Allergic rhinitis, also known as allergic rhinitis, is an allergic disease of nasal mucosa, which can cause various complications. The other type, which is induced by nonspecific stimuli without specific allergens, is not an immune reaction process, but its clinical manifestations are similar to the above two types of allergic rhinitis, and it is called vasomotor rhinitis or neuroreflex rhinitis. Stimulation can come from in vitro (physical and chemical aspects) or in vivo (endocrine and mental aspects), so some people regard it as allergic rhinitis, but because there is no antigen-antibody reaction, desensitization therapy, hormones or.

Etiology: Allergic rhinitis can occur at any age, both men and women, and it is common in young people. Typical symptoms are itchy nose, paroxysmal sneezing, a lot of runny nose and stuffy nose.

Visit guide:

1. Understand the etiology of allergic rhinitis and avoid contact as much as possible.

(1) Inhalable allergens: such as indoor and outdoor dust, dust mites, fungi, animal fur, feathers, cotton tidbits, etc. This often causes perennial attacks; Plant pollen causes seasonal attacks.

(2) Food allergens: such as fish and shrimp, eggs, milk, flour, peanuts, soybeans, etc. In particular, some drugs, such as sulfonamides, quinine, antibiotics, etc., will cause disease.

(3) Contacts such as cosmetics, gasoline, paint and alcohol.

2, when necessary, can do nasal secretion smear examination, allergic provocation test, etc.

3. Desensitization therapy.

4. Drug therapy: including 1. Antihistamine drugs: This kind of drugs include cimetidine, chlorpheniramine and so on. Sodium cromoglycate, 3. Ketotifen, 4. Local application of steroid hormones, such as Burke's sodium and Raynaud, has better effect.

5. Microwave and laser can be used for local treatment to reduce the sensitivity of nerve endings, which is partly effective.

6. Surgical treatment: pterygoid neurotomy or superficial petrosal neurotomy to reduce the excitability of parasympathetic nerve. The latest treatment methods include plasma therapy, please refer to the topic of allergic rhinitis.

allergic rhinitis

For more than a year, my father often has a lot of runny nose when he gets up in the morning, but not much at ordinary times. Occasionally there will be a little bloodshot. I don't know what to do.

Dr Julia, Department of Otolaryngology, Shanghai Changzheng Hospital

The point of this matter can be regarded as allergic rhinitis. To put it mildly, it's nothing. Winter should be common, but summer is generally ok, right? Because the climate in winter is dry, the nasal mucosa will bleed a little at night because of dryness.

allergic rhinitis

I am 28 years old and have been suffering from allergic rhinitis and asthma for more than ten years. There is nothing wrong with asthma now, but rhinitis is really annoying. Always stuffy and runny nose. If you can't get it, you still have insomnia, headache and irritability. It is especially serious when inhaling dust for hygiene. I sneezed dozens of times in a row and my eyes cried. Sometimes it affects work. I have been to many hospitals, used many medicines, such as Biyankang, Biyankang drops, Baiqian Biyan tablets, and also treated with laser and cauterization. But it didn't work at all. I started inhaling with Berkner a year ago, inhaling four times a day and spraying twice each time. It worked well for a while, but it was abandoned after a cold and returned to the old style. Excuse me, Dr. Ye, is there any good way to treat my problem?

Dr Julia, Department of Otolaryngology, Shanghai Changzheng Hospital

Allergic rhinitis is caused by your allergic constitution, which can't be cured in theory, but it can be controlled if the medicine is used properly. Berkner This medicine is specially used to treat allergic rhinitis with asthma, so you used the right medicine. In addition, Qin Xin granules and other traditional Chinese medicine granules can also be used as conditioning. If you find the right medicine, use it. If it's useless, find a new medicine. Fortunately, new drugs for allergic patients come out almost every year.

Talking about allergic rhinitis

A mother wrote that her son 18 is a senior three. At the turn of spring and summer every year, people suffer from allergic rhinitis, often sneezing, a lot of runny nose, and stuffy nose at night, which is difficult to spread. My son has been suffering from allergic rhinitis since he was 3 years old. As he grew older, his symptoms became more and more serious. He received medication this year, but now many drugs are ineffective. She is worried that her son's allergic rhinitis attack will seriously affect the preparation for the college entrance examination, and she is very anxious, hoping to tell her the cause of allergic rhinitis and the ways to alleviate it. After receiving her letter, I wrote back and told her that we should do more household cleaning before and after the Spring Festival, keep the air circulation at home in winter, and then cut off the connection with the cause of allergic rhinitis. This may reduce the attack of allergic rhinitis and do more physical activities to alleviate the symptoms of rhinitis.

Allergic rhinitis is also called allergic rhinitis in medicine. Why can allergic rhinitis occur? Let me start with the physiological function of the nose:

First, the physiological function of the nose

The nose is a passage for air to pass in and out, and its main function is to filter, moisten and heat the inhaled air, so as to remove particles with a diameter greater than 10UM. However, even substances as small as 2UM can be filtered out when passing through the nasal cavity. Generally speaking, the bigger and heavier the particles are, the faster they are filtered and deposited on the nasal mucosa. In addition, the nose has special olfactory nerve to provide sense of smell. The response of nasal mucosa to external stimuli is mainly manifested in four aspects: obstruction of airflow caused by nasal congestion, runny nose, sneezing and nasal itching caused by increased secretion of nasal mucosa. ① Nasal congestion is caused by mucosal congestion and edema, increased mucus secretion or adenoid hyperplasia; ② When local nerve endings are stimulated, the central nervous system will reflexively cause sneezing; ③ Increased secretion, runny nose and sneezing are simple and important nasal reflexes. Any stimulation to the nasal mucosa, including allergic, autonomic and psychological factors, will cause runny nose and sneezing, which will help to eliminate foreign bodies. ④ Nasal itching is caused by inflammatory mediators, such as histamine released by mast cells and basophils.

In addition, S-IgA secreted by nose can inactivate virus, and its solution can prevent bacteria from invading. If microorganisms have invaded, they are mainly eliminated by phagocytosis and immune response.

Second, the causes of allergic rhinitis

It is known that allergic rhinitis is caused by allergic children's contact with allergens, mainly inhalation allergens (such as dust mites, fungi, pollen, etc.). ) and specific IgE that has been combined with mast cells, eosinophils, platelets and other cells, so that these cells release solid media, thus causing nasal mucosa inflammation. The inflammatory process includes the infiltration of inflammatory cells, eosinophils and neutrophils, the release of primary and secondary solid media such as histamine, LTS and PG, and the early and late reactions caused by the activation of eosinophils. The local tissue showed vasodilation, edema and increased secretion of soft tissue of nasal mucosa. Dust mites, animal dander and food are the most common allergens that induce nasal allergy within one year old, and pollen is generally induced after three years old. The mites in house dust are extremely faecal in beds, dead corners of houses, carpets and other places. Children crawl on the bed or carpet and inhale a lot of allergens to induce or aggravate the disease. Babies often catch a cold in winter, which is probably allergic rhinitis caused by dust mites. Animal dander and saliva indoors can induce allergic symptoms, and animal-related allergens will still play a role indoors even after animals are removed for up to 6 months. In infants and young children, food-induced nasal allergic reactions are most common, among which eggs and milk are the most common. However, eating allergic foods, in addition to causing nasal allergic symptoms, is generally accompanied by other organ system symptoms, such as measles, swelling of face and lips or bronchospasm. People who only have symptoms of nasal allergy are rarely induced by food. In addition to pollen, there are also some irritants that will aggravate the symptoms of allergic rhinitis. These irritants include perfume, smoke, paint, newspaper ink, deodorant or other sprays, and pollutants in the air (sulfur dioxide, carbon monoxide, nitrogen dioxide, ozone, etc.). ).

Third, classification

From the duration of onset, allergic rhinitis is often divided into the following categories:

1, seasonal rhinitis. Pollen is the most common cause, and the types of pathogenic pollen vary with time and place, usually in spring and/or autumn. Fungi is another important reason. This kind of rhinitis is characterized by acute onset, severe symptoms, paroxysmal sneezing, itchy nose, a large number of watery nose and stuffy nose. Often accompanied by conjunctivitis, sometimes accompanied by measles and asthma.

2, perennial rhinitis. The so-called perennial, refers to the symptoms last for more than 9 months every year, mostly caused by indoor allergens, such as dust mites or their feces. Although the symptoms are perennial, when mites breed, patients will get worse, and the severity of symptoms varies from day to day. Generally, it is the heaviest in the bedroom, because there are the most dust mites. Nasal congestion leads to nasal congestion at night and sneezing all the time in the morning. Things often get worse when children play with pillows or touch other dusty bedding. Animals at home, especially cats and dogs, are another important cause of perennial rhinitis. Perennial rhinitis rarely sneezes in the morning, and there are few symptoms of conjunctivitis. Perennial rhinitis can also be aggravated seasonally, which is probably the reason why patients are allergic to indoor and outdoor allergens at the same time.

3, intermittent rhinitis. Occasionally contact with allergens, such as contact with dust storage room, study room, or contact with other people's cats and dogs, leads to sudden attacks and intermittent attacks. Nasal mucosa is an extension of nasal mucosa. Therefore, any allergic inflammation of the nose can spread to the sinus. In the past, it was thought that the sinus developed late, so there were fewer complications in infants. But in fact, ethmoid sinus and maxillary sinus can be seen when the fetus is three or four months old, and they already exist at birth. Frontal sinus can be seen 6 ~ 12 months after birth, and sphenoid sinus appears later, about three years old. Therefore, sinusitis may occur over 1 year. Because of the small sinus outlet and poor drainage, it is easy to get secondary infection.

Fourth, the incidence and clinical manifestations

The disease can occur at any age, including infancy, and most patients appear before the age of 20. This is a common disease. According to domestic and foreign literature reports, as many as 10% children and 20% teenagers suffer from perennial rhinitis, most of which are allergic. About 75% children with asthma also have this disease. Because patients with nasal congestion have to breathe through their mouths, they inhale more allergens directly from their mouths, which makes asthma worse. There is no gender difference in the incidence of allergic rhinitis. Its pathogenesis is related to genetic factors, environmental factors and allergen exposure.

Sneezing, itchy nose, runny nose and stuffy nose are the four most common symptoms. Sneezing is the most important thing in the morning and when you wake up. Older children sneeze more than five times at a time. When the nasal congestion is serious, open your mouth and breathe. Because nasal mucus flows to the nasopharynx at night, it causes repeated cough, so you should clear your throat. Nasal congestion often changes with the change of body position. For example, lying on the left side leads to left and right nasal congestion, while lying on the right side leads to right and left nasal congestion, which is a characteristic manifestation of rhinitis. It can be seen that children constantly wipe the front of the nose with their fingers or palms, which is called "allergic modification". There are a few children who often make strange actions such as crooked mouth and shrugged nose because of itchy nose. Older children complain of a lack of sense of smell. Snuff is clear as water, and it can also be thickened by nasal congestion or secondary infection. Children can also see gray-blue annular shadows and wrinkles under the orbit, which are called "allergic coloring" or "Dennie—Mergan suborbital wrinkles". This is caused by edema around the orbit and venous congestion, and it is also a characteristic manifestation of atopic children's eye and nose allergy. Comprehensive eye symptoms, including itchy eyes, are more common in animal allergens and seasonal pollen, and children often have a family history of allergic reactions.

Internal examination of nasal cavity shows turbinate edema, often called white or purple, covered with a thin layer of watery mucus. In severe cases, swollen turbinates can completely block the nasal passages.

V. Treatment of degenerative rhinitis

Non-drug therapy

1, avoid allergens and irritants. Children spend more than half their time in the bedroom, so we should change the indoor environment, remove animals, clean furniture, do not lay carpets, do not buy plush toys, and reduce pathogenic allergens and irritants. Air conditioning is especially useful for people with pollen allergy. Windows can be closed all summer to prevent pollen from entering, and dry air will aggravate nasal congestion in winter. The relative humidity should be kept at about 40%-50%. If it is caused by a certain food, it is necessary to completely avoid contact with food.

2, steam inhalation or salt water atomization inhalation. Steam can temporarily relieve nasal congestion and increase airflow. Normal saline can dilute viscous secretions, improve the sense of smell, remove allergens in the nose and relieve symptoms, and also reduce the blood flow in the nose, thus playing the role of a mild blood-lowering drug. Both can prevent dry mouth.

3. Exercise. Exercise can reduce nasal airway resistance and enhance physical fitness.

(2) drug therapy

For many patients with allergic rhinitis, it is not enough to use only one drug to eliminate symptoms, but also need a variety of treatment methods. Antihistamines are the first choice, which can inhibit sneezing, itchy nose and runny nose caused by histamine. Congestive agents, such as pseudoephedrine and metazoline, should be supplemented for nasal congestion. If it is chronic, because the local mucosa has been inflamed (allergic inflammation), anti-inflammatory drugs should be used, and topical corticosteroids can reverse the existing inflammation. Sodium cromoglycate can prevent nasal symptoms. Generally speaking, it is not recommended to inject corticosteroids into the turbinate because there are some reports that there is a risk of vision loss.

(3) Other therapies

1, immunotherapy. Originally called desensitization therapy, it was later found that the body of effective cases would undergo immunological changes after treatment. Caused by a small amount of pollen, other methods are ineffective and can be applied to strictly selected patients. Immunotherapy is not to cure allergic rhinitis, but to obviously improve the symptoms of 80%-85% patients. Children under 5 years old are prone to skin complications due to continuous injection and should not be used.

2. Surgical treatment. Surgical resection is not a radical method for this disease, but it can be used as an auxiliary treatment, such as nasal septum distortion. The effect of cryotherapy is also temporary.

3. Chinese medicine therapy. Acupoint sticking therapy is an external therapy that combines acupuncture points with drugs and gives full play to the specificity of acupuncture points and drugs. This method is simple, effective and widely used in clinic. The basic prescription of medicine is Xiaochuan ointment. The timing of treatment is based on the principle of "treating winter diseases in summer", with three times as a course of treatment in early summer, middle summer, late summer (dog days) or Xia Hou every 10 day/kloc-0. We need to hold on 1-3 years. The mechanism is that the application therapy mainly regulates the immune function and endocrine function of the body, and has certain anti-inflammation, reduces airway hyperresponsiveness and improves lung function, thus preventing and alleviating the symptoms of allergic rhinitis.

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