In contact with many parents of young patients with allergic rhinitis, there are two extremes of opinion. Some parents believe that allergic rhinitis cannot be cured, so they simply give up treatment; while others believe that allergic rhinitis must be cured when their children are still young, so there is often over-treatment.
“Desensitization” is the treatment method for allergic rhinitis that parents mention most often and have high hopes for. So what is desensitization? Simply put, “desensitization” is a form of immunotherapy. It uses low titers of allergens to stimulate the body to produce antibodies, and then increases the titers of allergens to gradually reach a high saturation of antigen-antibody combination, so that when external allergens enter the body again, no more allergic reactions will occur, thus achieving a non-allergic state of allergy. This is the basic principle of “sublingual” or “intramuscular” desensitization treatment.
However, the above situation is only the ideal state, the actual medical treatment has the following realistic problems: 1, the complexity and diversity of allergens. There are many allergens in nature, and we can detect only 30 kinds of them, including the food group and inhalation group, so the current “desensitization” treatment is mainly effective for patients who are allergic to mites alone. 2, the treatment cost is high, the course of treatment is long. 3 years (some manufacturers advertise that 2 years is not appropriate) of treatment, the cost of 20-30,000, is difficult for many families to afford. 3, “desensitization” treatment can not completely replace the drug, the first 50 weeks, nasal spray hormone and antihistamine, anti-leukotriene drugs can not be reduced, the second year under the premise of effective treatment, drug therapy two can be reduced to 1/2. After the third year, it is still necessary to use maintenance medication.
Therefore, “desensitization” treatment must be considered under the premise of medication. In the “Standard for the Treatment of Allergic Rhinitis”, “desensitization” treatment is not the first line of medication. “Desensitization” is a common phenomenon in the treatment of allergic rhinitis that is extremely irregular at present. So, under what circumstances is “desensitization” treatment suitable? According to our clinical cases, the following patients can be used: 1. Patients with allergic rhinitis combined with allergic asthma can be treated with immunotherapy in addition to medication. It can reduce both respiratory and nasal symptoms. For mite allergy alone, sublingual administration is sufficient; for those with other allergens combined, intramuscular injection can be considered.
2. Patients with allergic rhinitis with pure mite allergy can consider sublingual treatment for 3 years.
3.Refractory or perennial allergic rhinitis patients with poor long-term medication effect can consider combined “desensitization” treatment.
4. For patients with allergic rhinitis who are not sensitive to hormones, “desensitization” treatment is a potentially effective method.
“The most common misconception is that “desensitization” treatment can cure allergic rhinitis, which is the most common misconception, and that the current level of medical technology cannot completely cure allergic rhinitis, which should be a common understanding between doctors and patients. In particular, the current single “desensitization” of allergens makes the actual clinical efficacy very limited, which is a problem that our physicians must pay attention to before using “desensitization” treatment for patients. 2. This is a problem that our physicians must pay attention to before giving patients “desensitization” treatment. In fact, there are strict limitations in children. For the common desensitizing drugs, “sublingual” can only be used at the age of 4 years or older. And “intramuscular injection” must be used only at the age of 6 years or older, and the method of use must be strictly referred to the drug instructions, gradually increase the amount, not in one step. Especially in children, I do not advocate the use of immunotherapy if only seasonal rhinitis is present. The literature shows that children’s immunity is greatly enhanced twice around the ages of 9 and 13, which is the reason why many asthma patients do not have attacks after the age of 9 and allergic rhinitis patients heal themselves at the age of 13. The appropriateness of “desensitization” treatment for children with seasonal rhinitis alone is a questionable issue from all aspects.
3. The belief that “desensitization” treatment has no side effects. This is also a big misunderstanding, the so-called “desensitization” is to add the appropriate allergens to the body, then we can produce both anti-allergic state, but also may cause the body’s allergic state, and once the allergic reaction occurs, the consequences are also very serious. In China, there has been a reported case of an adult who suffered a serious side effect during immunotherapy, which is something that clinicians must be aware of when recommending patients for “desensitization” treatment. For patients who are undergoing or have undergone “desensitization” treatment, it is found that desensitizing drugs should be stopped in case of severe colds or other diseases, just to avoid such side effects.
4, think “desensitization” treatment can be used after the drug, especially hormonal drugs. Many parents have high hopes for “desensitization” treatment because they are afraid of using nasal spray hormones. In fact, desensitization therapy is only an adjuvant therapy under the premise of first-line medication. After the “desensitization” course (3 years) is over, maintenance medication must be administered if there is efficacy. For patients who are found to be ineffective at an early stage, medication is still the main treatment method, and “desensitization” treatment can even be stopped to reduce the patient’s burden.
In conclusion, we have controlled or “cured” many patients clinically by using “desensitization” methods, but we also found that the so-called “desensitization” treatment is far from the ideal requirements of doctors. This is a problem that cannot be avoided. Due to the uncertainty of the cause of allergic rhinitis and the uncertainty of the treatment effect, it is destined to bring psychological, physiological and economic burdens to the patients. The claim of “cure” brings high expectations to the patients, but the unsatisfactory results bring despair and heavy economic burdens to the disease treatment. How to choose a suitable personalized treatment plan for allergic rhinitis is a question worth thinking about. Therefore, as a doctor, only by treating the “patient” first can we treat the “disease” more effectively.