Extrinsic allergic alveolitides (EAA) are a group of hypersensitivity lung dis eases caused by organic dusts of diverse origins. Despite the similar clinical, radiological, histological, serological and pulmonary function findings, the causative allergens in the dusts do not belong to a common molecular species. All EAA dusts have particles within the respirable range (i.e. up to 5 μm) some allergens are wholly soluble, some partly soluble and others associated with insoluble particles. EAA is not due to endotoxin in dusts, and the presence of specific antibodies and sensitized lymphocytes against the allergens provides a pointer to the hypersensitivity pathways that are activated to produce disease episodes. However, some EAA dusts can activate these pathways per se at high dust levels. Exposure to EAA dusts does not always lead to sensitization, yet some people respond to extremely low levels. Heredity has little influence on EAA, and although smoking reduces the immune response to EAA dusts, it does not prevent EAA. Prevention is dependent on reducing or abolishing exposure, and several techniques are outlined.
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