Allergic rhinitis is an inflammatory disease of an allergic nature, in which there is a lesion of the mucous membrane of the nasal cavity and one or more paranasal sinuses. It is manifested by a violation of nasal breathing, runny nose, sneezing attacks, headaches, as well as symptoms of damage to the bronchopulmonary system. The diagnosis is based on the data of a clinical examination by an ENT doctor and an allergist-immunologist, the study of the results of allergological tests, X-ray and endoscopic examination of the paranasal sinuses. Complex treatment: antihistamines, anti-inflammatory therapy, allergen elimination, specific immunotherapy.
ICD 10
J01.9 J32.9
General information
Allergic rhinitis (allergic rhinosinusitis) is a pathological condition caused by an allergic lesion of the mucous membrane of the nasal cavity and its paranasal sinuses, manifested by difficulty in nasal breathing, paroxysmal rhinorrhea, sneezing and other symptoms. The disease develops with a violation of the reactivity of the body, its immune system, rarely occurs in isolation and, as a rule, is accompanied by allergic inflammation of other organs and systems (pharynx and larynx, bronchi and lungs, eyes, skin).
Allergic rhinitis occurs in 10-20% of the population, more often in children, as well as in young people aged 18-24 years. In the United States of America, more than 35 million people with symptoms of allergic lesions of the nasopharynx and paranasal sinuses seek medical help annually, and the cost of their treatment is more than seven billion dollars a year. Timely referral to an allergist-immunologist and an otolaryngologist allows you to prevent complications (the transition of rhinosinusitis into a chronic form, the development of bronchial asthma, etc.).
Causes
The development of allergic rhinitis is often due to a hereditary predisposition (increased reactivity of the immune system to stimuli with the development of an IgE-dependent allergic reaction). In this case, it is possible to detect the presence of allergic conditions (rhinitis, atopic dermatitis, bronchial asthma) in the patient’s relatives.
The main cause of allergic rhinitis is the effect on the mucous membrane of the nasopharynx and paranasal sinuses of plant allergens (pollen of flowering herbs and trees), pathogens, household dust and various chemicals contained in the inhaled air (including household chemicals, tobacco combustion products, etc.). Among the possible causal factors, food and drug allergens should also be taken into account. Gorenje and medicinal allergens.
Allergic rhinitis often develops with prolonged inhalation exposure to various irritating substances at work associated with occupational hazards (coal miners, drillers, workers of foundries, chemical and pharmaceutical enterprises, painters, etc.).
Pathogenesis
Allergens, first entering the respiratory tract, cause sensitization (increased sensitivity) of the mucous membrane of the nasal cavity and paranasal sinuses. With repeated penetration of the same allergen, an inflammatory IgE-dependent reaction develops with infiltration of the nasopharyngeal mucosa. The resulting swelling of the mucous membrane makes it difficult for the sinuses to communicate with the nasal cavity and causes the development of allergic rhinosinusopathy, which quickly turns into a chronic form. With a prolonged course of the disease, increased reactivity begins to develop not only on incoming allergens, but also on any substances irritating the mucous membrane of the nasopharynx.
Classification
According to the nature of the appearance of symptoms and their duration, several forms of allergic rhinitis are distinguished: acute episodic, seasonal and year-round (persistent):
- Acute rhinosinusitis. Acute and rapidly passing symptoms of allergic inflammation of the nasal cavity and paranasal sinuses are observed with episodic (rare) contact with inhaled allergens (more often these are animal and bird waste products that enter the respiratory tract accidentally, once).
- Seasonal rhinosinusitis. Allergic rhinosinusopathy is characterized by the appearance of typical symptoms of nasopharyngeal lesions during the flowering period of plants.
- Persistent rhinosinusitis. It manifests itself at least nine months a year.
Symptoms
Characteristic signs of rhinosinusitis are difficulty in nasal breathing, paroxysmal copious discharge of mucous watery secretions from the nasal passages and sneezing attacks. At night, sneezing decreases, and nasal congestion increases. Often a feeling of heaviness in the head and in the paranasal region bothers.
In the chronic course of allergic rhinosinusopathy, headache can bother almost daily, increasing when the head is tilted down. Infection of the mucous membrane of the upper respiratory tract leads to the development of an acute inflammatory process in the sinuses (the maxillary sinuses and cells of the lattice labyrinth are more often affected). At the same time, symptoms of a violation of the general condition appear with an increase in body temperature, chills, general weakness, sleep and appetite disorders, irritability, mood fluctuations.
Complications
Increased reactivity of the immune system with the development of hypersensitivity in response to the penetration of allergens is a common reaction of the body, which often leads to the generalization of the process and the appearance of foci of allergic inflammation in other organs and tissues. At the same time, along with allergic rhinosinusopathy, there are often symptoms of damage to the bronchopulmonary system – cough with difficult-to-separate sputum, a feeling of lack of air, suffocation (with bronchial asthma). On the skin, the appearance of foci of recurrent urticaria, atopic dermatitis can be detected.
Diagnostics
To detect allergic rhinosinusopathy, an initial clinical examination of the patient by an allergist-immunologist and ENT doctor is necessary. At the same time, anamnesis, rhinoscopy data, instrumental examination, allergological tests are studied. When examining the nasal cavity during the period of exacerbation, there is swelling of the lower nasal conchs, often of the middle nasal passage, mucous or mucopurulent discharge. With a chronic process, polypous growths in the nasal passages and sinuses are often found.
Radiography of the paranasal sinuses reveals the presence of parietal thickening of the mucous membrane, an unstable decrease in the transparency of the sinus, and with chronic allergic rhinosinusopathy and the presence of polyps, persistent darkening of the sinus. Diagnostic puncture of the sinus allows you to clarify the nature of the flushing fluid (with an allergic process, it is clean, without signs of purulent inflammation). The diagnosis of allergic rhinosinusopathy is confirmed by positive allergological tests (skin allergy tests, study of specific immunoglobulins). Differential diagnosis is carried out with viral and bacterial rhinosinusitis, vasomotor rhinitis.
Allergic rhinitis treatment
Treatment of allergic rhinitis includes the elimination of allergens, drug therapy using intranasal glucocorticosteroids and antihistamines, as well as specific immunotherapy.
- Elimination measures, that is, ensuring the maximum reduction of contact with allergens, are carried out with seasonal rhinosinusopathy by limiting the time spent outdoors, using air conditioning systems. The main fight against household and household allergens (dust, insects, animal waste products, mold fungi) is carried out with the help of regular cleaning of residential premises, maintaining sufficient humidity in the rooms.
- Drug therapy of allergic rhinosinusopathy involves the use of local (intranasal) glucocorticosteroids (beclomethasone, budesonide, fluticasole, mometasone), second- and third-generation antihistamines (cetirizine, loratadine, fexofenadine, desloratadine), cromones (cromoglycic acid).
- Specific immunotherapy is an effective method of treating allergic lesions of the upper respiratory tract. With ASIT, the paranteral administration of gradually increasing doses of the allergen is carried out (the administration scheme is drawn up individually). The duration of specific immunotherapy for allergic rhinosinusopathy can range from several months to 3-4 years.
With pronounced pathology of the paranasal sinuses and hypertrophy of the nasal concha, ineffectiveness of conservative treatment, surgical intervention can be performed.
Prognosis and prevention
Timely detection and properly selected treatment of allergic rhinitis allows you to eliminate the symptoms of the disease and prevent the appearance of complications. With the development of concomitant allergic diseases, the question of changing the place of residence or profession may arise. The preventive direction is to exclude contacts with potential allergens and occupational hazards. At the first signs of respiratory allergy, a comprehensive allergological examination is necessary.
Literature
- Casale T. B. Allergic rhinitis/asthma interrelationships // Clin Rev Allergy Immunol. 2001 Aug;21(1):27-49.
- Bousquet J. et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen) // Allergy. — 2008; 63 (86): 8-160.
- Kay A. B. Allergy and allergic diseases (part 1) // N Engl J Med. — 2001, 344:30-37.
- Lee M. S., Pittler M.H ,Shin B.C., Kim J.I., Ernst E. Acupuncture for allergic rhinitis: a systematic review // Ann Allergy Asthma Immunol. — 2009; 102(4): 269-279. link
- Schoenwetter W. F. et al Economic impact and quality-of-life burden of allergic rhinitis // Curr Medres Opin. — 2004: 20: 305-317.link
