Autumn has arrived and the coolness is getting stronger. For patients suffering from allergies such as rhinitis, nasal allergy and asthma, this is the season of easy onset and preventive measures have to be taken. Allergic rhinitis is a common disease with a high incidence among young adults and is very prone to recurrence. There are various adverse factors that can trigger the disease, such as pollen, smoke, cold air, industrial exhaust, etc. According to the survey, there are more than 1 million people suffering from allergic rhinitis in our city alone, accounting for about 1/3 of the total population.
Its main manifestations are: nasal congestion, runny nose, itchy nostrils, occasional sneezing, some patients are also accompanied by forehead and orbital pain and other symptoms, often with complications, such as persistent nasal blockage due to open-mouth breathing can cause dry throat, pain, combined with sinusitis can cause headache, loss of smell, bad breath, allergic rhinitis can also be combined with nasal polyps, so that the nasal blockage can not be relieved, with allergic asthma can Allergic asthma can cause breath-holding, breathing difficulties and even anaphylaxis.
I. What is allergic rhinitis
Allergic rhinitis, also known as allergic rhinitis, is caused by the inhalation of external allergic antigens in patients with allergies and occurs mainly in the nasal mucosa, with sudden nasal itching, sneezing, runny nose and nasal congestion as the main symptoms, and recurrent attacks. It is divided into intermittent and persistent according to the duration of symptoms, and mild, moderate and severe according to whether it affects the quality of life. With the development of industrialization, the causative factors of allergic rhinitis are increasing, and the incidence is rising year by year.
II. What are the common causes
(i) Genetic factors
A family history of allergic reactions predisposes people to this disease. The patient’s family has a history of asthma, urticaria, allergic conjunctivitis or drug allergy. Certain antigenic substances, which are harmless to most normal people, develop once they act on atopic individuals.
(ii) Nasal mucosal susceptibility
Susceptibility arises due to frequent stimulation by antigenic substances, but the degree of susceptibility varies depending on the number of mast cells and basophils in the nasal mucosal tissue and the ability to release chemical mediators. It has been shown that in the nasal mucosa of patients with allergic rhinitis, the number of these cells is not only higher than normal, but also has a stronger ability to release chemical mediators.
(iii) Antigenic substances
Also known as allergens, they are necessary for the occurrence of allergic reactions. There are 2,000-3,000 common antigenic substances and nearly 20,000 medically documented ones. The allergens that cause the disease are divided into inhalation, ingestion, injection, contact and other types according to the way they enter the body, with inhalation and ingestion allergens being more common. Common allergens are.
1, inhalation allergens
Inhalation through breathing into the nasal cavity. These allergens are mostly particulate matter suspended in the air.
(1) Pollen: Not all pollen from plants can cause disease. Only those pollens with high pollen volume, extensive vegetation, strong allergenicity, and spread by wind are most likely to be allergens. Due to the differences in vegetation species, pollen with allergenicity varies from region to region. In the northern part of China, most of the attacks occur in July-September and are dominated by wild Artemisia pollen, which should be taken seriously. In recent years, with the continuous development of industrialization, the concentration of harmful substances such as sulfur dioxide in the air has increased, which can cause mutations in the protein structure on the surface of pollen suspended in the air, so that pollen that was not allergenic has a strong allergenicity. This may be one of the main reasons for the significant increase in incidence. The pollen type and content in the air have significant seasonality and dispersion period, and the peak of pollen dispersion is in spring and autumn.
(2) Fungi: Extremely widely distributed in nature, mainly found in soil and decaying organic matter. It can be widely spread by wind, and the amount in the air is sometimes higher than pollen, and higher in rural than urban areas. Indoor high temperature and darkness and humidity are conducive to the growth of fungi. The soil of indoor ornamental plant pots is also often a good place for fungus to grow.
(3) Mites: There are hundreds of species, and there are five common domestic dust mites, of which dust mites and house dust mites are most likely to cause allergic rhinitis. Mainly parasitic in all corners of the living room, most in mattresses, pillows, carpets, sofa cushions, clothes, toys with hair, etc. They feed on human or animal dander, nails and hair. It reproduces most in late summer and early autumn. Mites’ excrement, eggs, debris and their disintegrated limbs can all be allergens.
(4) Animal dander: Animal dander is one of the strongest allergens. Susceptible individuals can be sensitized if they have prolonged contact with the animal in question. If re-exposed after sensitization, even a small amount of dander can stimulate allergic symptoms in the nose. Animal dander that causes respiratory allergic reactions mainly comes from animals in close contact with people, such as domestic pets (ornamental dogs and cats), domestic dogs, cattle, horses and sheep.
(5) feathers: poultry or bedding, pillows, clothing in the feathers, domestic ornamental birds shed feathers, can become allergens.
(6) House dust: refers to the stale dust in the house, which is one of the common allergens causing perennial rhinitis. Its composition is quite complex and is a hodgepodge of various substances, including a blend of animal, plant and chemical substances.
(7) Other: such as willow, paint, oil smoke, car exhaust, gas, cigarettes, etc.
2.Eating allergens
Allergens that enter the body from the digestive tract and cause nasal symptoms. The way it acts on the nasal mucosa is very complex and still not very clear. Milk, eggs, fish and shrimp, meat, seafood, animal fat, allogeneic protein, alcohol, drugs, antibiotics, anti-inflammatory drugs, sesame oil, onion, ginger, garlic, a certain shoe vegetables, fruits, etc., can become allergens.
Third, the typical symptoms
The typical symptoms of allergic rhinitis are mainly paroxysmal sneezing, clear watery nose, nasal congestion and nasal itch. Some of them are accompanied by reduced sense of smell. 1. Sneezing: several paroxysmal attacks several times a day, more than 3 each time, mostly in the morning or at night or immediately after contact with allergens. 2. Clear nasal discharge: large amount of clear watery nasal discharge, sometimes unconsciously dripping down from the nostrils. 3. Nasal congestion: intermittent or continuous, unilateral or bilateral, with varying degrees of severity. 4. Nasal itching: most patients have itching in the nose, and hay fever patients may have itchy eyes, itchy ears and itchy throat. 5. Examination: pale mucous membrane of the tip of the nose, edema of both inferior turbinates, clear or mucous snot can be seen in the common nasal passage and nasal floor.
IV. Diagnosis
Clinical symptoms sneezing, clear watery mucus, nasal congestion and nasal itching appear 2 or more (including 2), and the symptoms last or accumulate for more than 1 hour per day. May be accompanied by eye symptoms such as itchy eyes and conjunctival congestion. Signs commonly include pale, edematous nasal mucosa and aqueous nasal discharge. Allergen skin prick test is positive and/or serum specific IgE is positive, and nasal excitation test is feasible if necessary.
V. Treatment
1, allergic rhinitis when the first choice of treatment Avoid contact with allergens, such as pollen. Reduce outdoor activities during the pollen season, or arrange for off-site living, allergy to city dust or mites can reduce indoor furnishings, ground removal carpets, etc. Clean carpets ; wash bedding, curtains, mite allergens dissolve in water, water washing textiles can remove most of them; use air purifiers with filters, vacuum cleaners, etc.
2.Immunotherapy
Immunotherapy is a treatment recommended by the World Health Organization that may alter the course of the disease. 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-cumulative phase and a dose-maintenance phase, with a total duration of at least 2 years. Standardized allergen vaccines should be used. The indications are mainly for patients with allergic rhinitis who have failed to respond to conventional drug therapy. However, immunotherapy may have local and systemic adverse effects, especially during asthma attacks; patients are using beta-blockers; combined with other immune diseases; women during pregnancy; etc. should be used with caution or prohibited.
3. Topical medication has lower side effects than oral medication and is convenient to use, so it is the drug of choice for the treatment of allergic rhinitis. It is worth mentioning that it is the eve of pollen season, so the use of topical steroid drugs in advance can prevent the onset of rhinitis in patients and safely spend the pollen season. Systemic treatment generally uses oral drugs, such as antihistamine H1 receptor antagonists and corticosteroids, which are very effective in controlling the inflammation and symptoms of allergic rhinitis, but some drugs can cause systemic side effects, although sometimes its application is unavoidable.
4.Increase patients’ knowledge of allergic rhinitis, understand the pathophysiology of allergic rhinitis, cooperate with conventional treatment, relieve patients’ pain, promote early recovery of the disease, avoid frequent attacks of the disease due to insufficient knowledge of the disease p difficult to control p lesion migration p prolonged course of the disease.
5.Surgical treatment
Indications:
①No improvement of nasal congestion symptoms by drug or immunotherapy, with obvious signs, affecting the quality of life;
②Nasal cavity with obvious anatomical variation, accompanied by dysfunction, such as nasal septal deviation, adenoid hypertrophy, etc;
③ Combined with chronic rhinosinusitis, nasal polyps, drug treatment is ineffective.