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Allergic alveolitis in Swedish farmers
1Department of Occupational Medicine, University Hospital, Uppsala, Sweden.
Abstract:
Allergic alveolitis due to mold dust inhalation in farmers is a severe but rare disease in Scandinavia. In this report 38 cases of the disease are presented. There were 31 men and 7 women, with mean ages of 46 and 38 years respectively. Strict diagnostic criteria were used, resulting in 21 definite, 12 probable and 5 possible cases. None of the patients were current smokers, but 10 of the men were ex-smokers. The great majority of the patients fell ill between October and April. The symptoms were dyspnea, cough, fatigue, episodes of fever, and in some cases loss of weight. The average duration of the disease was 6 months. The moldy material most commonly associated with the disease was straw, followed by hay, grain, and wood chips. For those tested serum lactate dehydrogenase was raised in 80% and the mean value for PaO2 was 7.8 kPa. Precipitating antibodies to mold antigens were positive in 68%. In general, pulmonary function tests showed a restrictive pattern. Over half of the patients still had dyspnea on exercise after recovery. Three fourths of the patients were treated with antibiotics and thus clearly had been misjudged as having an infection.
Insights
Allergic alveolitis in farmers, caused by mold dust, is a serious condition. Many patients were misdiagnosed with infections and treated with antibiotics.
Area of Science:
- Pulmonary Medicine
- Occupational Health
- Immunology
Background:
- Allergic alveolitis is a severe lung disease caused by inhaling mold dust, particularly affecting farmers.
- This condition is rare in Scandinavia, but this study details 38 cases.
Purpose of the Study:
- To present and analyze 38 cases of allergic alveolitis in Scandinavian farmers.
- To describe the clinical presentation, diagnostic findings, and outcomes of this occupational lung disease.
Main Methods:
- Retrospective case series analysis of 38 farmers diagnosed with allergic alveolitis.
- Inclusion based on strict diagnostic criteria, categorizing cases as definite, probable, or possible.
- Data collection included patient demographics, symptom duration, exposure history, laboratory tests, and pulmonary function.
Main Results:
- The majority of patients (31 men, 7 women) presented with dyspnea, cough, and fatigue, primarily between October and April.
- Common exposures included moldy straw, hay, grain, and wood chips.
- Elevated serum lactate dehydrogenase (80%), positive mold-specific precipitating antibodies (68%), and a restrictive pulmonary function pattern were observed. Many experienced persistent dyspnea on exertion post-recovery.
Conclusions:
- Allergic alveolitis in farmers is characterized by specific mold exposures and distinct clinical and immunological findings.
- A significant proportion of patients were misdiagnosed with infections and received inappropriate antibiotic treatment.
- Early and accurate diagnosis is crucial to prevent misdiagnosis and ensure appropriate management of this occupational lung disease.