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Allergic rhinitis
Last reviewed: 17.10.2021
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Allergic rhinitis is manifested by itching, sneezing, rhinorrhea, nasal congestion and sometimes conjunctivitis due to exposure to pollen or other allergens in a certain season or year-round. The diagnosis is based on anamnesis and skin tests. Treatment consists in the combination of antihistamines, decongestants (decongestants), nasal glucocorticoids or in severe, refractory cases - in the conduct of desensitization.
Allergic rhinitis can occur seasonally (hay fever) or year-round (year-round rhinitis). At least 25% of long-term (all-the-year-round) rhinitis is not allergic. Seasonal rhinitis is the result of contact with pollen of trees (for example, oak, elm, maple, alder, birch, juniper, olive) in spring, pollen of grass (eg Bermuda, timothy, sweet spring, garden, jonson grass) and pollen of weeds (for example, Russian thistle, English plantain) in the summer; and also pollen of other weeds (for example, ragweed ambrosia) in the fall. The causes are different in different regions, and seasonal rhinitis is sometimes the result of contact with airborne fungal spores. Prolonged (year-round) rhinitis is the result of year-round contact with the inhaled allergen (for example, dust mites, cockroaches, livestock products, mold) or resistant reactivity to pollen of plants in the appropriate season.
Allergic rhinitis and asthma often coexist; it is not clear whether rhinitis and asthma are the result of the same allergic process (the hypothesis of "single airway"), or rhinitis is a triggering factor in asthma.
Non-allergic forms of long-term (all-the-year-round) rhinitis include infectious, vasomotor, atrophic, hormonal, medicinal and taste.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]
Symptoms of allergic rhinitis
The patients have itching of the mucous membranes of the nose, eyes, mouth; sneezing; rhinorrhea; congestion of the nose and paranasal sinuses. Obstruction of the paranasal sinuses can cause headaches in the forehead; a frequent complication are sinusitis. Cough and dyspnea may also occur, especially if the patient has asthma. The main sign of year-round rhinitis is chronic nasal congestion, which in children can lead to chronic otitis media; Symptoms vary in severity throughout the year. Itching is less pronounced.
Of the objective signs should be noted edematous, purple-cyanotic nasal concha and in some cases seasonal rhinitis injected conjunctiva and edema of the eyelids.
Diagnosis of allergic rhinitis
Allergic rhinitis is diagnosed on the basis of anamnesis data. Diagnostic tests are not necessary, except in cases where patients have no improvement in empirical treatment; In this case, skin tests reveal a reaction to seasonal pollen or dust mite, livestock products of domestic animals, a mold or other antigens (permanent); based on the tests performed, additional therapy is prescribed. Eosinophilia, revealed in the analysis of a smear from the nose with negative results of skin tests, suggests aspirin sensitization or non-allergic rhinitis with eosinophilia (NARES, NARES - nonallelic rhinitis with eosinophilia).
With infectious, vasomotor, atrophic, hormonal, medicinal and taste rhinitis, the diagnosis is based on anamnesis and the results of treatment.
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Treatment of allergic rhinitis
Treatment of seasonal and long-term (all-the-year-round) allergic rhinitis, as a rule, is similar, although with long (year-round) rhinitis it is recommended to try to remove the irritant (eg, dust mites or cockroaches).
The most effective first-line drugs are oral antihistamines, decongestants, drops from rhinitis, and nasal glucocorticoids with or without oral antihistamines. Less effective alternative drugs are nasal mast cell stabilizers (cromolyn and nedocromil), which are taken 2 or 4 times a day, nasal H2 blocker azelastine 2 injections once a day and nasal ipratropium 0.03% 2 injections after 4-6 hours , which helps with rhinorrhea. Entered intranasally normal saline, which is often forgotten, helps to cope with a dense nasal secretion and moisturizes the nasal mucosa.
Immunotherapy can be more effective in seasonal than with year-round allergic rhinitis; it is required in cases where the symptoms are severe, the allergen can not be removed, drug therapy does not help. The first attempts at desensitization should be carried out immediately after the end of the pollen season in preparation for the next season; side effects intensify when immunotherapy begins during the pollen season, since at this time allergic immune reactions are already maximally stimulated.
Montelukast facilitates the course of allergic rhinitis, but its role in comparison with other methods of treatment is not completely clear. The role of anti-1gE antibodies in the treatment of allergic rhinitis is being studied, but, apparently, their use will be limited due to the availability of less expensive and effective alternative treatments.
NARES is treated with nasal glucocorticoids. Treatment of aspirin sensitization consists in the rejection of aspirin and, if necessary, desensitization and administration of leukotriene receptor blockers; nasal polyps can successfully use intranasal glucocorticoids.