Allergic rhinitis: an overview of information

Allergic rhinitis is a disease caused by allergens and characterized by the development of IgE-dependent inflammation of the nasal mucosa. It manifests itself as a classical triad of symptoms: rhinorrhea, sneezing, nasal breathing (often also smelling).

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Epidemiology of allergic rhinitis

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

According to the WHO forecast, in the 21st century, allergic diseases will take the second place, losing only mental illnesses to their prevalence, Moreover, weighting of the course of allergy, the development of polysensitivity, frequent attachment of various infectious complications against immunological disorders are noted.

Diseases of the respiratory system in the structure of the overall incidence consistently rank second after cardiovascular pathology, accounting for about 19%. All this obliges us in daily clinical practice to pay special attention to the allergic pathology of the nose and paranasal sinuses.

Allergic rhinitis is a global health problem. Close attention of the international medical community to this issue is caused by a whole spectrum of both medical and social aspects:

• the incidence of allergic rhinitis is 10-25% in the general population;
• observe a persistent tendency to increase the incidence of allergic rhinitis;
• the influence of the disease on the development of bronchial asthma is proved, the concept of a "single respiratory system, a single disease" is discussed;
• allergic rhinitis reduces the social activity of patients, affects the performance of adults and the school performance of children;
• the disease leads to significant financial costs. Direct costs for its treatment in Europe are at least 1.5 billion euros per year.

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

[11], [12], [13], [14], [15], [16], [17], [18], [19]

Causes of allergic rhinitis

The starting factors of the development of allergic rhinitis are mainly air allergens. The most common "home" allergens: secretions of house dust mites, saliva and animal dander, insects and allergens of plant origin. The main "external" allergens include pollen from plants and molds.

There is also a professional allergic rhinitis, which is most often accompanied by a lesion of the lower respiratory tract and is in the competence of occupational physicians.

Allergic rhinitis - Causes and pathogenesis

[20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30]

Symptoms of allergic rhinitis

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

Allergic rhinitis - Symptoms

Classification of allergic rhinitis

Until recently, two main forms of allergic rhinitis were identified: 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 symptoms and indicators of the quality of life of the patient. According to this classification, intermittent and persistent allergic rhinitis is distinguished on the basis of the duration of preservation of symptoms,

[31], [32], [33], [34], [35], [36],

Intermittent allergic rhinitis

The duration of symptoms is less than 4 days per week or less than 4 weeks per year. The course of the disease is easy. At the same time, sleep is not disturbed, the patient retains normal daily activity, he can go in for sports. Their professional activity at school does not suffer. There are no painful symptoms.

Persistent allergic rhinitis

The duration of symptoms is more than 4 days a week or more than 4 weeks per year. The course of the disease is medium-heavy or severe. Characteristically, the presence of at least one of the following symptoms: sleep disturbance, disruption of daily activity, inability to exercise, normally rest, disruption of professional activity or schooling, the appearance of painful symptoms,

Diagnosis of allergic rhinitis

Diagnosis of allergic rhinitis consists of a complex of clinical and laboratory methods of investigation, it is important to carefully collect the history, analyze complaints, local and general methods of examination.

When examining the nasal cavity with a rhinoscope, and with the help of an endoscope, characteristic changes are observed: edema of the mucous membrane of the nasal conchae of various degrees, pallor of the mucous membrane, sometimes with a bluish tinge, watery or foamy. In the embodiment of the flow in the nasal passages, exudate is found. Exudate, as a rule, serous. In these cases, the patient is diagnosed with allergic rhinosinusitis. Occasionally, polyposive growths, mainly from the mid-nasal passage, are detected. It is often possible to distinguish polypoid hyperplasia of the middle nasal shell.

Allergic rhinitis - Diagnosis

[37], [38], [39], [40], [41], [42]

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 injected subcutaneously (less often intranasally or sublingually). Data on the efficacy 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 the elimination of contact with the allergen after identification of the latter. It should be borne in mind that the effect of various measures aimed at removing the allergen from the environment is fully manifested only after a few months. However, it is often impossible to completely avoid contact with the allergen, as in most patients polyvalent sensitization is detected. Nevertheless, even partial implementation of measures to prevent contact with allergens significantly facilitates the course of the disease and allows you to reduce the dose of drugs or reduce the intensity of pharmacotherapy.

Forecast

The forecast is favorable. With proper diagnosis and combined treatment of allergic rhinitis with the use of modern medicines, it is possible to significantly improve the quality of life for patients.

[43], [44], [45]