Allergic rhinitis is allergic rhinitis, with sudden and recurrent nasal congestion, nasal itching, sneezing, runny nose as the main symptoms, often allergic history. The pathogenesis is allergic inflammatory reaction mainly caused by nasal mucosal immune reaction caused by external environmental factors acting on human body. Allergic rhinitis can be divided into mild, moderate, severe, intermittent and persistent types, so it can be divided into four types, from light to heavy successively for mild intermittent type, moderate and severe intermittent type, mild persistent type and moderate and severe persistent type. Intermittent allergic rhinitis usually occurs about 4 times a week, the course of disease is less than 4 weeks; Persistent allergic rhinitis occurs almost every day, and the course of the disease is longer. The symptoms of allergic rhinitis can vary depending on the time and amount of exposure to the irritant and the patient's reaction status.
According to whether the clinical symptoms of allergic rhinitis vary with the seasons, it can be divided into perennial allergic rhinitis and seasonal allergic rhinitis. Perennial allergic rhinitis has symptoms all year round, can attack at any time, when light when heavy, or every morning when getting up, and then gradually reduce. It is generally easy to develop in winter and spring, and often coexists with other allergic diseases in the whole body. Seasonal allergic rhinitis is a seasonal attack, more in the spring, autumn fixed season onset, common in adolescents, can rapidly appear symptoms, the onset of a few hours, a few days to a few weeks range, attack interval is completely normal. The symptoms are more severe and the sufferer is miserable.
The allergens of perennial allergic rhinitis include: inhalation allergens such as indoor and outdoor dust, dust mites, fungi, animal fur, cotton wool, etc.; Food allergens such as fish and shrimp, eggs, milk, flour, peanuts, soybeans, etc. Drug-induced allergens such as sulfonamides, quinine, antibiotics, etc. Pollen is the main cause of seasonal allergic rhinitis. However, in recent years, due to the acceleration of the industrialization process and the aggravation of air pollution, people who were not allergic often have allergic symptoms. In addition, although gasoline, paint, ethanol, formaldehyde, etc. are not allergens, they have become strong irritants to induce the onset of seasonal allergic rhinitis.
clinical picture
The typical symptoms of allergic rhinitis are nasal congestion, runny nose, itchy nose and sneezing. Nasal congestion is intermittent or persistent, unilateral or bilateral, varying degrees of severity; It is often accompanied by a sense of smell disturbance, which is usually temporary but may be permanent. There is often a large number of clear watery mucus, especially in the acute phase of the obvious, when the acute reaction tends to weaken or disappear, the mucus can be reduced or thickened, if secondary infection can become sticky purulent discharge. Nasal itching is mostly paroxysmal nasal itching, or even
Itching in eyes, soft palate, ears and throat. Continuous sneezing, aggravated early in the morning and at night, with as few as a few times each attack, as many as dozens of times, and a watery or thin mucus like nose.
Drug therapy
The treatment of allergic rhinitis is mainly oral and topical, including chlorpheniramine, loratadine and cyproheptadine for oral treatment of allergic rhinitis; topical nasal drops include naphthalazoline nasal drops, hydroxymethazoline nasal drops, xyloxazoline nasal drops and 1% ephedrine nasal drops; sprays include hydroxymethazoline hydrochloride spray and compound naphthalazoline spray.
Over the counter
Oral administration of the second-generation antihistamine loratadine is preferred, 10mg once daily. Loratadine can not only prevent the early inflammatory response, but also stabilize inflammatory cells such as mast cells, prevent the release of histamine and other inflammatory mediators and cytokines, and prevent the chemotactic and infiltration of eosinophils, thus inhibiting or alleviating the late inflammatory response. Also choose the first generation antihistamine chlorpheniramine: 4mg once, 3 times a day; Cyproheptadine: adults 2mg ~4mg once, 2~3 times a day.
Local administration Local treatment with epinephrine drugs, naphthalazoline nasal drops, hydroxymethazoline nasal drops, 1 to 2 drops at a time, 3 to 6 times a day; Seloxazoline nasal drops for children over 6 years of age and adults 2-3 drops at a time, twice a day. 1% ephedrine nasal drops, 1 to 2 drops at a time, 3 to 4 times a day. Oxymethazoline hydrochloride spray for adults and children over 6 years of age, 1 to 3 sprays on one side at a time, once in the morning and once before bed. Compound naphthalazoline spray, once every 4 to 6 hours, each time each nostril 1 to 2 spray, not more than 6 times a day. Adrenergic drugs can make the nasal mucosa blood vessels constriction, reduce congestion, relieve nasal congestion.
Prescription drug
The oral antihistamine can be cetirizine taken once a day, 10mg once for adults and children over 6 years old, 5mg once for children 2 to 6 years old.
Leukotriene receptor antagonists, such as Montelukast, can specifically inhibit cysteylleukotriene receptors and block leukotriene-induced nasal inflammation. Patients 15 years and older were given oral Montelukast sodium 10mg once daily. Montelukast sodium chewable tablets for children aged 2 to 14 years, 4mg once a day for children aged 2 to 5 years; Children aged 6 to 14 years were given 5mg once a day.
When necessary, oral corticosteroids, prednisone is preferred, 5mg once, 3 times a day. Hormones should be used under the guidance of a specialist and must not be used for a long time.
In the treatment of integrated Chinese and Western medicine, the most commonly used Chinese herbs are Astragalus, fried white art and parsnips, followed by cassia twig, Xanthium seed, Xinyi flower and so on.
Local administration local nasal spray, beclomethasone propionate nasal spray can be selected, inhaled in nasal spray, adults and children over 6 years old 100μg per nostril, twice a day; Or 50μg on each side of each nostril, 3 to 4 times a day. The daily dosage should not exceed 400μg. Or use budesonide nasal spray, starting dose of 256μg per day for adults and children over 6 years old, once in the morning or twice in the morning and twice in the evening. After achieving the desired effect, reduce the dosage to the smallest dose needed to control symptoms, such as 64μg sprays into each nostril every morning. When using triamcinolone nasal spray, adults and children over 12 years of age 110μg once per nostril, once a day; When symptoms are controlled, a maintenance dose of 55μg per nostril is applied once. If symptoms are not effectively controlled, the dose may be increased to 220μg per nostril. In children aged 6-12 years, 55μg per nostril once, once a day, with a maximum volume of 110μg per nostril.
Medication precautions and patient education
The use of anti-allergy drugs and glucocorticoid therapy can reduce the body's response to allergens and inhibit inflammation, but the treatment time should not be too long, long-term use will cause drug-induced rhinitis, making the condition more complicated. At the same time, the use of high doses of treatment in children and adolescents may cause growth retardation.
Prednisone is contraindicated in patients with systemic fungal infection and glucocorticoid allergy. Patients with a history of severe mental illness, epilepsy, active gastroduodenal ulcer, recent gastrointestinal anastomosis surgery, and patients with severe diabetes, hypertension, glaucoma, and osteoporosis are contraindicated. Infection with viruses, bacteria and fungi that cannot be controlled by drugs is prohibited. Use with caution in patients with heart disease or acute heart failure, hypertension, hyperlipoproteinemia, renal impairment or calculus, myasthenia gravis, and hypothyroidism. Use with caution for pregnant and lactating women.
Glucocorticoid nasal sprays should be used with caution in patients with tuberculosis, herpes and nasal fungal infections, and pregnant and lactating women. The nasal and paranasal sinuses with bacterial infection should be treated with antimicrobial agents. The function of the pituitary-adrenal system should also be checked when nasal spray is used to treat patients with systemic glucocorticoid and adrenal function injury. At the same time, note that the nasal spray can only be used in the nasal cavity, do not touch the eyes, if contact with the eyes, should be washed immediately with water.
There are no studies on the use of Montelukast in pregnant women, and pregnant women should avoid montelukast unless they clearly need it.
Patients with seasonal allergic rhinitis should take the drug 2 to 3 weeks in advance, and after the season, the drug cannot be stopped immediately, and the drug should be continued for about 2 weeks.
The typical symptoms of allergic rhinitis and cold symptoms are similar, patients should pay attention to the difference, if there is no way to determine, do not use drugs, to the hospital in time to diagnose and reasonable treatment.
Allergic rhinitis patients should avoid contact with known allergens, such as pets, feathers, pollen, etc. Do a good job of indoor environment control, such as frequent ventilation, keep bedding dry, do not use carpets, etc.
