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Pathology

Hypersensitivity reaction to inhaled allergens 
Acute phase: inflammation
Chronic exposure: granuloma formation, bronchiolitis obliterans

Aetiology

Multiple allergens: bird fanciers lung, pigeon fanciers lung, farmers lung (Micropolyspora Faeni), malt workers lung (Aspergillus clavatus)

Signs

Crackles, fever, weight loss if chronic process.

Symptoms

Acute (4-6hrs post-exposure): dry cough, dyspnoea, fever, rigors, myalgia. 
Chronic: progressive dyspnoea, weight loss, cor pulmonale

Investigations

FBC: ↑WCC (neutrophils), ↑CRP/ESR
Chest X-Ray: bilateral mid-zone shadowing 
Spirometry: restrictive defect, allergen testing

Treatment

Remove offending allergen, in the acute phase give oxygen if hypoxic and steroids

Prognosis

Resolves if allergen removed +/- steroids in the acute period
May progress to permanent lung damage if chronic exposure, type 1 respiratory failure, cor-pulmonale

Key Facts

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Key Images

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Key References

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