EXTRINSIC ALLERGIC ALVEOLITIS AND ASTHMA IN A SAWMILL WORKER - CASE-REPORT AND REVIEW OF THE LITERATURE

A 34 year old sawmill maintenance engineer developed a dry cough that was associated with widespread wheezes and crackles in his lungs. His symptoms worsened, with work related lethargy, fever, and breathlessne ss, and the loss of a stone in weight. At that time, while still at wo rk, he had a neutrophil leucocytosis and increased concentration of ga mma globulins. When seen subsequently some two months after stopping w ork, his chest radiograph and lung function tests were normal, but the cells recovered at bronchoalveolar lavage showed an increase in lymph ocytes and mast cells. a pattern consistent with extrinsic allergic al veolitis. Serum precipitins were identified to extracts of sawdust, wo od chips, and bark from the sawmill, and to eight species of mould gro wn from these samples. Specific IgG binding inhibition studies suggest ed that a common epitope present on Trichoderma koningii might be resp onsible for the cross reactivity of the patient's serum with the wood and fungal extracts. A diagnosis of wood associated extrinsic allergic alveolitis was made and since changing his job the patient has remain ed well. Wood associated allergic alveolitis has not previously been d escribed in British sawmill workers, but has been reported in Sweden, with a prevalence of 5%-10% in exposed workers. A review of published data suggests extrinsic allergic alveolitis in wood workers is primari ly caused by inhalation of the spores of contaminating fungi, but inha led wood dust may exert a synergistic effect.