Yi-Kun Peng, Department of Otolaryngology, Guizhou Provincial People’s Hospital
First question: What is allergic rhinitis?
A: Allergic rhinitis was the name in the past, but now it has been renamed as allergic rhinitis. Since the public is more familiar with the name of allergic rhinitis, this article still follows this old name of the disease.
Allergic rhinitis is an allergic disease of the upper respiratory tract associated with an atopic constitution. If the reaction site is mainly in the nose, it is called allergic rhinitis; if the reaction site occurs mainly in the trachea and bronchi, it is called asthma, or bronchial asthma. In some patients, the two diseases can occur simultaneously or sequentially if the reactions occur in all these areas. Many patients also have allergic conjunctivitis (itchy, red eyes) or a history or symptoms of other allergic diseases, such as skin urticaria, itching in the ear or ears, or itching in the throat.
Clinically, allergic rhinitis has two types of presentation: seasonal allergic rhinitis (also known as hay fever and chytridiomycosis) and perennial allergic rhinitis. The former is mainly caused by the patient’s allergic reaction to plant pollen, so there are seasonal episodes; the latter is allergic to a variety of substances, most commonly mites (present in the air dust, especially in their own homes), as well as various animal hair, eggs, fish, milk, etc., so the disease can develop throughout the year, and if the patient is also allergic to pollen, there is a seasonal aggravation of If you are also allergic to pollen, you may experience seasonal aggravation.
If you notice that you are prone to allergic reactions to certain substances, such as contact (or ingestion, including drugs) that can cause allergic rhinitis or asthma, rashes, itchy skin, etc., you should avoid contact or ingestion as much as possible to avoid triggering or aggravating symptoms.
Second question: How does allergic rhinitis occur?
A: The occurrence of allergic rhinitis is mainly related to the atopic constitution, which is, in fact, allergic constitution. Allergic people, endocrine function, plant nervous system function, immune function are mostly in a state of dysregulation, so they are prone to allergy to certain substances, repeatedly feel the substance, it causes an allergic reaction, the manifestation of the disease.
Allergic constitution can be improved, then allergic rhinitis can stop; allergic constitution can also be transformed from not allergic constitution. Some women develop allergic rhinitis after childbirth, which is actually caused by a weakened constitution after childbirth, in line with the principle of Chinese medicine that “where evil is played, its qi will be deficient” – because childbirth and breastfeeding deplete one’s positive qi. Allergies can also be inherited. If parents have a history of allergic diseases, their children may also be prone to allergic diseases. However, allergic rhinitis itself is not hereditary, which means that parents with a history of allergic rhinitis or asthma do not necessarily have children with allergic rhinitis.
Third question: How is allergic rhinitis diagnosed?
A: Diagnosing allergic rhinitis is generally not difficult. The main points of its diagnosis are as follows.
1. Paroxysmal nasal itching and continuous multiple sneezing at the same time (a few sufferers may have nasal bleeding due to the severity of sneezing, which may cause rupture of the nasal mucosa), followed by a large amount of clear runny nose, which usually lasts for a short time, a few seconds to a few minutes, and is indistinguishable from the normal state after the attack. This symptom is easy to occur in case of cold or hot air stimulation (so it is easy to occur in the morning, evening and night), irritating gas stimulation, etc., and it happens mostly every day. In the case of perennial, it occurs in all seasons; in the case of seasonal, it occurs only in the season when pollen from a certain plant is dispersed in the air. In addition to nasal symptoms, it may be accompanied by itchy eyes, itchy ears, itchy throat, and in some cases, itchy skin, or allergic symptoms such as asthma attacks. Many patients have a family history of allergic diseases (referring to those who may have a history of allergic diseases in the paternal line, maternal line, or siblings).
2. If you want to know what you are allergic to, you should generally perform an allergen test. There are various methods of allergen testing, the most common being subcutaneous injection of allergen on the arm. If one is allergic to a substance, within 15 minutes, red spots will appear on the skin area where the substance was injected that exceed the normal reaction range, which is called a positive skin test. + is mild, 4 + is the most severe (very severe). If the reaction is not positive, it is indicated by “-“, which is a negative skin test.
3. If the skin test is negative, allergic rhinitis cannot be completely excluded. Because the allergens usually used are limited, it is possible to be allergic to something else. In order to confirm the diagnosis, the doctor will take other diagnostic measures to confirm the diagnosis if necessary.
4. If the diagnosis of allergic rhinitis is difficult to make using a variety of tests, the doctor may make a diagnosis of other diseases based on the medical history and other relevant circumstances. There are two main types of these other diseases: vasomotor rhinitis and non-allergic eosinophilic rhinitis. The latter two diseases are not different from allergic rhinitis in the general treatment of Western medicine, so in most cases (except for scientific research), doctors do not conduct tedious examinations; if Chinese medicine is used for treatment, and there is no need for scientific research, Chinese medicine doctors do not need to conduct these tedious examinations; patients also do not need to have any burden of thinking that the diagnosis is unknown.
Fourth question: Is allergic rhinitis a frequent cold?
A: What some patients call “frequent colds” actually refers to allergic rhinitis because the symptoms and medical history are consistent with allergic rhinitis; however, some patients say they often catch colds or are prone to catch colds, which may indeed be colds (also called acute rhinitis). The characteristics of cold (acute rhinitis) are: it is mostly caused by cold, firstly, discomfort around the body, or headache, chill, fever, early dryness in the nose, sneezing, clear runny nose, which lasts 1-2 days, then the nose turns sticky and nasal congestion worsens, and after treatment, it gradually improves. The natural course of a cold has about seven days, and the course of the disease varies with different manifestations. However, allergic rhinitis is a daily attack, every day, and does not have the characteristic of different symptoms with different duration of illness. This is the difference between cold (acute rhinitis) and allergic rhinitis. Allergic rhinitis will have some effect when treated according to cold (acute rhinitis) (anti-cold medicine has some effect of anti-pathogenic), but it cannot solve the problem of recurrence, so it is always difficult to cure completely; while acute rhinitis is easy to recur, mainly caused by poor constitution.
Fifth question: What are the serious effects of allergic rhinitis on the body?
A: Allergic rhinitis mainly affects the quality of life and may sometimes cause some minor embarrassment for those who are engaged in social activities, and generally does not have a particularly serious impact on the body, nor does it turn into cancer. However, allergic rhinitis of longer duration and more severe form has the potential to induce asthma. Because allergic rhinitis can cause nasal secretions and nasal congestion, it can also cause chronic rhinitis, sinusitis, nasal polyps, olfactory disturbances, as well as non-suppurative otitis media (pain in the ear, swelling, occlusion, tinnitus and hearing loss), nasopharyngitis, pharyngitis, postnasal leakage syndrome, and in children, adenoid hypertrophy (snoring, open-mouth breathing).
Sixth question: How does Western medicine treat allergic rhinitis?
A: The treatment of allergic rhinitis by Western medicine mainly includes the following aspects.
1. Avoiding allergen attack: This method is of great significance for seasonal allergic rhinitis. Since seasonal allergic rhinitis is mainly allergic to the pollen of plants that bloom in this season, the occurrence of allergic rhinitis can be avoided by leaving this region in the season of flowering of these plants. For patients with perennial allergic rhinitis, they can only take the method of transferring away from the work and life of the region.
2, internal medication: mainly the use of anti-allergic drugs, of which the most commonly used are three types.
① antihistamines, such as paracetamol, reserpine (Astemizole), desloratadine (Enzyme, Flibrium, Dihexadione), loratadine (Kerratan, Dasenrei), Minchi (Nostatin), levocetirizine hydrochloride tablets (Uzer), levocetirizine hydrochloride tablets (Didi).
(ii) Cell membrane stabilizers or inflammatory mediator blockers, such as sodium cromoglycate, ketotifen, topost.
(iii) Leukotriene receptor antagonists, such as zallustat, montelukast, etc.
Clinically, antihistamines are generally used more often, and one is usually sufficient. The main characteristic of these drugs is that they are fast-acting and can quickly control episodic symptoms such as nasal itching, sneezing and clearing of the nose. However, these drugs have no curative effect on allergic rhinitis. The main side effect of such drugs is to cause a dozing sensation, so it can be taken only once before bedtime. However, many patients can have “drug resistance” to these drugs, that is, after taking them for a period of time, the effect is getting worse. In this regard, you can choose another one.
3, nasal drops (spray) medication: the main nasal medication for the treatment of allergic rhinitis has three categories.
(1) decongestant nasal drops (spray) agent: one can be used. Such as ephedrine nasal drops (furosemide liquid), selorazoline nasal spray (nortone), hydroxymetazoline hydrochloride nasal drops, naphthazoline hydrochloride nasal drops, and so on. The main role of these drugs is to quickly relieve nasal congestion, and control the symptoms of runny nose, but long-term use may cause drug rhinitis (if used -2 times a day, continuous use for four weeks, that may form drug rhinitis), the gains are not yet lost. Therefore, when using such drugs, you should pay attention to the interval between the 2 times of use at least 6 hours, and it is best to use a few days, stop using a few days, not heavy nasal congestion, do not easily use, so as to extend the safety period of the use of such drugs, in order not to cause drug rhinitis.
When the nasal congestion is heavy, decongestants can be used, the first week of the beginning of treatment can be used continuously (if necessary), but only intermittently thereafter, not every day without continuous use (when using, it is best to use only once in a day, not more than 2 times, and as little as possible.) . Only when there must be other treatment methods mainly, can we consider the cooperative application of decongestants, and must not be used as the main treatment method.
(2) Topical hormone: one can be used. The commonly used ones are Cochlear (fluticasone propionate nasal spray), Berkner (beclomethasone propionate), Triamcinolone nasal spray, Nesuna and so on. These drugs have anti-metabolic effects and their effects are maintained for a longer period of time, but many patients believe that their effects become less and less effective after a period of use. According to many research reports, no obvious side effects were found, and some people clinically find it difficult to accept Jendid because of the obvious irritation in the nose.
(3) Other anti-allergic rhinitis drugs: there is one can. Such as interferon nasal drops, nostatin nasal spray (Minqi), ketotifen nasal drops, sodium cromoglycate nasal drops, can be used for a longer period of time, but the side effects of ketotifen nasal drops are more obvious, mainly causing drowsiness, dry mouth, or gastrointestinal reactions. I am not sure whether the effect is diminished after using for a long time.
The above three types of nasal drops (nasal spray), hormones are generally mandatory, choose one of them can be.
In addition, if there is eye itching, you can drop sodium cromoglycate eye drops.
4, nasal turbinate injection: nasal turbinate (or nasal mound) within the injection of drugs can use Chinese medicine preparations, but more often use Western pharmaceutical preparations, commonly used hormonal drugs, such as tretinoin injection, or prednisone injection prednisolone injection. Prednisone, prednisolone injection has a very good effect, the effect can be maintained for up to six months, but the drug is not a local hormone, there are certain side effects. In addition, according to some reports in recent years, the inferior turbinate injection of such drugs, there are reports of at least 5 cases of central retinal artery obstruction, as well as abducens nerve palsy (1 case).
5, desensitization therapy: There are two types of desensitization therapy.
The first type of method is non-specific desensitization (such as histamine phosphate, nasal infection bacteria made into vaccine, etc.), administered by intramuscular injection, the course of treatment is long, and some patients have difficulty in adhering to it. In addition, placental lipopolysaccharide and strychnine injections are also used, which have the effect of enhancing immunity.
The second type is specific desensitization therapy (see question 7), which is the only method recommended by the World Health Organization for the treatment of allergic rhinitis with a radical effect. The course of treatment is at least one to one and a half years, preferably three to four years, with a maintenance period of more than 10 years or even for life.
The current clinical use of Changdi, mainly for those allergic to mites, is a perennial allergic rhinitis, rather than seasonal allergic rhinitis.
6, physical therapy: mainly laser, freezing, iontophoresis, radiofrequency treatment, etc., the purpose is to change the hypersensitive state of the nasal mucosa. Since the local elevated sensitivity of the nasal mucosa is only the local pathological state of this disease, and the most fundamental factor of allergic rhinitis is the overall allergic constitution, such methods have a certain effect, but there is still a possibility of relapse.
7, surgery: surgical treatment of allergic rhinitis has different needs targeted.
One is to change the nasal variation, but also may improve the hypersensitivity of the nasal cavity: such surgical methods are: nasal polyp removal, nasal septum correction, nasal septum submucosal correction, nasal septum submucosal dissection, sinus opening, etc. Sometimes these procedures may need to be applied in combination.
Secondly, severing the nerve (also by minimally invasive methods), or mucosal scratching: the aim is to block nerve conduction and thus stop the onset of allergic rhinitis. Since allergic rhinitis is a local reaction to an overall disease, and surgery only solves the local problem, surgical treatment can also be effective, but there is inevitably the possibility of recurrence (the validity period is usually more than six months).
Third, to change the pathological state of the nasal mucosa, as well as to eliminate the “trigger point”: “trigger point” is located in the front of the nasal cavity, when this area is stimulated, it is easy to cause allergic rhinitis or asthma attacks, so called “trigger point The “trigger point” can be treated with laser, microwave, low-temperature plasma radiofrequency ablation (all will destroy the nasal mucosa), as well as nasal threshold (the front of the lateral wall of the nasal cavity) “well” surgery, which can achieve certain results (valid for about six months or more). Among these different surgical methods, the “tic-tac-toe” surgery does not cause the sequelae of “empty nose syndrome” which damages the nasal mucosa, but other surgeries that destroy the mucosa of the turbinates may cause this complication (of course, the cases that cause this complication are, after all, only a few). Otherwise, this type of surgery would not be carried out. (But if it happens, it is bad luck).
It is worth stating that pediatric patients are not suitable for surgical treatment: first, because children are at a developmental stage and are not suitable for destructive surgical management; second, general anesthesia is not necessary for these procedures, and children have difficulty cooperating with local anesthesia for therapeutic operations. If the indications for Western medicine surgical treatment are not strictly mastered, or if the surgical operation is wrong, too much damage to the mucosa of the turbinates will easily cause surgical complications (the so-called “empty nose syndrome”, mainly characterized by the inferior turbinates becoming small, the nasal cavity is wide, and the ventilation in the nose is too large when breathing, causing dryness and discomfort in the nose, headache and dizziness, etc.).
8.Other treatment: If the allergic symptoms are accompanied by itchy eyes, you can use sodium cromoglycate eye drops. However, if the ear itches, there is no need for special medication, just use anti-allergy drugs orally; if there is skin gas, there is no need to use local medication, just take anti-allergy drugs orally, but of course, you can also consider using anti-skin allergy drugs applied topically.
Q7: Under what circumstances is specific desensitization therapy suitable?
A: The most important indication for atopic desensitization therapy is that it is only indicated for diseases that produce allergic reactions to the allergens (drugs) used in desensitization therapy. Since most of the drugs currently used clinically for specific desensitization therapy are mite allergens, after allergen test examination (skin test, or serological test), if only allergy to mites (positive allergy test) is performed, it is the most suitable indication.
Clinically, if an allergen skin test test is performed, what results are best for de per therapy?
A. Allergy to room dust mites, dust mites only, and being 3+, or 4+, desensitization therapy works best.
B. Allergy to house dust mite and dust mite only, and is 1+, or 2+, desensitization therapy is average or unsatisfactory.
C. Allergy to room dust mite and dust mite belongs to 3+, or 4+, while allergy to cockroach manifests as 2+, 3+, or 4+, the effect of desensitization therapy is generally not ideal, and desensitization therapy can be considered unnecessary.
D. If the allergy to room dust mite or dust mite is 3+ or 4+, and there are also positive reactions to several other allergens, the effect of desensitization therapy is not likely to be ideal and there is no need to carry out desensitization therapy at all.
2. If the test is positive for multiple allergens, it loses its value for efficient application. The reason is that because only one allergen is desensitized, there is a certain effect on allergic diseases, but because there is no specific desensitization of all other allergens, there is still a possibility of allergic diseases.
3. At present, it is not possible to perform desensitization therapy for multiple allergens at the same time. This is related to drug development and also to people’s affordability.
4. Is desensitization therapy possible for children with allergic rhinitis (or with asthma) who are only allergic to mites? A: According to the above principle, desensitization therapy with mite antigen desensitization drugs is possible in such cases. However, I personally do not advocate it for the following reasons: (1) Preschool children are at the age when the body’s immune function is at its worst (3-9 years old), and the immunity brought by the mother has been depleted, while their own immunity has not been established or is being established. If the family has good economic conditions, specific desensitization therapy can be carried out, otherwise, other more economical treatment methods can be used (according to the current price of drugs, the monthly medical cost of specific desensitization therapy is about 220 yuan); (2) in childhood, the body is in the developmental stage, the immune function is not yet stable (before the age of 15), the situation of allergens may also exist in an unstable state, with the growth of age and As the body quality changes, if there are other substances also allergic, the therapeutic effect of simply desensitizing to mite antigens will lose its efficient application price, and the symptoms of allergic rhinitis will still appear, and the expected effect cannot be achieved.
Eighth question: Why is allergic rhinitis difficult to cure and the condition is prone to recurrence?
A: The main factor of allergic rhinitis is the allergic body, but it is not without important relationship with the local condition of the nasal cavity. If the local variation of the nasal cavity can be solved (such as deviated nasal septum, nasal septum mucosa hypertrophy, chronic inflammation of nasal mucosa, etc.) and the physical problem can be better solved, the effect of treating allergic rhinitis should be faster and the efficacy should be consolidated, but in fact it is difficult to reach this state. For example, the biggest advantage of using only Western medicine is to solve the local problem, but it is difficult to solve the physical problem, so it is difficult to consolidate the effect; the biggest advantage of using Chinese medicine alone is to better adjust the body’s physical problem, but it is difficult to solve the local situation, so the effect is slow or repeated. Even if both Chinese medicine is used internally and Western medicine is used, there may still be factors such as inappropriate treatment course and poor targeting, which may easily lead to relapse.
Q9: What are the advantages of each of the two approaches to treating allergic rhinitis, Chinese medicine and Western medicine, and how can they be combined to treat this disease?
A: Western medicine has a variety of treatment methods for this disease. (1) cell membrane stabilizers or inflammatory mediator blockers, such as sodium cromoglycate, ketotifen, topost; (2) antihistamines, such as paracetamol, reserpine (astemizole), desloratadine, loratadine (keratan); leukotriene receptor antagonists, such as zallust, montelukast; (3) nasal hormone nasal topical application, such as beclomethasone propionate (Berkner) nasal spray, fluticasone propionate (coleus) spray, tretinoin (Jandex) nasal spray, budesonide (Reynocort) aerosol; ④ nasal decongestants, such as ephedrine nasal drops, celozoline hydrochloride nasal spray; ⑤ non-specific desensitization therapy, such as bacterial desensitization, histamine desensitization, closed antibody desensitization (placental lipopolysaccharide) therapy, and specific desensitization therapy, such as dust mite drops (Changdi), dust mite injections (Androda); ⑥ other Other treatments. The first four methods are the most widely used in clinical practice, mainly targeting the pathology of allergic reactions, and have the advantages of being highly targeted and fast-acting, but they all have certain side effects and may be easy to relapse after stopping. Non-specific desensitization therapy has the effect of enhancing the tolerance of the patient’s body to the allergens, and the effect is more consolidated and the course of treatment is longer; specific desensitization therapy is a new method that has been promoted in recent years, but the indications are too narrow, and the course of treatment is about one and a half years, and it is difficult to work on all the allergens, and the effect has yet to be further evaluated clinically.
The advantages of TCM for this disease are mainly reflected in regulating the balance of yin and yang of the organism through evidence-based treatment, i.e., consolidating the root and preventing relapse; modern pharmacological research on TCM shows that many drugs can intervene in multiple pathological aspects of metaplasia and have certain effect on controlling its attack state, but overall, it is not as targeted and fast-acting as western drugs.
According to the combined pathological understanding of Chinese and Western medicine, allergic rhinitis is due to the deficiency of Yang energy in the lung, spleen and kidney, and may be mainly due to the dysregulation of the endocrine system, the vegetative nervous system and immune system, as well as genetic factors, i.e., insufficient self-regulation and self-stabilization. Clinically, although Western medicine’s drug therapy is effective in controlling the attacks of allergic reactions, it cannot achieve the regulating and regulating effects on the endocrine, vegetative nerve and immune system self-stabilization, which may be an important reason why it is difficult to achieve consolidated efficacy in Western medicine’s treatment of allergic rhinitis. This may be the reason why western medicine has difficulty in consolidating the effect of treatment for allergic rhinitis. In contrast, the evidence-based treatment and acupuncture therapy of TCM have obvious effects in adjusting the functions of endocrine system, vegetative nervous system and immune system of such patients. The main idea and basic method of treating allergic rhinitis is to use Chinese medicine such as diagnosis and treatment or acupuncture therapy to improve the functional state of the patient’s body in a lasting way and to control the symptoms of attacks as early as possible with western medicine.
Q10: What is the best plan for treating allergic rhinitis so that there will be no recurrence or as little recurrence as possible after allergic rhinitis is cured?
A: To answer the question of my patient friend about, “Is it better to see a Chinese doctor or a Western doctor for the treatment of this disease?” According to the above basic methods of Chinese and Western medicine treatment and the etiology of the disease, I personally think that the treatment of allergic rhinitis should have the best plan, which is the combination of Chinese and Western medicine treatment, and this is not enough, but also for the specific personal situation, the development of different Chinese and Western combination treatment plan. In my personal experience, it is not difficult to achieve a more consolidated effect, and the following programs are available for reference.
Program 1: Comprehensive drug therapy program
Applicable to all kinds of allergic rhinitis.
1. Western medicine is used internally (mainly antihistamines) to control the symptoms quickly. Once the symptoms are controlled, that is, you can not take them, and then again, and again, without having to take them 2 times a day. Personal effect with cetirizine hydrochloride syrup or tablets, kairetan syrup or tablets.
2, choose the appropriate drops (spray) nasal drugs to quickly control the symptoms. You can adhere to the medication, but do not have to use the same drug to avoid reducing the effectiveness. My personal habit is to use Cozulan nasal spray for adults, Cozulan for children over 8 years old, and Nesuna nasal spray for children under 8 years old.
3, take Chinese medicine or Chinese patent medicine as a supplement (according to the principles of diagnosis and treatment prescription), in order to adjust the body’s physical state, and appropriate longer time to take medicine (can be intermittent medication). Personally, I like to add oral nasal abdomen and orthodontic granules or Cang Er Zi rhinitis capsule.
Program II: Comprehensive program of desensitization therapy.
It is suitable for allergic rhinitis that is only allergic to mites.
1. Specific desensitization therapy is used. (Changdi, drops under the tongue; Androda, subcutaneous injection. Both of them are mite desensitizing drugs)
2. Adopt western medicine for internal use (antihistamines mainly) to control the symptoms quickly. Once the symptoms are under control, you can stop the medication and take it again for another attack.
3, the use of appropriate drops (spray) nasal drugs to quickly control the symptoms. Should adhere to the medication, but do not have to use the same drug, so as not to reduce the effectiveness.
In addition, you can still take Chinese medicine or proprietary Chinese medicine for treatment.
Option 3: Adjunctive treatment protocols
Each article becomes a separate program, and 1-2 programs can be used in conjunction with program one and two at a time.
1.Surgical treatment: It is suitable for patients with abnormal nasal conditions (deviated nasal septum, nasal septum hypertrophy, chronic sinusitis, nasal polyps), who have been ineffective after regular conservative treatment. It should be proposed by the doctor and agreed by the patient. It is my custom to perform bilateral nasal symmetric dilation to reduce the symptoms of allergic rhinitis.
2. Nasal septum scratching therapy (surgical therapy). The doctor and the patient can propose it, and both parties should agree.
3.Nasal neurectomy or minimally invasive surgery. Both doctors and patients can propose and both parties should agree.
4.Physiotherapy (either one, see above for method). Patient or physician to propose.
5.Non-specific desensitization therapy.
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