδια εμφάνιση μπορεί να ανακουφιστεί φυσικά, οι ασθενείς με σαφή συμπτώματα πρέπει να χειριστούν τα συμπτώματα, αν τα συμπτώματα συνεχίζονται και επιδεινώνονται και υπάρχει σοβαρή κοιλιακή κόπωση, πρέπει να αναπνεύσουν οξυγόνο και να δοθεί πρεδνισον30～60mg/d, μετά την σταθεροποίηση της κατάστασης, χρειάζεται να δοθεί η συντηρητική δόση20～30mg/d1Ημέρες, μετά την πλήρη εξαφάνιση των συμπτωμάτων, μειώστε τη δόση και σταδιακά σταματήστε τη χρήση. Η βλάβη από την HRCT του θώρακα είναι η ομοιομορφία του υαλώδους σκιού, και είναι συχνά απορροφημένη και βελτιωμένη μετά τη θεραπεία με κορτικοστεροειδή. Όταν η σκιά είναι κυρίως η κελίμορφη σκιά, η αποτελεσματικότητα της θεραπείας με κορτικοστεροειδή είναι κακή.

　　Η πρόωρη διάγνωση και η αποφυγή της επαφής με το αλλεργιογόνο είναι κρίσιμη για τη θεραπεία, η αφαίρεση των αλλεργιογόνων από το περιβάλλον επαφής του ασθενούς έχει κρίσιμη σημασία για τη θεραπεία και την πρόληψη. Η φαρμακευτική αγωγή έχει σημαντική υποστηρικτική επίδραση μόνο σε μερικές περιπτώσεις. Η θεραπεία με κορτικοστεροειδή μπορεί να ανακουφίσει και να εξαλείψει τα συμπτώματα της επιδείνωσης, και μπορεί να προφυλαχθεί από μόνιμες βλάβες όπως η επέκταση των βρόγχων, η μη αναστρέψιμη βρόχνη阻塞 και η πνευμονική σclerosis. Για τους ασθενείς με ήπια βλάβη της πνευμονικής λειτουργίας, η αποφυγή της επαφής με το αλλεργιογόνο μπορεί να ανακουφιστεί από μόνη της χωρίς τη χρήση κορτικοστεροειδών. Οι ασθενείς με σοβαρές ασθένειες μπορεί να χρησιμοποιήσουν την πρεδνισον. Οι πρώτοι τέσσερις εβδομάδες της θεραπείας πρέπει να παρακολουθούνται δυναμικά η πνευμονική λειτουργία, και πρέπει να μειωθεί η δόση των κορτικοστεροειδών σταδιακά μέχρι να σταματήσει. Οι ανθεκτικές και προοδευτικές αλλεργικές πνευμονίες μπορούν να χρησιμοποιήσουν το τοξικό φάρμακο, όπως το κυκλοφωσφαμίδη, το κυκλοσπορίνη και το θειαζίνιο, αλλά δεν υπάρχει επαρκής έρευνα για την αποτελεσματικότητά τους.