Treatment of respiratory allergies

In all forms of respiratory allergy, one must strive for maximum isolation from the causative allergen (see Treatment and prevention of hay fever and bronchial asthma).

In case of exacerbation of allergic disease of the upper respiratory tract, children are prescribed antihistamines of the 1st (tavegil, suprastin, diazolin, fenkarol), 2nd (zirtek, claritin, semprex, histalong, kestin) or 3rd generation (telfast). In case of severe nasal congestion, it is necessary to prescribe decongestants with sympathomimetic action (galazolin). Treatment with these drugs is carried out for up to 5-7 days, since their longer use is fraught with the development of the "rebound" syndrome, manifested in an increase in the swelling of the nasal mucosa. New vasoconstrictors (otrivin, afrin, xymelin, nazivin, tizin) are not so aggressive, however, their use for more than 2-3 weeks is undesirable for the same reasons. Combined drugs with decongestant and antihistamine activity (antistin-privin, rinopront, klarinase) are effective. The use of antihistamines locally (intranasally) is indicated: allergodil, histimed.

Some differential diagnostic signs of allergic and infectious diseases of the respiratory tract

Clinical and paraclinical signs of the disease	Allergic etiology	Infectious etiology
Hereditary burden of allergic diseases	Very common	Not frequent
Extrapulmonary allergic manifestations, including history	Often there is	Rarely
Persistent recurring nature of the disease	Characteristic	Not typical
Uniformity of clinical manifestations during exacerbation	Characteristic	Different clinical manifestations depending on the etiology
Reduction and disappearance of clinical manifestations upon elimination of the suspected allergen	Eat	No
Increased body temperature	Usually absent	Usually present
Child's behavior	Excitement, hyperactivity, "talkativeness"	Lethargy, fatigue
Appetite	Saved	May be reduced
Features of blood analysis	Eosinophilia	Signs of viral or bacterial inflammation
The effect of antibacterial therapy	Absent	Maybe good
The effect of using antihistamines	Good	None or moderate
Allergy diagnostic tests	Positive	Negative
Total IgE level in blood serum	Increased	Normal
Cytomorphology of nasal secretion	Eosinophils 10% or more	Eosinophils less than 5%

In case of persistent recurrence of allergic disease of the upper respiratory tract and in order to prevent transformation into bronchial asthma, it is advisable to conduct a three-month course of zaditen (ketotifen) 0.025 mg/kg in 2 doses; zyrtec (cetirizine): for children 2-6 years old - 5 mg (10 drops) 1 time per day or 1.5 mg 2 times per day, for children over 6 years old - 10 mg per day.

In allergic rhinitis and adenoid hyperplasia of allergic etiology, lomuzole, cromoghexal or other intranasal forms of sodium cromoglycate are prescribed for nasal instillation. Opticrom (sodium cromoglycate) is used for eye instillation in allergic conjunctivitis. In severe cases of allergic rhinitis, treatment is carried out with topical glucocorticosteroids in the form of nasal sprays (flixonase, aldecin, etc.). Surgical removal of adenoids in children with respiratory allergy is carried out according to strict indications when conservative treatment is ineffective: grade IV hyperplasia with complete absence of nasal breathing, repeated purulent otitis and sinusitis. This tactic is due to the fact that removal of adenoids often leads to the manifestation of bronchial asthma in a child with minor forms of respiratory allergy.

In case of sensitization to any group of allergens, it is necessary to diagnose and treat inflammatory, parasitic diseases of the gastrointestinal tract, dysbacteriosis; deficiency states; diseases of the central and autonomic nervous system. However, it should be emphasized that changes in almost any organ and system of the body in a child with respiratory allergy can be manifestations of "atopic disease", which must be clarified and taken into account when determining treatment tactics.

Specific immunotherapy (SIT) is an effective method of treating hay fever and other minor forms of respiratory allergy with inhalation monosensitization. SIT in the early stages of respiratory allergies in some cases prevents the severity of the disease and its transformation into bronchial asthma.

In most cases, parenteral (i/c) administration of the causative aqueous-salt extract of the allergen is performed in an increasing dose and concentration. For hay fever, some clinics perform oral SIT, which is as effective as parenteral and is a less traumatic and safer method of treatment. In recent years, allergoids with lower allergenic but quite pronounced immunogenic activity have been used for SIT. After SIT (at least three courses - one course per year), a tendency towards a decrease in the level of total IgE and specific IgE antibodies is noted. SIT is an expensive and unsafe treatment method. Its effectiveness depends on the correct determination of indications, the quality of therapeutic allergens and compliance with the treatment method. SIT is performed by an allergist during the period of remission of the disease.

Education of parents of children with allergic diseases helps to increase compliance (the percentage of parents following doctor’s orders) and improve the effectiveness of treatment.