Introduction to allergic diseases

  The prevalence of various allergies in children, especially in young children, has increased significantly in the past decade, with the prevalence of allergic rhinitis in children now reaching 7.5% and the prevalence of asthma in children aged 0-14 years at 1.56%. The number of children with asthma in Shanghai has more than doubled in the last decade. Although allergic rhinitis is not life-threatening, it is a widespread disease that is closely related to bronchial asthma/sinusitis/conjunctivitis and affects children’s life and learning.  Allergic diseases are multifactorial diseases induced by the interaction of genes and environmental factors, often with a certain family history of exposure to certain allergens that cause the disease. Common inhalant allergens include dust mites/various molds/animals and various plants, and can also be triggered by food-based allergens.  Allergic diseases occur sequentially in early childhood and are called atopic processes. Dermatitis, such as eczema or tinea cruris, often occurs during the first 6 months of life, followed by migration of sensitized cells to the nose and upper and lower respiratory tract causing upper and lower respiratory tract disease. The manifestation in the nose is allergic rhinitis. Allergic rhinitis is a disease characterized by nasal symptoms such as runny nose, sneezing, nasal congestion and nasal itching caused by IgE-mediated inflammation of the nasal mucosa after exposure to allergens. It is often confused with the common cold, but the duration of the common cold is usually about 10 days, while the cold-like symptoms in the nose of allergic rhinitis can last for hours or days, or even for a month or longer. The manifestation in the lower respiratory tract is asthma. Because of the similarity between the mucous membranes of the nose and airways, allergy causes inflammatory cells to be present in all airways, making the bronchi hyperreactive and giving a continuity to the allergic disease. Most children with asthma also have allergic rhinitis, and the presence of allergic rhinitis often exacerbates asthma and increases the number of asthma attacks, both of which develop through a common pathogenic mechanism. In infants and younger children, the onset of asthma often precedes the symptoms of allergic rhinitis.  Allergic children can also have other concomitant diseases and complications, such as allergic rhinitis, rhinosinusitis, adenoiditis, nasal polyps, eustachian tube dysfunction, exudative otitis media, chronic cough, and gastroesophageal reflux disease.  For the treatment of allergic diseases, avoidance of allergens is primary. This can be clarified by testing allergic children for allergens and intervening with clothing, food, housing and transportation. The next step is pharmacological treatment. Intranasal glucocorticoids are the most effective medication for allergic rhinitis. The ones commonly used in children on the market today are endosulphan, colecalciferol, and rhinocort. The use of H1 antihistamines in the treatment of allergic rhinitis in children is particularly important as many children clearly prefer oral medications to intranasal topical medications. Second-generation antihistamines that do not have a central inhibitory effect such as cetirizine and loratadine are advocated. Nasal antihistamines such as lisdexamfetamine have the advantage of rapid onset of action and few side effects and can be used in children whose symptoms are confined to the nose. Anti-leukotrienes such as montelukast can block the inflammatory process and thus improve symptoms. Nasal saline can help children to clear their nasal cavity before meals and bedtime, reduce the concentration of allergens in the nose and promote the recovery of nasal mucosal function, and can be used as an adjunctive medicine.  Immunotherapy, also commonly known as desensitization, is currently the only possible cure for allergic diseases. This treatment involves the administration of allergen extracts in incremental doses to allergic patients in order to modify the natural course of the allergic disease and improve the symptoms that arise when exposed to allergens thereafter, thereby reducing allergen sensitization. Immunotherapy in children with rhinitis reduces the likelihood of developing asthma and remains effective in patients who undergo subcutaneous immunotherapy for several years after treatment has been discontinued. Commonly used desensitization therapies in China include sublingual immunotherapy for dust mite desensitization and subcutaneous immunotherapy for household dust mite desensitization.