Allergic rhinitis is a non-infectious chronic inflammatory disease of the nasal mucosa mediated mainly by IgE after exposure of the organism to allergens.
Clinical classification
I. Classification by allergen type
1. Seasonal AR: Symptom onset is seasonal.
2. Perennial AR: the onset of symptoms is perennial.
B. Classification according to the time of symptom onset
1.Intermittent AR: symptom attack <4 days/week, or <4 consecutive weeks.
2. Persistent AR: symptom onset ≥ 4 days/week and ≥ 4 consecutive weeks.
C. Classification according to disease severity
1.Mild AR: symptoms are mild and have no significant impact on the quality of life (including sleep, daily life, work and study; the same below).
2.Moderate-severe AR: the symptoms are severe or serious and have a significant impact on the quality of life.
Clinical diagnosis
Diagnosis based on.
1.Symptoms: sneezing, clear watery mucus, nasal itching and nasal congestion appear for 2 or more symptoms, and the symptoms last or accumulate for more than 1 hour per day, which may be accompanied by eye symptoms such as eye itching, tearing and eye redness;
2.Signs: pale and edematous nasal mucosa, watery nasal discharge are common;
3, allergen testing: positive for at least one allergen SPT and/or serum-specific IgE.
Differential diagnosis
1, vasomotor rhinitis.
2, Non-allergic rhinitis with eosinophilia.
3, Infectious rhinitis.
4.Hormonal rhinitis.
5, Drug rhinitis.
6.Aspirin intolerance triad.
7, Cerebrospinal fluid rhinorrhea.
Treatment
Although this disease cannot be completely cured yet, through standardized comprehensive prevention and treatment, patients’ various symptoms can be well controlled and the quality of life can be significantly improved.
I. Allergen avoidance
Avoid contact with allergens and various irritants.
Second, drug treatment
1.Glucocorticoid
(1) Nasal glucocorticosteroid: the first-line treatment drug for AR. It has significant improvement on all nasal symptoms including sneezing, runny nose, nasal itching and nasal congestion in AR patients, and is currently the most effective drug for the treatment of AR. It can be used for the treatment of mild and moderate-severe AR, and the recommended dose is 1 to 2 nasal sprays per day for at least 2 weeks; for moderate-severe persistent AR, it is the drug of choice for more than 4 weeks. Nasal glucocorticoids are safe and well tolerated. Mastering the correct method of nasal spraying can reduce the occurrence of rhinorrhea, and patients should be instructed to avoid spraying toward the nasal septum.
(2) Oral glucocorticoids: second-line therapeutic drugs for AR, used at clinical discretion. Patients with moderate-severe persistent AR may consider short-term oral glucocorticoids if severe nasal congestion cannot be controlled by other treatment methods.
2.Antihistamines
(1) Oral antihistamines: The second-generation antihistamines are the first-line treatment for AR and are clinically recommended. They have a rapid onset and long duration of action, and can significantly relieve nasal symptoms, especially nasal itching, sneezing and runny nose, and are also effective for combined eye symptoms, but have limited effect on improving nasal congestion.
(2) Nasal antihistamines: the first-line treatment for AR, clinically recommended. Its efficacy is equivalent or better than that of second-generation oral antihistamines, especially for the relief of nasal congestion symptoms.
3.Anti-leukotrienes
Oral leukotriene receptor antagonists are the first-line therapeutic drugs for AR and are clinically recommended. When used in combination with second-generation oral antihistamines or nasal glucocorticoids, their efficacy is better than that of drugs used alone.
4.Mast cell membrane stabilizer
Second-line treatment for AR, used clinically as appropriate.
5.Decongestants
Second-line therapeutic drugs for AR, used at clinical discretion. Nasal decongestants should be strictly controlled the number of times and the course of treatment, generally 2 nasal sprays per day, 1 to 3 sprays per side / time, continuous use of no more than 7 days.
6.Anticholinergics
The second-line therapeutic drugs for AR, used at clinical discretion. For AR patients with persistent or recurrent runny nose as the main symptom, local medication can be considered.
7.Chinese medicine
8.Nasal rinse
III. Immunotherapy
Allergen-specific immunotherapy is the first-line treatment for AR and is clinically recommended. Allergen-specific immunotherapy can be used in AR patients with clear clinical diagnosis and no contraindications, without the prerequisite of ineffective drug therapy.
This includes subcutaneous immunotherapy and sublingual immunotherapy. Among them, sublingual immunotherapy has a low incidence and mild severity of systemic adverse effects, and has been recommended by WHO in recent years.
IV. Surgical treatment
Adjuvant treatment for AR is used at clinical discretion. Surgical modalities include 2 types: inferior turbinoplasty to improve nasal ventilation function and parasympathectomy to reduce nasal mucosal hyperreactivity.