Allergic rhinitis (allergic rhinitis) - perhaps the most common disease with which people seek help from an allergist. This article will contain the most complete information about the symptoms, diagnosis and treatment of allergic rhinitis.
Allergic rhinitis is an inflammatory lesion of the mucous membranes of the nose that arises from an allergic reaction.
Usually, allergic rhinitis or rhinorrhea manifests itself as a rhinorrhea (watery secretion is actively allocated from the nose), sneezing, difficulty in nasal breathing, and sensation of itching in the nasal cavity.
According to the statistical data on this disease, every fifth resident of Russia suffers from allergic rhinitis
Causes of allergic rhinitis
At the heart of the development of this disease is immediate type hypersensitivity, and if more simply, an allergic reaction.
Allergic reaction means most allergic processes of immediate type, the symptoms of which develops from a few seconds to twenty minutes from the moment of initial contact with the allergen.
Allergic rhinitis along with allergic bronchial asthma and atopic dermatitis is included in the "big three" of the major allergic diseases.
Possible allergens can cause the development of allergic rhinitis: library or house dust; Mites in the house dust mites; pollen of plants; allergens of insects; medications; some food; allergens of yeast and mold fungi.
A serious risk factor for the development of this disease is a genetic predisposition
Symptoms of allergic rhinitis
The most characteristic signs and symptoms of allergic rhinitis:
• Transparent watery discharge from the nose, which, in case of attachment of a secondary infection, is transformed into a paroxysmal frequent prolonged sneezing
• Difficult nasal breathing (usually with a severe form of allergic rhinitis), with nasal congestion usually worse at night
• Severe itching in the nose
With an exacerbation of allergic rhinitis, the appearance of the patient is quite typical. Owing to the difficulty of nasal breathing, the patient breathes mainly with the mouth, slight swelling of the face is observed, the eyes are often red, lacrimation is present, dark circles can appear under the eyes. Quite often and involuntarily patients with allergic rhinitis rub their nose with the palm of their hand (this symptom is called "allergic salute").
Most often, allergic rhinitis manifests itself first time in childhood or early adolescence, and among blood relatives of the patient with allergic rhinitis, people with various allergic diseases are often observed.
Allergic rhinitis, depending on the severity of symptoms classified into light, medium and heavy.
Light degree of severity - the symptoms of allergic rhinitis do not interfere with sleep and do not reduce efficiency. The average severity - sleep and daytime activity is reduced moderately. Severe degree of allergic rhinitis - a strong violation of sleep and performance due to the severity of symptoms.
By the length of the symptoms, year-round and seasonal allergic rhinitis is isolated.
Usually seasonal allergic rhinitis occurs as a result of pollen allergy and is less common as an allergy to spores of mold fungi.
Often, when visiting a doctor, patients themselves point to allergic rhinitis-provoking factors (cleaning in an apartment, contact with animals, departure to nature, being in a dusty room, etc.).
When trialing antihistamines, temporary relief is often observed. Often the manifestations of an allergic rhinitis are combined with the symptoms of allergic conjunctivitis, or precede bronchial asthma.
Practically all known rhinitis (professional rhinitis, atrophic rhinitis, psychogenic rhinitis, medicinal rhinitis, hormonal rhinitis, infectious rhinitis), with the exception of minor differences, have similar symptoms, however, each of them requires individual treatment. That is why correctly diagnose the disease can only specialist in this field, i.e. allergist.
Often, patients take nasal vasoconstrictor drugs for a long time, but over time, with the abuse of these drugs, the course of the disease only worsens.
Most people with allergic rhinitis have increased sensitivity to such sharp smells as the smell of tobacco and chemical household chemicals
Analyzes for suspected allergic rhinitis
In the case of the slightest suspicion of allergic rhinitis, it is necessary not delaying to visit an ENT doctor and allergist. The otolaryngologist will be able to identify the possible presence of concomitant pathology of the ENT organs, and the allergist will exclude or vice versa confirm the allergic nature of the patient's delivery of severe inconveniences of manifestations. The most important question in the formulation of the correct diagnosis of allergic rhinitis is the identification of the causative allergen, a substance whose contact leads to the development of the above symptoms. For this, the following diagnostic types are usually used:
. • Skin tests . This is perhaps the most economical and informative method for diagnosing allergies, which should always be carried out only in specially equipped honey. office. When conducting a survey, the patient is often on the inner surface of the forearm doing several scratches, which are applied to 1 drop of the tested allergen, after which, after the due time, the reaction is evaluated. This method is the most reliable and informative, but it has some limitations (skin tests are prohibited during the period of exacerbation of the disease, as well as for lactating and pregnant women).
At least five days before the procedure, all antihistamines taken before are canceled.
. • Blood test for specific immunoglobulins . This method will detect allergens by analyzing blood, and is more convenient than skin tests in that it can be taken during an exacerbation, during pregnancy, feeding a child, and on the background of taking antihistamines. Also, there are no age limits, while skin tests for up to one year are not put. Despite all the above pluses, this blood test has two rather serious and sometimes decisive disadvantages - a high frequency of false positive results (about 20%) and a very high cost ($ 10 for one allergen, and sometimes they are tested up to 50). Often in children under one year, a blood test revealed an allergy to exotic fruits and seafood (mussels, shrimps, crabs), while parents swore that the child had not even seen them in the eye. That is why , if the general condition allows, it is still better to be examined by staging skin tests.
Sometimes, in case of any doubt, the doctor can prescribe additional tests (smear from the nose to the fungus and microflora, x-ray of the sinuses of the nose).
Very rarely, to determine the degree of disturbance of airway patency, anterior rhinomanometry
Treatment of allergic rhinitis
To begin treatment of an allergic rhinitis it is possible only after the definitive establishment of its allergic nature and confirmation of the nature of the disease. Like most other allergic diseases, treatment of allergic rhinitis is to reduce allergic inflammation of the mucosa and conduct allergen-specific therapy (immunotherapy)
Immunotherapy for allergic rhinitis
Immunotherapy is the most radical and effective method of treating allergic rhinitis. You should know that this treatment can only be carried out by an allergist in an allergic room or in a hospital. The tactics of this treatment is to introduce small doses of a reaction-provoking allergen with a gradual increase in its concentration. The purpose of these manipulations is the development of resistance (tolerance) to allergens in the body. In the case of proper administration of this treatment, allergic rhinitis can disappear forever. As early as possible the initiation of immunotherapy significantly increases the chance of absolute resistance to allergens and so the result, the complete cure of the disease. In a large number of patients, this method completely cured allergic rhinitis
Anti-inflammatory treatment of allergic rhinitis
This method of treatment of allergic rhinitis provides for the integrated use of a number of medications. Most often, the treatment of an allergic rhinitis begins with the appointment of antihistamines in the form of drops or tablets. In recent years, preference has been given to the second (Kestin, Zodak, Claritin, Cetrin) and third (Zirtek, Telfast, Erius) generations, which are administered only once a day inward, at the appropriate dosage of the patient. The duration of treatment is highly individual, but usually it lasts no more than two weeks. Despite the over-the-counter release of these drugs in the pharmacy network, they can not be prescribed for themselves for a long time, as some of these drugs negatively affect the cardiac muscle, while others noticeably inhibit the ability of the mind. Third-generation drugs are the most safe, but their high cost is often the main limiting factor for many patients, especially when long-term treatment is needed.
In the event that the therapeutic measures described above have proved to be ineffective, local remedies acting directly on the nasal mucosa are additionally assigned. At an easy degree of an allergic rhinitis appoint derivatives kromoglikat sodium (Kromosol, Kromoglin, Kromogeksal), issued in the form of nasal sprays. Drugs should be used during the entire period of exacerbation 3 r. per day for 1 injection. The therapeutic effect of the use of these sprays appears not earlier than in five days (maybe later), therefore their action is considered more preventive than curative.
Usually, drugs of this group are prescribed for the treatment of allergic rhinitis in children or mild rhinitis in adults. As a rule, the course of treatment of allergic rhinitis is not less than two to four months, although all-the-year-round use of drugs is possible.
Particular attention should be paid to a fairly new drug NAZAVAL, which is based on plant cellulose. This drug is available as a nasal spray and on the mucous membranes of the nose creates a microfilm that prevents contacting the mucous with the allergen.
During an exacerbation of allergic rhinitis, this spray is practically ineffective, therefore it is recommended for use only as a prophylaxis of the disease.
In severe course of allergic rhinitis, the main drugs of choice are spinal nasal corticosteroids (Benorin, Nazarel, Fliksonase, Nazonex, Baconase, Nasobek, Aldetsin). Preparations are prescribed in the dosages corresponding to the current age of 1-2 r. per day, while the duration of treatment is determined exclusively by the attending physician.
Often a possible error in the treatment of allergic rhinitis is a long-term use to facilitate the breathing of vasoconstrictive drops (Vibrocil, Naphthysine, etc.). Prolonged use of these drugs always leads to the development of medical rhinitis of any degree of severity, for the treatment of which surgical intervention on the nasal passages may be required. It is advisable to use vasoconstrictors before using intranasal glucocorticoids and only in case of severe nasal congestion.
And in general, vasoconstrictors for the nose for allergic rhinitis is better not to abuse
Folk treatment of allergic rhinitis
Allergic rhinitis is one of the few diseases in which traditional medicine can not help. To date, no one has developed a working technique that could be recommended for patients with allergic rhinitis. Therefore, the treatment of allergic rhinitis using traditional medicine can lead to the attachment of a secondary infection, exacerbation of the disease and the delay in the appointment of adequate medication.
The only thing that can be recommended for patients with rhinitis, is twice a day to rinse the nose with salt r-rum (for 200 ml of water 1.5 ts. Of salt). However, even this method must necessarily be combined with medication, since when applied alone, it will not give any visible results
Lifestyle and nutrition with allergic rhinitis
The main aspect of the treatment of allergic rhinitis is the elimination or reduction of contact with the allergen provoking the development of the disease. Individual recommendations are made for each patient after identifying the causative allergen. The nature of preventive measures directly depends on the type of certain allergen.
So, during the exacerbation of pollen allergies, patients are advised to change their place of residence to an area where causative plants do not grow, and in case of impossibility - try to leave the room only after dinner, when the concentration in pollen air is declining. Food allergies involve the complete exclusion of products that the patient has had positive tests ( allergy test ). Allergy to dust provides a permanent wet cleaning room, during which to prevent the ingress of dust allergens to mucous should wear a special mask
Allergic rhinitis in pregnancy
In every third woman, pregnancy promotes the first appearance or aggravation of already existing allergic diseases. As for the patients themselves, and for their doctors, this presents certain difficulties, since during pregnancy most methods of examination and medication are strictly forbidden.
Symptoms of allergic rhinitis in pregnant women are absolutely no different from classical manifestations. A definite effect on the fetus can have a disease only in case of severe forms of the disease and with inadequate treatment.
The causes of allergy during pregnancy are identified based only on the results of a blood test, since carrying out skin tests in this condition is contraindicated.
Treatment of allergic rhinitis during pregnancy is carried out with the maximum possible restriction of the use of antihistamines, because of their potentially negative effect on the fetus. In case of emergency, 3-generation drugs (Telfast, etc.) are used in minimum dosages. Nasal corticosteroids should not be prescribed in the first trimester of pregnancy. For local treatment of allergic rhinitis, derivatives of sodium cromoglycate (Cromogexal, etc.) and Nasawal (a cellulose-based agent)
Allergic rhinitis in children
In children, allergic rhinitis, as a rule, manifests after three years, and most often allergic rhinitis in a child develops in the event that in the past, he already had any allergic manifestations (more often in the form of allergic or atopic dermatitis).
A similar change in clinical allergic manifestations: atopic dermatitis → allergic rhinitis → bronchial asthma, is called an "atopic march."
Symptoms of allergic rhinitis in a child are almost identical to those observed in adults, with only one difference: children experience a somewhat greater sensitization to food allergens.
Treatment of allergic rhinitis in children begins with the selection of the most optimal drugs that have the largest possible safety profile. However, at an early age immunotherapy is the most beneficial.
The prognosis of allergic rhinitis is quite favorable, however, in the absence of adequate treatment, the disease may begin to progress, as evidenced by a greater severity of symptoms ( headache , epistaxis, deterioration of odor recognition, coughing, sore throat, skin irritation on the wings of the nose and / or over the upper lip), as well as the expansion of the spectrum of causative allergens.
Today, as such, the prevention of allergic rhinitis has not yet been developed. In the case of an already developed allergy, all preventive measures consist in eliminating contact with a provoking allergen and conducting adequate timely treatment.