From the history of allergology: Extrinsic allergic and toxic alveolitis

The flagship of extrinsic allergic alveo-litis was, historically, farmer's lung, whose history can be traced back to the year 1500. Later, however, it turned out that allergic alveolitis from various dusts of birds and bed feathers is by far most common. Surprisingly, this was not discovered until 1960. The immunological processes with the precipitating IgG antibodies were detected in the 1960s primarily by J. Pepys in London. Later, more than 50 different clinical pictures have been described with this so-called type III allergy caused by bacteria, fungi, yeasts, plants, animals, and chemicals. Outstanding are indoor alveolitis and humidifier lung caused by humidifiers and air conditioning systems as well as misting fountains, steam irons, whirlpools, and wind instruments. From a clinical point of view, toxic alveolitides are confusingly similar to allergic alveolitis. Thus, thresher's lung is often confused with farmer's lung. For the toxic alveolitides from organic dusts such as hay, straw, cotton, flax, hemp, or jute dust, the term ODTS (organic dust toxic syndrome) has become established. In contrast to allergic alveolitis, ODTS does not lead to fibrosis of the lung and also lacks the high titer IgG antibodies typical for allergic alveolitis. Of the inorganic toxic alveolitides, metal fume fever has been known since 1832, the silo filler's disease since 1956, polymer smoke fever, on the other hand, only since the 1980s. These inorganic toxic alveolitides of toxic vapors, smokes, and gases are very heterogeneous, and their pathomechanisms are poorly understood.