Perennial rhinitis, also known as allergic rhinitis, is an allergic disease of the nasal mucosa and can cause a variety of complications. In recent years, the incidence has tended to increase. According to statistics, allergic rhinitis accounts for about 40% of all rhinitis. Clinically, there are two types of rhinitis: perennial and seasonal.
There is another type of rhinitis that is induced by nonspecific stimuli without specific allergens and is not an immune response process, but the clinical manifestations are similar to the above two types of allergic rhinitis, called vasomotor rhinitis or neuroreflex rhinitis. Allergic rhinitis, however, desensitization therapy, hormone or immunotherapy are not effective because there is no antigen-antibody reaction in the body.
Etiology and pathology
Perennial rhinitis can occur at any age, in both men and women, and is easily seen in young people, with the main causes being
(a) Inhalation allergens: such as indoor and outdoor dust, dust mites, fungi, animal fur, feathers, cotton wool, etc., mostly cause perennial attacks; plant pollen causes more seasonal attacks.
(B) food allergens: such as fish and shrimp, eggs, milk, flour, peanuts, soybeans, etc.. In particular, certain drugs, such as sulfonamides, quinine, antibiotics, etc. can cause the disease.
(iii) Exposure to substances such as cosmetics, gasoline, paint, alcohol, etc.
Others may be certain bacteria and their toxins, physical factors (such as hot and cold changes, temperature imbalance), endocrine disorders or imbalance of acid-base balance of body fluids and other etiological factors can cause the disease. It can also be due to the simultaneous or sequential presence of multiple factors.
Clinical manifestations
Symptoms may vary depending on the duration and amount of exposure to the irritant and the response of the patient’s organism. Perennial allergic rhinitis can strike at any time, sometimes lighter, sometimes heavier, or gradually diminish after each morning wake-up call. It usually develops in the winter and often coexists with other allergic diseases of the body. Seasonal allergic rhinitis has a seasonal onset, mostly in the spring and fall, with rapid onset of symptoms, which can last from a few hours to several days to several weeks, with completely normal intervals between attacks.
Typical symptoms are nasal itching, continuous episodes of paroxysmal sneezing, profuse watery nasal discharge and nasal congestion. The specific manifestations are as follows.
(i) Nasal itching and continuous sneezing: There are often several paroxysmal episodes per day, followed by nasal congestion and runny nose, especially noticeable in the morning and at night. Nasal itching is seen in most patients, sometimes itching outside the nose, soft palate, face and external ear canal, etc. Seasonal rhinitis is more obvious with eye itching.
(b) A large amount of clear watery nasal discharge, but when the acute reaction tends to diminish or disappear, it may decrease or thicken, and if secondary infection occurs, it may become mucopurulent discharge.
(iii) Nasal congestion: varying degrees of severity, unilateral or bilateral, intermittent or continuous, or alternating.
(iv) Olfactory disturbance: caused by mucosal edema and nasal congestion, mostly temporary. Those caused by persistent edema of mucous membrane leading to atrophy of olfactory nerve are mostly persistent.
Diagnosis
It is easier to diagnose typical cases, but often misdiagnosed as acute or chronic rhinitis due to the lack of detailed history or atypical symptoms, which should be paid attention to, so to obtain the correct diagnosis, multiple examinations must be performed.
(a) Detailed medical history, past medical history and family history, especially allergic diseases, to find the relevant etiology.
(ii) Main symptoms such as nasal itching, continuous sneezing, and large amount of clear watery nasal discharge.
(c) Anterior rhinoscopy: pale edema of nasal mucosa and large amount of clear water-like secretion can be seen, and nasal polyps or polypoid degeneration can occur if due to persistent edema.
(D) nasal secretion smear examination: during the attack of allergic reaction, eosinophilic leukocytes can be seen in the nasal secretion, and more eosinophilic leukocytes or mast cells can also be detected.
(E) allergic excitation test: generally use skin test (scratch, intradermal and contact method, etc.), the principle is that there are a variety of hypothetical allergic substances, so that after contact with the body, depending on whether there is a reaction to appear, can assist in the diagnosis. The allergens can also be applied for desensitization after the diagnosis of the allergens is clear.
The external causes of allergic rhinitis are allergens such as pollen, viruses, parasites and cold. But the key is the internal cause. Changes in living environment, diet and other factors result in injury to the spleen and stomach, resulting in internal dampness, loss of appetite, soft stools, lumbar soreness and easy fatigue symptoms. The second is the relationship with the lungs. According to Chinese medicine, the spleen and stomach are the mother of the lungs, “the lungs are the master of gas”, and its gas comes from the air of nature and the essence of water and grain in the diet, which is transported to the lungs through the transformation of the spleen and stomach. If the spleen and stomach are weak, the lungs will be affected first. If the mother’s spleen and stomach are weak, the essence of water and grain will not rise, and the lungs, which are the “son”, will also become weak, so symptoms of lung qi deficiency such as runny nose will appear. According to the treatment principle of “If there is deficiency, the mother should be tonified”, it is advisable to tonify the middle Jiao and reconcile the Ying and Wei.
The most fundamental health care measure for allergic rhinitis is to know the substance that causes your allergy, i.e. allergen, and try to avoid it.
When the symptoms occur mainly outdoors: outdoor activities should be limited as much as possible, especially contact with flowers or decaying leaves, as well as willow wool and fruit hairs on phacelia, and you can wear a mask when you go out, or you can go to a seashore with fewer allergens.
When the symptoms occur mainly indoors: the following points can be noted.
1, pay attention to the details of life; HOT!
2, control the occurrence of indoor mold and mildew.
3. Thoroughly kill cockroaches and other pests.
Perennial rhinitis prevention and care
1.Participate in physical exercise regularly to increase resistance.
2.Be careful not to enter or leave the hot and cold environment abruptly.
3, often do nasal massage, such as long-term use of cold water to wash the face better.
4.If the allergen is known, try to avoid contact.
5.During an attack, keep warm.
7.Before each wild sneeze, massage the Yingxiang point urgently until the place is hot.
Medication for perennial rhinitis
The following drugs can be applied for the treatment of perennial rhinitis.
(1) Antihistamines Generally, they are histamine H1 receptor antagonists. These drugs have the effect of antagonizing the histamine released in the allergic reaction and can specifically bind to the histamine H1 receptor while competitively blocking the effect of histamine. Traditional histamine H1 receptor antagonists include paracetamol, promethazine, and phenazopyridine. These drugs have a satisfactory inhibitory effect on the clinical symptoms of allergic rhinitis, but they can cross the blood-brain barrier and have side effects such as sedation and drowsiness; after oral administration, patients are mentally unstable and affect their work; they should not be taken by vehicle drivers and staff engaged in high-risk work at height. New histamine H1 receptor antagonists such as Xylazine, Tefillin and Paracetamol not only preserve the advantages of the classical histamine antagonists, but also do not easily cross the blood-brain barrier, have no central sedative effect, and have long-lasting effects. Histamine H1 antagonists are more effective in the control of clinical symptoms, such as nasal itching, sneezing and clear runny nose. The efficacy for relief of nasal congestion is less satisfactory. This is because when H1 receptors are inhibited by antagonists, H2 receptor function still exists, and chemical mediators such as histamine released by mast cells can still act on H2 receptors, causing nasal mucosa vasodilation and reduction of nasal ventilation volume, resulting in clinical manifestations of nasal congestion. H2 receptor antagonists, mainly cimetidine and ranitidine, can be used in the treatment of allergic rhinitis in reduced doses. If combined with H1 and H2 antagonist solution nasal drops, the clinical symptoms of allergic rhinitis can be basically controlled.
(2) Mast cell stabilizers These drugs can stabilize the mast cell membrane so that it is not easy to degranulate, and thus the chemical mediators are stored in the mast cells without contact with the nasal mucosa effector tissue, thus blocking the clinical symptoms. These drugs are mainly sodium cinnabar, etc.
(3) Adrenocorticotropic hormones These drugs have powerful anti-allergic effect, whether systemic or local, the efficacy appears rapidly. However, because of their systemic side effects, they are often used topically at present. Peclomethasone dipropionate has only local effects, no whole ear reactions, and has a large anti-inflammatory effect, and has been widely used in the local treatment of allergic rhinitis.
(4) Ketotifen has both antihistamine effect and the effect of preventing the release of inflammatory mediators from leukocytes. However, there is drowsiness after taking the drug, so drivers and passengers, and those engaged in precision operation should be noted.
(5) Anticholinergic agents In allergic rhinitis, the parasympathetic nerve in the nasal cavity is overly reactive. Stimulation of the nasal mucosa with cholinergic nerve agonists can induce clinical symptoms of allergic rhinitis, such as large amounts of watery nasal secretions and sneezing and nasal congestion, which can be blocked by cholinergic antagonists such as atropine. The current application of ipratropium treatment has yielded satisfactory results. However, excessive dosage can cause dry throat, but otherwise there are no significant side effects.