Allergic rhinitis, also known as allergic rhinitis, is a metamorphic reaction that occurs in the nasal mucosa and is a common manifestation of respiratory metaplasia, sometimes coexisting with bronchial asthma. The incidence of this disease has increased significantly in the last 20 years, especially in developed countries. The age of onset is predominantly young adults, but it is now found to be more common in children as well. Although there is no significant difference in incidence by gender, female hormones can exacerbate the allergic reaction. It includes seasonal rhinitis and perennial rhinitis and can cause a variety of complications. There is another type of rhinitis that is induced by nonspecific stimuli, without specific allergens and 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. Antigen-antibody reactions do not exist in the body, so desensitization therapy, hormone or immunotherapy are not effective.
Etiology.
1. Allergic genetics does not cause allergic rhinitis in all people, but generally occurs specifically in people with allergic constitution. Allergic constitution is genetically related and is usually due to heredity. Most people with allergic rhinitis have a family history of allergies, but in recent years, due to accelerated industrialization and increased atmospheric pollution, some originally non-allergic people have also evolved into allergic.
2, contact allergens at home the most important allergens are dust mites, mold, pets and insects. In close contact with the human body bedding, underwear, dust mites and their excrement more; indoor mold is easy to grow in a humid, warm, poorly ventilated environment; a variety of insects, including crickets, flies, moths, especially cockroach excrement are certain allergens. Outdoor allergens may be present in spring, summer, fall and winter. These include: balsam fir, walnut trees, hazelnut trees, juniper berries, poplar, birch and oak trees. In addition, with the increase of vehicles in recent years, aromatic hydrocarbon particles in diesel exhaust and formaldehyde caused by home renovation are strong irritants for seasonal allergic rhinitis attacks, although they are not allergens.
Clinical manifestations.
The disease can occur at any age including young infancy, with most patients presenting before the age of 20 years, and is a common condition, with domestic and international literature reporting that up to 10% of children and 20% of adolescents suffer from perennial rhinitis, most of which is allergic. About 75% of children with asthma also have the disease, which is exacerbated by the fact that patients with nasal congestion have to breathe through their mouths and therefore inhale more allergens directly from their mouths. There are no gender differences in the onset of allergic rhinitis. Its onset is associated with genetic factors, environmental factors and allergen exposure.
Sneezing, nasal itching, runny nose and nasal congestion are the four most common symptoms. Sneezing is most severe in the early morning and upon awakening, with older children experiencing more than five sneezes at a time. When nasal congestion is severe, the mouth is opened to breathe, and the throat is cleared due to recurrent coughing triggered by the flow of nasal mucus into the nasopharynx at night. Nasal congestion often changes with the change of position, such as lying on the left side, the left nasal blockage and right nasal passage, lying on the right side, the right nasal blockage and left nasal passage nasal Xiang is a characteristic manifestation of rhinitis, children can be seen constantly using their fingers or palms to rub the front of the nose, the action is called “allergic grooming”. Some children often make strange movements such as crooked mouth and shrugging nose because of itchy nose. Older children complain of a loss of smell. The nasal mucus is clear and may thicken due to nasal congestion or secondary infection. Children may also see a dark gray-blue circular shadow and folds under the orbit, called “allergic staining” or “infraorbital folds”, which is due to periorbital edema and venous stasis, and is a characteristic manifestation of atopic children’s oculonasal allergy. This is a characteristic manifestation of atopic oculonasal allergy in children. Combined ocular symptoms include itchy eyes, mostly due to animal allergens and seasonal pollen, and often a family history of allergic reactions.
Internal examination of the nasal cavity reveals turbinates that are edematous, often referred to as white or purple, and covered with a thin layer of watery mucus. In severe cases, the swollen turbinates may completely block the nasal passages.
Complications.
Epistaxis, allergic sinusitis, pharyngitis, bronchial asthma, exudative otitis media
Treatment
Treatment :
1. Avoid exposure to allergens. Keep the living space in a clean condition. Wash sheets, curtains, and other items that can harbor dust and bacteria in a timely manner.
2. Specific immunotherapy, also known as desensitization, is more effective in treating intermittent allergic rhinitis induced by pollen and dust mites, with an overall efficiency of more than 80%. Although specific immunotherapy cannot completely cure allergic rhinitis, it can significantly improve the symptoms of allergic rhinitis, prevent the occurrence of asthma, and improve the prognosis of allergic diseases. It needs to be continued for at least 2 years of treatment, and the current efficacy of the treatment for pollen allergy is definite. Can you last for 2 years? Are you only allergic to pollen?
3.Non-specific treatment
Anti-histamine drugs: The first generation of anti-histamine drugs such as paracetamol and benadryl are gradually abandoned clinically because of the shortcomings such as drowsiness and other side effects. The common features of the second generation antihistamines are no drowsiness, drowsiness and other side effects, and the action time is up to 24 hours, such as cetirizine, loratadine, azulfidine, ketotifen, terfenadine and astemizole, etc. Due to the serious cardiotoxic side effects of terfenadine and astemizole have been rarely used, ketotifen is less used due to drowsiness, at present, the main commonly used drugs in China are cetirizine, loratadine, epinephrine, etc. The main drugs commonly used in China are cetirizine, loratadine, epalrestine, etc.
The third generation antihistamines include fexofenadine, levocetirizine, eflornithine, dexloratadine, etc. The third generation antihistamines have no central nervous system depressant effect and no cardiotoxic side effects, which can better control the symptoms of allergic rhinitis and have a certain effect on the prevention of asthma.
4, glucocorticoid inhalation: usually choose budesonide, fluticasone, mometasone furoate, etc. The use of glucocorticoid aerosol for asthma with oral and nasal storage fog cans for nasal inhalation can achieve better results than the above drugs, this inhalation method does not have the irritation of the nasal mucosa, but can also comprehensively control nasal inflammation and prevent recurrence, and more importantly, can simultaneously prevent and control the airway inflammation of asthma, is the preferred mode of administration of allergic rhinitis, and has achieved good clinical results.
5, mast cell membrane stabilizers include sodium cromoglycate: sodium nedolac and trenbolone, etc.
Professional physician’s opinion.
1, avoid contact with allergens is the most direct and effective treatment, can you do it?
2, only to pollen or specific dust mite allergies, desensitization therapy is feasible, after all, is the most accurate efficacy, but the treatment process is long, and the proportion of allergic rhinitis is limited, not applicable to the promotion of all aspects.
3, drug conservative treatment is still the first choice for quite a long time in the future.
4, strengthen exercise, increase resistance is also a good method, but also can use drugs to improve immunity, why the same environment, others are not allergic to your allergy, is certainly their own body resistance problem, I boldly predict that the future to completely cure it, this breakthrough is likely to be large, after all, the prospect of genetic research is unlimited.