Allergic rhinitis (AR), or allergic rhinitis, is a non-infectious disease of the nasal mucosa mediated primarily by IgE after exposure of the organism to allergens.
It contains three components.
First, AR is a non-infectious disease of the nasal mucosa, and anti-inflammation is the main measure of treatment for this disease;
The second is that the causative factor is allergens, suggesting the rationality of environmental control and immunotherapy;
Third, the disease is characterized as “predominantly” IgE-mediated, and the possibility of a non-IgE-mediated Th2 response is considered.
Epidemiology of allergic rhinitis
AR is a global health problem
The prevalence of AR is reported to be 10-20% in foreign countries and even up to 30% in some developed countries;
There is a lack of national epidemiological observation data in China, with preliminary observation data of 5-10% in some central cities, and the estimated number of people with the disease is over 50 million nationwide.
Allergic rhinitis: impact on QOL
High prevalence
Impairment of quality of life
Absence from work and school
Affects learning
Affects sleep
Allergic rhinitis triggers many diseases
Correlation between allergic rhinitis and asthma
One third of patients with allergic rhinitis have asthma and the remaining 2/3 of patients without asthma have bronchial mucosal hyperresponsiveness;
93% of children with asthma have rhinitis; 58% of adults with asthma have rhinitis.
Etiology – Allergens
Inhalant allergens: indoor and outdoor dust, dust mites, fungi, animal fur, feathers, cotton wool, plant pollen, particles, etc;
Food allergens: fish and shrimp, eggs, milk, flour, peanuts, soybeans, drugs, etc;
Contact: cosmetics, paint, gasoline, alcohol, etc.
Treatment
Drug treatment
1. Antihistamines
2. Glucocorticoids
3. Anti-leukotrienes
4. Chromones
5. Intranasal decongestants
6. Intranasal anticholinergic drugs
7. Chinese medicine
1Antihistamines
Antihistamines: The second generation or new H1 antihistamines are recommended and have significant effects on suppressing sneezing and runny nose.
Duration of treatment: generally not less than 2 weeks.
Indications: Mild intermittent and mild persistent allergic rhinitis; combined with intranasal topical glucocorticoids for moderate to severe allergic rhinitis.
2 Glucocorticoids
Glucocorticoids: can effectively relieve nasal congestion, runny nose, sneezing and other symptoms. The course of intranasal glucocorticosteroids should not be less than 12 weeks. Severe patients who do not respond to other medications or cannot tolerate nasal medications can be treated with oral glucocorticosteroids for a short period of time. Intranasal injections are not recommended.
Proper use of intranasal glucocorticosteroids
1. Gently shake the spray bottle well;
2. Lower your head slightly;
3. Hold the bottle in your right hand and spray the left nostril, extending the bottle just into the nasal cavity and turning it slightly toward the lateral wall, spraying 1~2 times;
4. Hold the bottle in the left hand and spray the right nostril, repeat the above steps;
5. Avoid forceful inhalation when spraying the nose.
3. Anti-leukotriene drugs
Anti-leukotriene drugs: effective for allergic rhinitis and asthma.
4. Chromones
Chromones: effective in relieving nasal symptoms and eye drops are effective in relieving eye symptoms.
5. Intranasal decongestants
Intranasal decongestants: they are effective in relieving nasal congestion caused by nasal mucous membrane congestion, and the course of treatment should be controlled within 7 days.
6. Intranasal anticholinergic drugs
Intranasal anticholinergic drugs: can effectively inhibit runny nose.
The treatment principles for children and the elderly are the same as those for adults, but special attention should be paid to avoid the side effects of the drugs. Various drugs should be used with caution in patients during pregnancy
For patients with poor results of conservative treatment, individualized surgical treatment can be adopted according to the nasal condition, such as: anterior septal nerve block, double inferior turbinate plasma ablation, submucosal correction of nasal septum, nasal focused ultrasound therapy, etc.