How to do allergic rhinitis?

1. Why do some people have allergic symptoms?

Answer: first explain what allergic rhinitis is, which is often called allergic rhinitis. It is a non-infectious inflammatory disease of nasal mucosa mainly mediated by IgE and belongs to type I allergic reaction. Including allergen sensitization stage and re-excitation stage, the pathogenesis is very complicated, which is the result of the interaction of genetic, environmental and other stimulating factors.

Who is easy to send? It is suggested that dust mites, fungi, pollen, mugwort and cat/dog hair are the main allergens in Wuhan, and the family allergic history of first-degree relatives (such as parents, siblings and children), positive screening of dust mites allergens, drug allergy (such as penicillin and cephalosporin), use of blankets and bedding are all risk factors.

For this kind of people, we should pay attention to avoid using chemical fiber pillows, blankets, bedding (including cotton wool) and keeping pets (especially cats). At home, we should also pay attention to avoid planting suspicious flowers and plants, use solid wood furniture as much as possible, do a good job of cleaning and hygiene, avoid dust mites and fungal spots (mildew spots) in the room (floor/ceiling), and ventilate and remove dust.

2. Are sneezing and runny nose the main symptoms of patients with allergic rhinitis?

A: The main symptoms of allergic rhinitis are recurrent nasal itching, paroxysmal continuous sneezing and watery nasal discharge, which may be accompanied by nasal congestion (poor ventilation), itchy eyes (tears), itchy throat (tears) and cough.

3. Can you judge that you have allergic rhinitis after these symptoms appear?

Answer: According to the typical symptoms, you can make a preliminary judgment by yourself, but it is suggested that you should go to the otolaryngology department for diagnosis when you have an attack.

The diagnostic criteria formulated by the Chinese Medical Association are:

Perennial allergic rhinitis: onset all the year round, with three main clinical manifestations: sneezing (more than three times in a row), runny nose and nasal mucosal swelling. 1 year cumulative onset days >; The cumulative onset time within 6 months 1 day >: 0.5 hours, and the course of disease is at least 1 year.

Pollen disease: seasonal onset, the annual onset season is basically the same, and it is consistent with the pollination period of sensitized pollen. It occurs in the same season for at least 2 years, and the onset period has typical clinical symptoms and signs.

If there is a clear history of allergen inhalation and personal/family allergic diseases, the diagnosis can be made by positive cytological smear (eosinophils), allergen detection and serum sIgE detection of nasal secretions.

The diagnostic criteria set by the World Health Organization (WHO) are:

Intermittent: the number of days when symptoms appear.

Mild: normal sleep, normal daily life, normal sports and entertainment, normal work and study; Moderate-severe (one or more of the following): unable to sleep normally, affecting daily life, sports and entertainment, unable to work and study normally, with annoying symptoms.

It can be divided into mild intermittent allergic rhinitis, mild persistent allergic rhinitis, moderate and severe intermittent allergic rhinitis and moderate and severe persistent allergic rhinitis.

It needs to be differentiated from the following diseases:

Allergic rhinitis and acute rhinitis (cold):

allergic rhinitis

Symptoms: sneezing, runny nose, itchy nose, stuffy nose, itchy eyes, itchy throat, itchy skin and headache.

Occurrence: Symptoms appear almost immediately after exposure to allergens.

Duration: As long as you are exposed to allergens, the symptoms will not subside; Avoid contact with allergens, and the symptoms will gradually ease.

Signs: pale nasal mucosa, edema and runny nose.

Cytological smear of nasal secretions (eosinophils), allergen detection and serum sIgE detection were all positive.

acute rhinitis

Symptoms: stuffy nose, sneezing, runny nose (clearing nose first and then sticky pus), sore throat, often accompanied by systemic symptoms, such as chills, low fever, weakness of limbs and so on.

Onset: Symptoms will not appear until several days after exposure to the virus.

Duration: Symptoms usually last for 7- 10 days, with self-healing.

Signs: diffuse congestion and swelling of nasal mucosa, clearing nasal mucus first and then sticking nasal mucus.

4. Is there any cure for allergic rhinitis?

Answer: In theory, if we can absolutely avoid contact with allergens or change allergic constitution through allergen-specific immunotherapy, it can be cured, but it is not easy to achieve in real life. The average incidence of allergic rhinitis in the world is 10% ~ 25%. According to the national telephone survey on the incidence of allergic rhinitis in 1 1 cities, the incidence rate is 8.5% ~ 2 1.3%, and with the constant change of people's lifestyle and eating habits and the increasing environmental air pollution, due to genetic and environmental factors and other stimuli,

5. What is antiallergic desensitization therapy? How to take medicine? How long does the treatment take?

A: Allergen-specific immunotherapy (SIT), also known as desensitization therapy, is to act on allergic individuals with increasing doses of allergen extracts (vaccines) to reduce their sensitivity and reduce the occurrence of clinical symptoms in the season of natural allergen exposure. It can induce immune tolerance, obviously improve clinical symptoms, reduce the demand for conventional drugs, improve the quality of life of patients, and has long-term curative effect to prevent the occurrence of new allergies. It is considered as a "cause-related therapy" that may fundamentally adjust the pathogenesis of allergic reactions, and it is the only treatment that may change the natural course of allergic diseases at present. Theoretically, it can achieve radical effect, which is considered as one of the basic methods to treat allergic diseases of respiratory tract.

The traditional method of allergen-specific immunotherapy is subcutaneous (injection) immunotherapy (SCIT), which can effectively improve the symptoms of allergic rhinitis, prevent the formation of new sensitization and prevent allergic rhinitis from developing into asthma, and change the natural course of allergic diseases. It has a long-term and sustained curative effect, which can be maintained for at least 3 years after the treatment, but its compliance is poor and there is a risk of inducing serious adverse reactions.

Sublingual (oral) immunotherapy (SLIT) has the characteristics of good curative effect, safety, simple operation, non-invasive and good compliance, and is suitable for patients to treat at home. Slit, as a new treatment method, has been widely used in clinic. Slit can be used alone or in combination with drug therapy as an initial and early treatment strategy for respiratory allergic diseases. In sublingual immunotherapy, allergen vaccine drops or tablets are swallowed after 1 ~ 2 minutes under the tongue, and the dose and concentration gradually increase, reaching the maintenance amount within 4 ~ 6 weeks, and maintaining the treatment for 1 ~ 3 years. The recommended course of treatment is not less than 2 years. The main products include: house dust mite, dermatophagoides farinae, pollen (grass, wall grass, olive and ragweed) and cat dander vaccine.

6. How do patients choose treatment methods?

A: The comprehensive treatment of allergic rhinitis includes avoiding contact with allergens, drug therapy, allergen-specific immunotherapy and surgical treatment. It is necessary to choose appropriate personalized comprehensive treatment according to the patient's condition, mainly from the aspects of condition, compliance and cost.

The most important thing is to avoid contact with allergens. Nonspecific and specific allergens can be determined by daily observation and allergen detection (serology and skin prick):

Inhalable allergens: dust mites, fungi, pollen, mugwort and cat/dog hair are the main allergens in Wuhan, and dust, dust mites, fungi, animal fur and feathers are "non-inhalable" for perennial attacks; Pollen triggers are mostly seasonal attacks.

Edible allergens: "Don't eat", such as fish and shrimp, eggs, milk, flour, and some drugs such as sulfonamides.

Contact with allergens: "Do not touch", such as cosmetics, gasoline, paint, alcohol, etc.

Measures that can be taken:

Wear a mask and wash your nose (saline concentration < 2.3%, 1.8-2. 1% is the best).

7. Will long-term use of hormone spray have side effects?

A: Any drug will have side effects if taken for a long time, which is called "three-point toxicity". The adverse reactions of nasal corticosteroids include nosebleeds and cataracts, which may inhibit the growth and development of children, and it is also a matter of great clinical concern. Therefore, it is suggested to use drugs with low bioavailability, that is, drugs with low absorption side effects, such as nashuna, ranolol, frisonidase and so on.

In a word, it is suggested to take individualized comprehensive treatment and use nasal corticosteroids reasonably and effectively: patients with perennial and/or moderate and severe allergic rhinitis are advised to continue to use nasal corticosteroids routinely, and patients with mild seasonal diseases should be treated as needed; Oral and nasal antihistamines are also the first-line drugs for allergic rhinitis, which can be used alone or as auxiliary drugs for nasal corticosteroids.

8. Long-term use of a drug to treat rhinitis will produce drug resistance like anti-inflammatory drugs?

Answer: it should be. Therefore, it is suggested to adopt individualized comprehensive treatment instead of relying on only one drug.

9. Can allergic rhinitis lead to asthma?

A: Both allergic rhinitis and asthma belong to respiratory allergic diseases, that is, "one respiratory tract, one disease". Allergic constitution, especially allergic rhinitis, is closely related to the incidence of asthma, which can be used as an important index to screen people with high incidence of asthma. Research shows that the prevalence rate of allergic rhinitis in children with asthma in Wuhan is 20 times that of the control group. But not every patient with allergic rhinitis will develop asthma, and the specific mechanism remains to be studied.

10, can allergies be inherited?

A: The immune response mechanism is very complicated, which is the result of the combined action of genetic, environmental and other stimulating factors. Therefore, allergic constitution has certain heredity, especially the family allergic history of first-degree relatives (such as parents, brothers and sisters, children), and the specific mechanism is still unclear.

Why can't allergic rhinitis be cured? Anyway, if you can't cure it, you don't have to cure it?

Answer: Some patients question why allergic rhinitis can't be cured. I want to make it clear that doctors are not omnipotent, and medicine is gradually developed and perfected. Each treatment has its advantages and disadvantages. Allergic rhinitis involves the interaction of genetic, environmental and other stimulating factors. The pathogenesis is very complicated, and everyone's allergens and incidence are different. Therefore, doctors and patients need to develop their own personalized comprehensive treatment plan, gradually improve and gradually adjust. "You can't eat a fat man in one bite."

Some patients think that there is no need to treat it if it is not cured anyway. I also want to make it clear that prevention is the key to disease. Early detection, prevention and treatment are needed, so that the results can be controlled and reversed. Recurrent allergic rhinitis can induce nasal polyps and sinusitis, pharyngitis, otitis media, allergic conjunctivitis and systemic allergic dermatitis, especially one of the important risk factors of bronchial asthma. Therefore, the longer the course of the disease, the more difficult it is to control the disease, let alone improve and cure it. Life is beautiful, and the improvement of the quality of life depends on ourselves. Don't give up easily. If the patient has resistance to treatment, it is useless.