Which allergic rhinitis requires surgery?

  Allergic rhinitis is a series of allergic inflammatory diseases of the nasal mucosa involving a variety of IgE-mediated inflammatory mediators resulting from exposure of susceptible individuals to allergens. The main clinical manifestations are nasal congestion, nasal itching, sneezing, clear runny nose, and nasal examination: pale, edematous or congested, swollen nasal mucosa. Allergen skin test is positive for at least one of them. Treatment options are allergen avoidance, medication, specific immunotherapy and surgery. Surgery may be considered for allergic rhinitis that has failed with medication and immunotherapy or that does not want to receive long-term medication.  The main pathogenesis of allergic rhinitis is the abnormal local immune response, but the occurrence of clinical symptoms is still closely related to the autonomic innervation and nerve reflexes of the nasal cavity. This can block the sensory-sympathetic reflex and disrupt the afferent pathway of the sneezing reflex arc, resulting in reduced vasodilation of the nasal mucosa, reduced glandular secretions and decreased sensitivity to external stimuli, thus relieving or eliminating symptoms such as nasal itching, nasal congestion, runny nose, sneezing, etc. The surgical treatment of allergic rhinitis is based on this principle.  The surgical treatment of allergic rhinitis is based on this principle. At present, our department mainly adopts transnasal low-temperature plasma radiofrequency blocking the anterior sieve nerve branch and low-temperature plasma bilateral inferior turbinate ablation for allergic rhinitis. The recent efficacy of this surgical method for allergic rhinitis is positive, but the long-term efficacy is controversial, and some patients still have recurrence. However, it is a good way to treat allergic rhinitis because it enables patients to avoid long-term medication, and the procedure is simple, less invasive, and basically free of complications.