Allergic rhinitis
Allergic rhinitis, also known as allergic rhinitis, is an allergic disease of the nasal mucosa and can cause a variety of complications. There is another type induced by non-specific stimulation, no specific allergens are involved, and it is not an immune reaction process, but the clinical manifestations are similar to the above two types of allergic rhinitis, which is called vasomotor rhinitis or neuroreflex rhinitis. It can come from outside the body (physical and chemical aspects) or from the body (endocrine and mental aspects), so some people regard it as allergic rhinitis. However, because there is no antigen-antibody reaction in the body, desensitization therapy, hormones or Immunotherapy was ineffective.
Cause: Allergic rhinitis can occur at any age, in both men and women, and is more common in young people. Typical symptoms are nasal itching, continuous episodes of paroxysmal sneezing, large amounts of watery nasal discharge, and nasal congestion.
Guide to medical treatment:
1. Understand the causes of allergic rhinitis and avoid contact as much as possible.
(1) Inhalation allergens: such as indoor and outdoor dust, dust mites, fungi, animal fur, feathers, cotton wadding, etc., which mostly cause perennial attacks; those caused by plant pollen are mostly seasonal attack.
(2) Food allergens: such as fish, shrimp, eggs, milk, flour, peanuts, soybeans, etc. In particular, certain drugs, such as sulfa drugs, quinine, antibiotics, etc., can cause illness.
(3) Contact objects such as cosmetics, gasoline, paint, alcohol, etc.
2. Nasal secretion smear examination, allergic provocation test, etc. can be done if necessary.
3. Desensitization therapy.
4. Drug therapy: including 1. Antihistamine drugs: This type of drugs includes astamine, kamine, etc., 2. Sodium cromoglycate3. Ketotifen, 4. Steroids are mostly applied locally, and those with better effects include Burke sodium, Renacote, etc.
5. Microwave and laser can be used to reduce the sensitivity of nerve endings in local treatment, which is partially effective.
6. Surgical therapy: vidian neurotomy or superficial petrosal neurotomy to reduce the excitement of parasympathetic nerves. Latest treatments include plasma therapy, see the topic on allergic rhinitis.
Allergic rhinitis
For more than a year, my father often has a lot of runny nose when he gets up in the morning, which is not much at ordinary times. Occasionally there will be a little bloodshot. Don't know what method to adopt?
Shanghai Changzheng Hospital Otolaryngology Doctor Ye Qing
To put it bluntly, it can be regarded as allergic rhinitis. To put it mildly, it is not a big deal. It should be common in winter. Summer is usually fine, isn't it? Because the climate is dry in winter, the nasal mucosa may bleed a little overnight due to dryness.
Allergic rhinitis
I am 28 years old, suffering from allergic rhinitis and asthma for more than ten years. Asthma is fine now, but rhinitis is really annoying. I always have nasal congestion and runny nose, which can lead to insomnia, headaches and irritability. It was especially severe when inhaling dust while doing hygiene. I would sneeze dozens of times in a row and my eyes would shed tears. Sometimes it affects the work very much. I visited many hospitals and took many medicines, such as Biyankang, Rhinitis Drops, Qianbai Rhinitis Tablets, and also had laser and cauterization treatments. But it had no effect at all. I started using Birkner inhaler a year ago, inhaling 4 times a day, 2 puffs each time. It worked well for a while, but after a cold, all the previous efforts were lost and it returned to the same old routine. I would like to ask Dr. Ye if there is any good way to treat this problem of mine.
Dr. Ye Qing, ENT, Shanghai Changzheng Hospital
Allergic rhinitis is caused by your allergies, so theoretically it cannot be cured, but it can be cured if the medication is used properly. control. Berkner's medicine is specially used to treat allergic rhinitis associated with asthma, so you are taking the right medicine. In addition, you can also use traditional Chinese medicine granules such as Xinqin granules for conditioning. Once you find the right medicine, use it. If the medicine doesn't work in the future, look for new medicines. Fortunately, new anti-allergy medicines are launched almost every year.
Talk about allergic rhinitis
A mother wrote to say: Her son is 18 years old and is in the third grade of high school.
Every year at the turn of spring and summer, I suffer from allergic rhinitis, which causes me to sneeze frequently and have a lot of runny nose. My nostrils are blocked again at night, which is difficult to detect. My son has been suffering from allergic rhinitis since he was 3 years old. As he gets older, the symptoms become more and more serious. He has been treated with medication this year, but many medicines are no longer effective. She was worried that her son's allergic rhinitis attack would seriously affect his preparation for the college entrance examination. She was very anxious and hoped that he could tell her about the causes of allergic rhinitis and ways to reduce allergic rhinitis attacks. After receiving her letter, I wrote back and told her that she should do more home cleaning before and after the Spring Festival, maintain good air circulation in the home in winter, and cut off contact with the causes of allergic rhinitis. Doing so may reduce the risk of allergic rhinitis. When rhinitis attacks, doing more physical activities can alleviate the symptoms of rhinitis.
Allergic rhinitis, also known as allergic rhinitis in medicine (referred to as: allergic rhinitis.) Why does allergic rhinitis occur? Let me start with the physiological functions of the nose:
1. Physiological functions of the nose
The nose is the entry and exit passage for air. Its main functions are to filter, moisten and warm inhaled air. of air, and clearly inhale particles with a diameter greater than 10UM in the air. However, even substances as small as 2UM can be filtered out partially when passing through the nasal cavity. Generally speaking, the larger and heavier the particles, the faster they are filtered and deposited on the nasal mucosa. In addition, the nose has special olfactory nerves that provide the sense of smell. The reaction of the nasal mucosa to external stimuli is mainly manifested in four aspects: "nasal blockage" causing airflow obstruction, increased nasal mucosal secretion causing "runny nose", "sneezing" and "nose (itching)". ① Nasal congestion is caused by mucous membrane congestion and edema, increased viscous secretions or adenoid hyperplasia; ② When local nerve endings are stimulated, the central nervous system will reflexively cause sneezing; ③ Increased secretion, runny nose and sneezing are both simple It is also an important nasal reflex. Any stimulation of the nasal mucosa, including allergies, autonomic nerves, psychological and other factors, can cause runny nose and sneezing. They help eliminate foreign bodies; ④ Nasal itching is due to inflammatory mediators, such as mast cells and basophils. Caused by histamine released by granulocytes.
Also, S-IgA secreted by the nose can inactivate viruses, and the solution in it can prevent bacterial invasion. If microorganisms have invaded, to remove them, phagocytosis cells and immune cells will be needed to remove them. reaction to complete.
2. Causes of allergic rhinitis
It is now known that allergic rhinitis is caused by exposure of atopic children to allergens, mainly inhaled allergens (such as Dust mites, fungi, pollen, etc.) combine with specific IgE that has been bound to mast cells, eosinophils, platelets and other cells, causing these cells to release symptom mediators, thereby causing inflammation of the nasal mucosa. The inflammatory process includes infiltration of inflammatory cells and cells such as eosinophils and neutrophils, release of primary and secondary disease mediators such as histamine, LTS and PG, and activation of eosinophils leading to early and late reactions. Local tissue manifestations include dilation of nasal mucosal blood vessels, soft tissue edema and increased secretion. The most common reactants that induce nasal allergy within one year of age are dust mites, animal dander and food, and pollen is usually induced after the age of 3 years. Mites in house dust and feces are most common on beds, dead corners in the house, carpets, etc. Children crawling on the bed or carpet inhale a large amount of allergens to induce or aggravate the disease. Frequent colds in babies in winter are likely to be allergic rhinitis caused by dust mites. Animal dander and saliva indoors can trigger allergic symptoms, and animal-related allergens can remain active indoors for up to 6 months after the animals are removed. In infants and young children, nasal allergies are caused by food, of which eggs and milk are the most common. However, eating allergic foods, in addition to causing nasal allergy symptoms, is usually accompanied by other organ system symptoms, such as measles, facial and lip swelling, or bronchospasm. wait. However, those who only have nasal allergy symptoms are rarely triggered by food. In addition to pollen, there are irritants that can worsen the symptoms of allergic rhinitis, including perfume, smoke, paint, newspaper ink, deodorant or other sprays, and air pollutants (sulfur dioxide, carbon monoxide , nitrogen dioxide, ozone, etc.).
3. Classification
According to the duration of onset, allergic rhinitis is often divided into the following categories:
1. Seasonal rhinitis.
Pollen is the most common cause. The types of pollen that cause disease vary from time to time and place to place. It is generally more common in spring and/or autumn. Fungi are also another important cause. This type of rhinitis has an acute onset and severe symptoms, often including paroxysmal sneezing, nasal itching, large amounts of watery mucus, and nasal congestion. Often accompanied by conjunctivitis and sometimes measles and asthma.
2. Perennial rhinitis. The so-called perennial refers to symptoms that last for more than 9 months every year and are mostly caused by indoor allergens, such as dust mites or their feces. Although symptoms are perennial, patients may experience worsening symptoms during periods of increased mite reproduction, and symptoms may vary in severity throughout the day. It is usually most severe in the bedroom, where dust mites are most abundant. Nasal congestion causes nasal congestion at night, and sneezing persists in the morning. It is often aggravated when children play with pillows or come into contact with other dusty bedding. Animals at home, especially cats and dogs, are another important cause of perennial rhinitis. Perennial rhinitis is less likely to sneeze except in the early morning, and is rarely accompanied by conjunctivitis symptoms. Perennial rhinitis may also worsen seasonally, which may be due to the patient being allergic to both indoor and outdoor allergens.
3. Intermittent rhinitis. Occasional exposure to allergens, such as exposure to dusty storage rooms, study rooms, or exposure to other people's cats and dogs, causes sudden onset of the disease, and the onset is intermittent. The sinus mucosa is an extension of the nasal mucosa. Therefore, any allergic inflammation of the nose can spread to the sinuses. In the past, it was believed that the sinuses developed later, so there were fewer complications in infants and young children. But in fact, the ethmoid sinus and maxillary sinus can already be seen in the 3rd to 4th month of pregnancy and are already present at birth. The frontal sinus can be seen in the 6th to 12th month after birth, and the sphenoid sinus appears later, about three years old. Therefore, people over 1 year old may suffer from sinusitis. Because the sinus exits are small and drainage is poor, secondary infections are prone to occur.
IV. Incidence and clinical manifestations
This disease can occur at any age, including infancy. Most patients appear before the age of 20. It is a common disease and has been reported in domestic and foreign literature. , as many as 10 children and 20 teenagers suffer from perennial rhinitis, most of which are allergic. About 75% of children with asthma also have this disease. Because patients with nasal congestion have to breathe through their mouths, more allergens are inhaled directly from the mouth, which aggravates asthma. There is no gender difference in the onset of allergic rhinitis. Its onset is related to genetic factors, environmental factors and allergen exposure.
Sneezing, itchy nose, runny nose and nasal congestion are the four most common symptoms. The most common sneezes are in the early morning and after waking up from sleep, with more than 5 sneezes per time in older children. When the nasal congestion is severe, you open your mouth to breathe. Because the mucus flows to the nasopharynx at night and causes repeated coughing, clear your throat. Nasal blockage often changes with changes in body position. For example, when lying on the left side, the left nose is blocked and the right nose is open; when lying on the right side, the right nose is blocked and the left nose is open. This is a characteristic manifestation of rhinitis. It can be seen that children constantly rub with their fingers or palms. In the front of the nose, this action is called "allergic grooming". Some children often make strange movements such as twisting their mouths and shrugging their noses due to nasal itching. Older children report superficial loss of smell. The nasal discharge may be clear and watery, but may also become thickened due to nasal congestion or secondary infection. Children can also see gray-blue ring-shaped shadows and wrinkles under the orbits, called "allergic coloration" or "Dennie-Mergan infraorbital folds". This is caused by edema and venous stasis around the orbits, and is also atopic in children. A characteristic manifestation of eye and nose allergies, combined with eye symptoms including eye itching, is mostly caused by animal allergens and seasonal pollen. Children often have a family history of allergies.
Internal examination of the nasal cavity shows turbinate edema, often called white or purple, with a thin layer of watery mucus on the upper cover. In severe cases, the swollen turbinates can completely block the nasal passages.
5. Treatment of degenerative rhinitis
(1) Non-drug therapy
1. Avoid allergens and irritants. Children spend more than half of their time in the bedroom, so the indoor environment should be changed, animals should be removed, furniture should be cleaned, carpets should not be laid, and plush toys should not be purchased to reduce disease-causing allergens and irritants. An air conditioner is particularly useful for those who are allergic to pollen. Windows can be closed throughout the summer to prevent pollen from entering. Dry air in winter can aggravate nasal congestion. It is best to keep the relative humidity at around 40-50. If the cause is a certain food, contact with that food should be avoided entirely.
2. Steam inhalation or saline atomization inhalation. Steam can temporarily relieve nasal congestion and increase airflow.
Salt water can dilute viscous secretions, improve the sense of smell and remove allergens in the nose to alleviate symptoms. It can also reduce the blood flow in the nose, thus acting as a mild lightening agent. Both can prevent dry mouth.
3. Exercise. Exercise can reduce nasal airway resistance and improve physical fitness.
(2) Drug treatment
For many patients with allergic rhinitis, if they want to eliminate symptoms, using one drug is not enough, and requires multi-faceted treatment. Antihistamines are preferred and suppress histamine-induced sneezing, nasal itching, and runny nose. For nasal congestion, decongestants should be added, such as pseudoephedrine, bematazoline, etc. If it is chronic, anti-inflammatory drugs must be used because the local mucosa has been inflamed (referred to as allergic inflammation). Local nasal corticosteroids can reverse the existing inflammation. Cromoglycate sodium prevents the onset of nasal symptoms. Injection of corticosteroids into the turbinates is generally not recommended because there are individual reports of the risk of visual loss.
(3) Other therapies
1. Immunotherapy. Originally called desensitization therapy, it was later discovered that immunological changes would occur in the body of effective cases after treatment. A few cases are caused by pollen, and other treatment methods are ineffective. They can be applied to strictly selected patients. Immunotherapy does not cure allergic rhinitis, but significantly improves the symptoms of 80-85% of patients. Children younger than 5 years old are not suitable for use because continuous injections are prone to skin complications.
2. Surgical treatment. Surgical resection is not a radical cure for this disease, but it can be used as an auxiliary treatment for cases such as nasal septum distortion. The effects of cryotherapy are also temporary.
3. Traditional Chinese medicine therapy. Acupoint sticking therapy is an external therapy method that combines acupoints and drugs to give full play to the specificity of acupoints and drugs. It is simple and easy to perform, has good curative effect, and is widely used in clinical practice. The basic drug prescription is "Xiaochuan Cream". The timing of treatment is based on the principle of "treating winter diseases in summer". It should be done every 10 days at the beginning, middle and end of summer (the dog days of summer) or after the dog days of summer. Generally, three times constitute a course of treatment. It takes more than 1-3 years. The mechanism of action is that the application therapy mainly regulates the body's immune function and endocrine function, and has certain anti-inflammatory effects, reducing airway hyperresponsiveness and improving lung function, thereby preventing and alleviating the symptoms of allergic rhinitis.
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