Allergic Rhinitis - Information Overview

Allergic rhinitis is a disease caused by allergens and characterized by the development of IgE-dependent inflammation of the mucous membrane of the nasal cavity. It manifests itself with a classic triad of symptoms: rhinorrhea, sneezing, impaired nasal breathing (often olfactory dysfunction).

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Epidemiology of allergic rhinitis

Currently, the incidence of allergic diseases is high. According to statistical reports, up to 25% of the urban and rural population living in regions with highly developed industry suffers from allergies, and in ecologically unfavorable areas these figures reach 30% or more.

According to the WHO forecast, in the 21st century, allergic diseases will take second place, second only to mental illnesses in prevalence. In addition, they note the worsening of the course of allergies, the development of polysensitization, and the frequent addition of various infectious complications against the background of immunological disorders.

Respiratory diseases consistently occupy second place in the structure of general morbidity after cardiovascular pathology, accounting for about 19%. All this obliges us to pay special attention to allergic pathology of the nose and paranasal sinuses in everyday clinical practice.

Allergic rhinitis is a global health problem. The international medical community's close attention to this issue is due to a whole range of both medical and social aspects:

• The incidence of allergic rhinitis is 10-25% in the general population;
• a persistent tendency towards an increase in the incidence of allergic rhinitis is observed;
• the influence of the disease on the development of bronchial asthma has been proven, the concept of “one respiratory system, one disease” is discussed;
• Allergic rhinitis reduces the social activity of patients, affects the performance of adults and the school performance of children;
• The disease results in significant financial costs. Direct costs for its treatment in Europe amount to at least 1.5 billion euros per year.

In this regard, it is advisable to introduce modern and effective treatment regimens for allergic rhinitis that comply with the principles of evidence-based medicine, as well as uniform requirements for prevention and diagnosis.

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Causes of allergic rhinitis

The triggers for the development of allergic rhinitis are mainly airborne allergens. The most common "household" allergens are: house dust mite secretions, animal saliva and dander, insects and plant allergens. The main "external" allergens include plant pollen and mold fungi.

There is also occupational allergic rhinitis, which is most often accompanied by damage to the lower respiratory tract and is the responsibility of occupational pathologists.

Allergic Rhinitis - Causes and Pathogenesis

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Symptoms of allergic rhinitis

For adequate assessment of the severity of the process, correct choice of the treatment method and accurate prosthetics of the disease course, it is of great importance to study complaints and anamnesis. It is necessary to accurately determine the form (intermittent or persistent) of allergic rhinitis for each patient. The main complaints of patients: nasal discharge, nasal congestion and sneezing attacks. To establish a diagnosis, it is necessary to have two or more symptoms lasting at least 1 hour per day for a long time.

Allergic Rhinitis - Symptoms

Classification of allergic rhinitis

Until recently, two main forms of allergic rhinitis were distinguished: seasonal, caused by sensitization to plant pollen allergens, and year-round as a reaction to household allergens.

In 2001, this classification was revised by WHO experts. The new classification takes into account the patient's symptoms and quality of life indicators. According to this classification, intermittent and persistent allergic rhinitis are distinguished based on the duration of symptoms,

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Intermittent allergic rhinitis

The duration of symptoms is less than 4 days a week or less than 4 weeks a year. The course of the disease is mild. At the same time, sleep is not disturbed, the patient maintains normal daily activity, he can play sports. Professional activity and school studies do not suffer. There are no painful symptoms.

Persistent allergic rhinitis

Symptoms last more than 4 days a week or more than 4 weeks a year. The course of the disease is moderate to severe. At least one of the following symptoms is characteristic: sleep disturbance, disturbance of daily activities, inability to play sports, to rest normally, disturbance of professional activity or school performance, occurrence of painful symptoms,

Diagnosis of allergic rhinitis

Diagnosis of allergic rhinitis consists of a complex of clinical and laboratory research methods; careful collection of anamnesis, analysis of complaints, local and general examination methods are of great importance.

When examining the nasal cavity with a rhinoscopy, and if possible with an endoscope, characteristic changes are determined: swelling of the mucous membrane of the nasal turbinates of varying degrees of severity, paleness of the mucous membrane, sometimes with a bluish tint, watery or foamy discharge. In the exudative variant of the course, exudate is found in the nasal passages. The exudate is usually serous. In these cases, the patient is diagnosed with allergic rhinosinusitis. Sometimes polypous growths are found, mainly originating from the middle nasal passage. Polypoid hyperplasia of the middle nasal turbinate can often be identified.

Allergic Rhinitis - Diagnosis

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Treatment of allergic rhinitis

Treatment of allergic rhinitis includes allergen-specific immunotherapy and pharmacotherapy.

Allergen-specific immunotherapy is a treatment with increasing doses of an allergen, which is most often administered subcutaneously (less often intranasally or sublingually). Data on the effectiveness and safety of subcutaneous immunotherapy are contradictory. It is believed that immunotherapy is most effective in children and adolescents with monovalent sensitization and a mild course of the disease.

Allergic Rhinitis - Treatment and Prevention

Prevention of allergic rhinitis

The main method of preventing allergic rhinitis is considered to be the elimination of contact with the allergen after identifying the latter. It is necessary to take into account that the effect of various measures aimed at removing the allergen from the environment is fully manifested only after several months. However, complete elimination of contact with the allergen is often impossible, since most patients have polyvalent sensitization. Nevertheless, even partial implementation of measures to prevent contact with allergens significantly alleviates the course of the disease and allows to reduce the dose of drugs used or reduce the intensity of pharmacotherapy.

Forecast

The prognosis is favorable. With proper diagnosis and a combined approach to the treatment of allergic rhinitis using modern drugs, it is possible to significantly improve the quality of life for patients.

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