There are four treatments for allergic rhinitis as follows.
1. Avoid exposure to allergens
(1) Reduce the number of dust mites indoors; maintain the relative humidity of the living space to below 60%, but too low (e.g., below 30% to 40%) will cause discomfort; clean carpets; wash bedding and curtains, mite allergens are soluble in water and washing textiles can remove most of them; use air purifiers with filters, vacuum cleaners, etc.
(2) Avoid allergens in the corresponding pollen allergy season.
(3) Avoid allergens in patients allergic to animal fur.
2. Drug treatment
The following factors should be considered: efficacy, safety, cost/effectiveness ratio, etc. Intranasal and oral administration are commonly used, and efficacy may vary between patients. There is no long-term sustained efficacy after discontinuation of the drug, so maintenance therapy is required for persistent allergic rhinitis. Prolonged treatment does not result in rapid drug resistance. Intranasal administration has many advantages. The high concentration of the drug acts directly on the nose, avoiding or reducing systemic side effects. However, for patients with other allergic diseases, drugs need to act on different target organs, intranasal administration is not the best choice, systemic drug therapy is recommended, and various drugs should be used with caution in patients during pregnancy and lactation.
(1) Antihistamines
Oral or intranasal use of 2nd generation or new H1 antihistamines can effectively relieve nasal itching, sneezing and runny nose. It is indicated for mild intermittent and mild persistent allergic rhinitis, and combined with nasal glucocorticoids for moderate-to-severe allergic rhinitis.
(2) Glucocorticoids
Nasal glucocorticosteroids can effectively relieve symptoms such as nasal congestion, runny nose and sneezing. 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.
(3) Anti-leukotrienes
Effective for allergic rhinitis and asthma.
(4) Chromones
Effective in relieving nasal symptoms, and eye drops are effective in relieving eye symptoms.
(5) Intranasal decongestants
It is effective in relieving nasal congestion caused by nasal congestion, and the course of treatment should be controlled within 7 days.
(6) Intranasal anticholinergic drugs
It can effectively inhibit runny nose.
(7) Chinese medicine
Some herbal medicines are effective in relieving symptoms. The treatment principles for children and the elderly are the same as those for adults, but special attention should be paid to avoid the adverse effects of drugs.
3. Immunotherapy
Immunotherapy induces clinical and immune tolerance, has long-term effects, and can prevent the development of allergic diseases. Allergen-specific immunotherapy is commonly administered by subcutaneous injection and sublingual administration. The course of treatment is divided into a dose accrual phase and a dose maintenance phase, with a total duration of not less than 2 years. Standardized allergen vaccines should be used.
(1) Indications
It is mainly used for patients with allergic rhinitis who have failed to respond to conventional drug therapy.
(2) Contraindications
(1) Asthma exacerbation; (2) Patients are using beta-blockers; (3) Combination of other immune diseases; (4) Pregnant women; (5) Patients are unable to understand the risks and limitations of treatment.
Local and systemic adverse effects may occur with immunotherapy.
4. Surgical treatment
The indications are no improvement of nasal congestion symptoms by drug or immunotherapy, with obvious signs that affect the quality of life; obvious anatomical variation of the nasal cavity with dysfunction; combined with chronic rhinosinusitis, nasal polyps and ineffective drug treatment. Surgical treatment is not used as a routine treatment for allergic rhinitis.