Allergic rhinitis. Allergic rhinitis - Causes, symptoms and treatment. MF.

Allergic rhinitis or allergic rhinitis is one of the most common diseases with which one comes to a doctor for an allergist-immunologist. The presented article contains all the necessary information on the symptoms, diagnosis and treatment of allergic rhinitis. After reading it, you can safely say that now I know enough about allergic rhinitis. The article is intended for patients, members of their families, as well as for all who are interested in this issue.

Allergic rhinitis( allergic rhinitis) is an inflammation of the nasal mucosa, which is based on an allergic reaction. Allergic rhinitis or common cold is usually manifested by sneezing, rhinorrhea( active secretion of a watery secretion from the nose), sensation of itching in the nose, complicated by nasal breathing.

According to medical statistics, allergic rhinitis in Russia suffers from 11 to 24% of the total population.

The cause of allergic rhinitis

The basis of the disease is an allergic reaction, or to be more precise, an immediate type of hypersensitivity. This term denotes the majority of allergic processes, the symptoms of which develop from a few seconds to 15-20 minutes from the moment of contact with the allergen( the substance that causes an allergic reaction).Allergic rhinitis is part of the so-called big three allergic diseases. In addition to allergic rhinitis, it includes atopic dermatitis and allergic bronchial asthma.

Possible allergens that can cause allergic rhinitis:

• home or library dust;
• ticks, living in house dust;
• insect allergens;
• pollen of plants;
• allergens of mold and yeasts;
• some food;
• medication.

Genetic predisposition is a risk factor for allergic rhinitis.

Symptoms of allergic rhinitis

The main symptoms and signs of allergic rhinitis are as follows:

1) sneezing, often paroxysmal;
2) the presence of discharge from the nose of a watery, transparent nature. When joining a secondary infection, the nature of the discharge from the nose can change to mucopurulent;
3) itching in the nose;
4) obstructed nasal breathing is less common and typical, as a rule, for severe forms of allergic rhinitis. Nasal congestion is often worse at night.

The appearance of the patient during an exacerbation of an allergic rhinitis is characteristic. Some swelling of the face is noted, nasal breathing is difficult, the patient breathes mainly with the mouth. Eyes often red, perhaps watery eyes. Sometimes there are dark circles under the eyes. Patients with allergic rhinitis may involuntarily and often rub their fingertips with the tip of the nose. Such a symptom was called "allergic salute."

Allergic rhinitis, as a rule, for the first time manifests( manifests itself) in childhood or in adolescence. Among close relatives of the patient with allergic rhinitis, it is often possible to identify people with allergic diseases.

Depending on the intensity of the symptoms, a mild, moderate and severe degree of allergic rhinitis is isolated. If the symptoms of allergic rhinitis do not reduce performance and do not interfere with sleep, talk about mild severity;if the daytime activity and sleep moderately decrease, they speak of an average severity level, and in case of severe symptoms of a severe degree of allergic rhinitis.

Depending on the extent of the symptoms of the disease, I select seasonal( symptoms only in the spring-summer period) and year-round allergic rhinitis. Seasonal allergic rhinitis most often occurs as a result of allergy to pollen of plants, less often to spores of mold fungi.
Often, patients can themselves indicate provoking( causing allergic rhinitis) factors. It can be contact with animals, cleaning in an apartment, being in a dusty room, traveling to nature on a summer day, etc.

The trial of antihistamines often brings temporary relief.
Often the symptoms of an allergic rhinitis are combined with the rules of allergic conjunctivitis, sometimes they are precursors of bronchial asthma.

Similar symptoms, with the exception of some nuances, have almost all rhinitis, and about ten of them are known( infectious rhinitis, hormonal rhinitis, medicinal rhinitis, psychogenic rhinitis, atrophic rhinitis, professional rhinitis, etc.).Each of them requires a number of therapeutic interventions, individual treatment. Therefore, the exact diagnosis should still be given to a specialist.

As a rule, patients very long use vasoconstrictive drugs for the nose and over time the abuse of such drugs can worsen the course of the disease. Many people with allergic rhinitis have an increased sensitivity to such irritants as sharp smells, chemical household products, tobacco smoke.

What tests will have to be taken if you suspect allergic rhinitis

If you suspect a allergic rhinitis, you should immediately visit two specialists, an allergist-immunologist and ENT doctor. The allergist can accurately confirm or, on the contrary, exclude, the allergic nature of problems with the nose, and the ENT doctor will be able to identify the concomitant pathology of the ENT organs. Consultation of the "ear-throat-nose" should not be neglected, even if you are sure that you are allergic to all 100 percent, becauseoften there are associated problems( for example, allergic rhinitis and nasal pollen or allergic rhinitis and sinusitis).In this case, taking only antiallergic drugs will not be effective enough, and conducted inadequate therapy will contribute to weighting the disease.

To confirm the diagnosis, you may be asked to give a smear from the nose to eosinophils or a blood test for IgE common( immunoglobulin E common).The detection of eosinophils in the smear( more than 5% of all detected cells) or an increase in total immunoglobulin E( more than 100 IU) will indicate the allergic nature of nasal congestion.

The most important question in the diagnosis of allergic rhinitis is the identification of a causally significant allergen, i.e.the substance with which it causes the above symptoms. For this, two types of diagnostics are most often used:

1) setting of skin tests. One of the most informative and economical types of allergodiagnostics. Should only be carried out in a special room for this procedure. During the examination, the patient is made several incisions( scratches) on the skin and 1-2 drops of a specially prepared allergen are dripped from above. The reaction is evaluated within 15-30 minutes. This method has the greatest certainty, but has a number of limitations. So skin tests are not made at the time of exacerbation of the disease, they are not carried pregnant and lactating. The optimal age for this type of study is from 4 to 50 years. At least 5 days before the procedure, antihistamines are canceled( suprastin, kestin, etc.).

2) a blood test for specific immunoglobulins E( IgE-specific).This is the detection of allergens by blood analysis. This method is more convenient than skin tests. The analysis can be taken against a background of worsening and against the background of taking antiallergic drugs. It is not contraindicated neither to pregnant, nor nursing, nor to persons with widespread skin diseases. There are no age restrictions. This method has only two minuses: a fairly high cost( from 2000 to 16,000 rubles for the panel of allergens or 300 rubles for 1 allergen) and a relatively high( up to 13-20% depending on the manufacturer of reagents) the frequency of false positive results. Repeatedly I encountered cases when in children under 1 year old, according to blood tests, an allergy to seafood( crabs, shrimps, mussels, etc.) or exotic fruits was detected. At the same time, parents swore that the child did not even see such delicacies, that is, an allergy to them is impossible in principle.

Therefore, if the condition allows, it should nevertheless strive precisely for the formulation of skin tests.
Sometimes, if you are not lucky with a medical institution, you can be offered to donate blood for the reaction of leukolysis with food. At the same time it will be necessary to bring food samples for analysis. This method has an insignificantly small reliability, and it is senseless to agree to it. Results can be thrown out at once.

In addition to the above tests, if there are doubts with the doctor, you may be assigned a clinical blood test, a x-ray of the sinuses of the nose, a smear from the nose to the microflora and fungi.

Rarely suggested to undergo anterior rhinomanometry. This method allows you to determine how much the upper air passages are broken.

Treatment of allergic rhinitis

Conducting therapeutic measures, that is, treating allergic rhinitis is possible only after confirming the nature of the disease and accurately establishing its allergic nature.

Treatment of allergic rhinitis, as, indeed, and most other allergic diseases, consists of several components.
1. Reduction of allergic inflammation on mucous membranes.
2. Conducting allergen-specific therapy.

Anti-inflammatory treatment of allergic rhinitis

The anti-inflammatory treatment of allergic rhinitis is the complex application of a number of medicines.

Often for the treatment of allergic rhinitis, antihistamines are given orally in the form of tablets or drops. Preferably the use of the second drugs( cetrine, claritin, zodak, kestin) and the third( eryus, telphast, zirtek) generations. They are administered orally, at age-related dosages, once a day. The duration of treatment is determined by the doctor, but rarely is less than 14 days. Despite the fact that these drugs for allergies are dispensed in pharmacies without a doctor's prescription, you can not prescribe them yourself for a long time. This is due to the fact that some drugs have a cardiotoxic effect( a negative effect on the heart), a number of them can suppress cognitive( mental) abilities. The greatest safety profile, of course, is the products of the latest generation, but their relatively high cost is often a limiting factor, especially with prolonged use.

In case of ineffectiveness of the previous treatment for allergic rhinitis, the appointment of "local remedies" affecting specifically the nasal mucosa is required.

With mild severity of allergic rhinitis, cromoglycate derivatives( trade names - cromogexal, kromoglin, cromosol) are assigned for this purpose. The drugs are available in the form of nasal sprays, nasalachayutsya 1-2 injections( 1-2 drops) in the nose 3 times a day throughout the exacerbation. It should be borne in mind that the effect of the appointment of such treatment occurs no earlier than 5-10 days( and sometimes later).Therefore, their action is more preventive than therapeutic. Drugs of this group are more often prescribed for the treatment of allergic rhinitis in children or with mild disease severity in adults. The course of treatment of allergic rhinitis, as a rule, is not less than 2-4 months. Possible year-round use of drugs.

Separately, I would like to highlight a relatively new drug, created on the basis of plant cellulose - NAZAWAL.The drug is available in the form of a spray for the nose and is prescribed 4-6 times a day. As a result, a microfilm is created on the mucous membranes of the nose, preventing contact of the mucous with the allergen. The drug has a low enough efficiency in the already developed exacerbation and can be recommended only for the prevention of the disease.

With severe severity of allergic rhinitis, nasal corticosteroids( aldecine, nasobek, baconase, nazonex, floxonase, nazarel, benorin) are the drugs of choice. They are available in the form of sprays for the nose. Drugs are prescribed 1-2 times a day in age-related dosages. The duration of treatment is determined by the doctor. It is very common misconception about poor tolerability and numerous side effects of intranasal glucocorticoids. To date, the safety and efficacy of these drugs has been confirmed by numerous international studies, they underlie the so-called "gold standard" for the treatment of allergic rhinitis and have helped many hundreds of thousands of patients worldwide.

A frequent mistake made in the treatment of allergic rhinitis is the prolonged use of vasoconstrictive drops to facilitate nasal breathing. These are drugs like naphthyzine, vibrocil, etc. Prolonged use of drugs of this group ALWAYS leads to the development of medical rhinitis of varying degrees, the treatment of which may require surgery on the nasal passages. The use of vasoconstrictors is advisable only with pronounced nasal congestion before using intranasal glucocorticoids, and in general it is advisable not to abuse vasoconstrictors for the nose with the established diagnosis of allergic rhinitis.

Against allergic rhinitis and for the prevention of diseases of ENT organs, as well as complications, a nose wash is used. However, most solutions for the treatment of runny nose in the form of ready-made aerosols imply a procedure for nasal irrigation, rather than for immediate rinsing. Irrigation, unlike washing, can only reduce the thick consistency of nasal secretions, but will not solve the problems with their removal along with harmful bacteria. After irrigation the mucous membrane quickly dries up, which further aggravates the rhinitis, provokes swelling.
Flushing, however, helps to reduce inflammation, improve the mucous membrane of the nose and reduce the risk of sinusitis and sinusitis. Modern methods involve the washing of the nasal passages with special antiseptic agents. For example, the components of the drug "Dolphin" get to the sinuses of the nose, diluting the clots of mucus and naturally leading them out.

Patients who do not respond poorly to conservative treatment or who have contraindications to drugs, it is advisable to discuss the possibility of conducting allergen-specific immunotherapy.

Allergen-specific therapy for allergic rhinitis

The most radical way to treat allergic rhinitis is to conduct allergen-specific therapy. This type of treatment is carried out only by trained allergists in a hospital or allergology room. The meaning of treatment consists in the introduction of small doses of the allergen in gradually increasing concentrations in order to develop tolerance towards them. The most common practice is parenteral( injectable) administration of allergens. If this type of treatment is successfully carried out, the symptoms of allergic rhinitis can be completely eliminated. Earlier initiation of treatment increases the chances of developing a full tolerance to allergens and, accordingly, a complete cure of the disease. The appearance of this method of treatment has completely cured allergic rhinitis in a number of patients.

Surgical methods of treatment in the treatment of allergic rhinitis are rarely used and only if there is concomitant ENT pathology( curvature of the nasal septum, etc.).

Adherents of homeopathic methods of treatment should pay attention to the preparation Rhinital( Germany) or rhinosennaia( Russia).

Treatment of allergic rhinitis with folk remedies.

Allergic rhinitis is one of those diseases where traditional medicine can not help. Currently, there is no known actually working method from this area that could be recommended to a wide range of patients with allergic rhinitis. An unreasonable hobby for such treatment can lead to an exacerbation of the disease, attachment of a secondary infection( which only people do not stuff into their noses and do not pour) and delay the appointment of adequate medication.

The only possible method is to wash the nose with brine.(1/3 teaspoon of salt for 1 cup of boiled water to wash your nose 1-2 times a day).But even this seemingly innocuous method MUST be combined with medical treatment. In itself, its use will be inadequate.

Features of nutrition and lifestyle in allergic rhinitis.

The most important component of the treatment of allergic rhinitis is the reduction of contact with allergens. The recommendations are made after carrying out allergological diagnosis and identifying a causally significant allergen.

By nature, allergens can be food( for various foods), household( house dust, feather pillows, house dust mites), pollen( pollen of plants), epidermal( animal hair, feathers of birds, etc.), fungal, washed, etc.

The nature of the elimination measures depends on the type of allergen.

So with food allergies, exclude those products, tests with which the patient had positive.
When pollen allergy during an exacerbation, patients are not recommended to go out of town, to nature. Leaving the house is better after 11-12 hours, when the concentration of pollen in the air decreases. It is not recommended to open windows, especially in the first half of the day. It is advisable to hang air cleaners. Do not drive in the car with the windows open. Do not use herbal preparations and cosmetics on herbs. The most radical measure is the change in the region of residence at the time of flowering.

It is proved that pollen content is lower on the sea coast and in the mountains.

For household allergies, a thorough cleaning is recommended at least three times a week. During cleaning, you need to wear a mask that prevents dust allergens from getting on the mucous membranes. Pillows, mattresses, blankets should be made from hypoallergenic materials or placed in special protective covers. It is recommended to get rid of carpets, rugs, large soft toys and other sources of dust. Instead of curtains and heavy curtains, it is preferable to use blinds, since they are easier to clean. Furniture should be made of materials that can often be wiped. A good effect is the use of air purifiers. The most common household allergen are house dust mites( about 50-60% of all cases of household sensitization).Therefore, when cleaning, it is necessary to use acaricidal drugs that destroy them. High efficiency in controlling household allergens was shown by vacuum cleaners with HEPA filters.

Allergic rhinitis in pregnancy

The occurrence of pregnancy in about 1/3 of women contributes to the aggravation or the first manifestation of allergic diseases. Usually it brings physicians and, accordingly, patients special difficulties due to the fact that most drugs and a number of methods of examination during pregnancy are not applicable.

Symptoms of allergic rhinitis in pregnant women do not differ from the classical ones. Influence on the fetus is possible only with very severe forms of the disease or with inadequate treatment.

Detection of the cause of allergy is possible only by blood tests( blood for IgE specific), skin tests at this time are contraindicated.

Treatment of allergic rhinitis in pregnancy:

Try to limit the antihistamines as much as possible because of their potential effect on the fetus. If necessary, preference is given to preparations of the third generation( telphase) in minimally effective dosages. Local treatment of allergic rhinitis begins with derivatives of sodium cromoglicate( cromogexal and similar preparations) or products based on plant cellulose( Nasaval).Nasal corticosteroids should not be prescribed in the first trimester of pregnancy.

Allergic rhinitis in children

Allergic rhinitis in children, as a rule, manifests at the age of more than 3 years, although there are exceptions. More often, allergic rhinitis occurs in children who have noted allergic manifestations in the past( usually by the type of allergic or atopic dermatitis).Such a change in the clinical manifestations of allergy: from atopic dermatitis to allergic rhinitis, and then to bronchial asthma was called atopic march.

Symptoms of allergic rhinitis in do not differ much from those of adults. Characterized by a somewhat greater prevalence of sensitization( allergic mood) to food allergens.

Treatment of allergic rhinitis in children:

In the selection of treatment try to adhere to stepwise therapy, starting selection from the more "light" and, accordingly, having a greater safety profile of drugs.

Allergen-specific therapy gives the greatest effect in childhood.

Possible complications of allergic rhinitis and

prognosis The prognosis for life is favorable. But in the absence of adequate treatment, the disease can progress, which manifests itself in an increase in the severity of the symptoms( the appearance of skin irritation over the upper lip and / or in the region of the nose, throat swelling, cough, deterioration of odor recognition, nosebleeds, headache) and in the expansion of the spectrumcause-significant allergens.

Prevention of allergic rhinitis

Specific prevention of allergic rhinitis, unfortunately, has not been developed. With the already developed disease, preventive measures are reduced to eliminating the allergen from the environment( see Features of Nutrition and Lifestyle in Allergic Rhinitis) and conducting adequate treatment.

Answers to frequently asked questions about allergic rhinitis:

I have allergic rhinitis. There are reactions to library dust. They made skin tests. Tests with cat hair are negative. Can I have a cat?

Animals are quite common causes of allergies. In addition to allergy to wool, a reaction to saliva, epidermis( the upper layer of the skin), fillers for toilets. If there is no allergy to the coat, this does not mean that there is no allergy to other "parts" of the cat. In addition, the allergy may develop later, when there is a psychological attachment to the pet. Thus, the answer is unequivocal: no. Just like you should not start dogs, fish, horses, etc.

Can allergic rhinitis be on food?

Allergy to food is extremely rare in patients with allergic rhinitis( less than 4-7 percent of cases).But a number of products( chocolate, citrus fruits, strawberries, mushrooms, sea fish, etc.) contain histamine. This substance strengthens the existing allergic inflammation. Abuse of such food in the period of exacerbation will help to increase symptoms.
In any case, if you notice a connection between your symptoms and the use of certain dishes - consult a doctor and take the appropriate examination.

Does breathing exercises help Buteyko and Strelnikova from an allergic rhinitis?

Yes. This method is effective in the complex treatment of allergic rhinitis.

I'm allergic to blooming trees( symptoms in the spring).But in the last year there were usual for an aggravation of a complaint in August. With what it can be connected? Is the climate changing?

You seem to have progression of the disease, manifested in the expansion of the spectrum of allergens. Given the time of the second exacerbation, there was an allergic mood to the pollen of composite herbs( wormwood, quinoa, etc.).Contact your doctor for treatment. The climate here is nothing to do with.