Treatment of respiratory allergies

With all forms of respiratory allergosis, one must strive for maximum dissociation with a causally significant allergen (see Lung and prevention of pollinosis and bronchial asthma).

When the allergic disease of the upper respiratory tract worsens, children are prescribed antihistamines I (tavegil, suprastin, diazolin, fenkarol), II (zirtek, claritin, semprex, histalkon, kestin) or third generation (telphast). With severe nasal congestion, the appointment of decongestants of sympathomimetic action (galazoline) is necessary. Treatment with these drugs is carried out for up to 5-7 days, as longer their use is fraught with the development of the "rebound" syndrome, manifested in the increase of edema of the nasal mucosa. New vasoconstrictive drugs (otrivine, aphrene, ximelin, nasivin, tizin) are not as aggressive, however, their use for more than 2-3 weeks is undesirable for the same reasons. Combined preparations with decongestant and antihistaminic activity (antistin-prion, rhinoproton, clarinase) are effective. The use of antihistamines is indicated locally (intranasally): allergodyl, 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 on allergic diseases	Very frequent	Not frequent
Extrathoracic allergic manifestations, including in the anamnesis	There are often	Rarely
Persistently recurrent nature of the disease	Characteristic	Not typical
Uniformity of clinical manifestations during exacerbation	Typical	Different clinical manifestations depending on the etiology
Reduction and disappearance of clinical manifestations in the elimination of a suspected allergen	There is	No
Increased body temperature	As a rule, there is no	As a rule, there is
Behavior of the child	Excitement, hyperactivity, "loquacity"	Lethargy, fatigue
Appetite	Saved	Can be reduced
Features of the blood test	Eosinophilia	Symptoms of viral or bacterial inflammation
The effect of antibiotic therapy	Absent	Can be good
The effect of using antihistamine drugs	Good	Missing or moderate
Tests of allergological diagnostics	Positive	Negative
The level of total IgE in serum	Enhanced	Normal
Cytomorphology of nasal secretion	Eosinophils 10% and more	Eosinophils less than 5%

With persistent recurrence of an allergic disease of the upper respiratory tract and with the goal of preventing transformation into bronchial asthma, it is advisable to perform a three-month course of treatment (ketotifen) of 0.025 mg / kg in 2 divided doses; zirteka (cetirizine): children 2-6 years - 5 mg (10 drops) once a day or 1.5 mg twice a day, children over 6 years - 10 mg per day.

In allergic rhinitis and hyperplasia of adenoids of allergic etiology, instillation into the nose of lomuzol, kromohexal or other intranasal forms of sodium cromoglicate is prescribed. For instillation into the eye with allergic conjunctivitis used optician (cromoglycate sodium). In severe allergic rhinitis, topical glucocorticosteroids are treated in the form of nasal sprays (fliksonase, aldecin, etc.). Surgical removal of adenoids for children with respiratory allergosis is carried out according to strict indications with ineffectiveness of conservative treatment: IV degree of 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 small forms of respiratory allergy.

At sensitization to any group of allergens it is necessary to diagnose and treat inflammatory, parasitic diseases of the digestive tract, dysbacteriosis; deficient conditions; diseases of the central and autonomic nervous system. It should be emphasized, however, that changes from almost any organ and system of the body in a child with respiratory allergy may be manifestations of "atopic disease", which should be clarified and taken into account when determining the tactics of treatment.

Specific immunotherapy (SIT) is an effective method for treating pollinosis and other small forms of respiratory allergy with inhalational monosensitivity. SIT in the early stages of respiratory allergosis in some cases prevents the weighting of the disease and transformation into bronchial asthma.

In most cases, parenteral (IV) administration of the cause-significant water-salt extract of the allergen in increasing dose and concentration is carried out. In hay fever in some clinics, oral SIT is administered, which is not less effective than parenteral and is less traumatic and safer method of treatment. In recent years, SIT has begun to use allergoids, which have a lower allergenic, but quite pronounced immunogenic activity. After the SIT (at least three courses - one course per year) there is a tendency to decrease the level of total IgE and specific IgE-antibodies. SIT is an expensive and unsafe method of treatment. Its effectiveness depends on the correct determination of indications, the quality of therapeutic allergens and the observance of the treatment technique. SIT is conducted by an allergist in the period of remission of the disease.

Education of parents of children with allergic diseases allows to increase compliance (the percentage of parents' appointments of a doctor), improve the effectiveness of treatment.