Allergic rhinoconjunctivitis is a lesion of the nasal mucosa and conjunctiva that occurs due to contact with a causally significant allergen and is characterized by the development of an IgE-mediated reaction of the first type. The main manifestations are the presence of mucous discharge from the nose, difficulty nasal breathing, itching and burning in the nasal cavity, lacrimation and redness of the conjunctiva, decreased sense of smell. Treatment: allergen elimination, use of antihistamines, corticosteroid hormonal agents, mast cell stabilizers and vasoconstrictors, allergen-specific immunotherapy.
ICD 10
J30.2 J30.3 H10.1
General information
Allergic rhinoconjunctivitis is a chronic inflammatory disease of allergic etiology, in which the mucous membrane of the nasal cavity and the conjunctiva of the eye are affected. Depending on the etiological factor leading to the development of the disease, there are two forms: seasonal (intermittent) and year-round (persistent). The prevalence of the disease is growing every year, currently it occurs in every 5-7 th adult inhabitant of the planet and in every 3rd child. Prolonged chronic course increases the risk of developing rhinosinusitis, chronic otitis media and bronchial asthma, significantly restricts social communication, creating difficulties for successful education and professional activity.
Causes
The list of allergens that can cause the development of allergic rhinoconjunctivitis is quite extensive. For the seasonal form of the disease (occurs mainly in the spring-summer period) these are plant pollen allergens that appear during certain periods coinciding with the flowering of trees, meadow and weeds. Clinical manifestations increase in dry hot weather and decrease on rainy days with high humidity of the surrounding air.
In the year-round (persistent) form of the disease, the main allergens that lead to the development of an inflammatory process in the nasal cavity and on the conjunctiva of the eye are mold fungi, house dust mites, as well as aeroallergens that affect the patient’s body during his professional activity.
Pathogenesis
The mechanism of development of allergic rhinoconjunctivitis is based on an IgE-mediated reaction of an immediate type. At the first contact with the allergen, there is a pronounced release of class E immunoglobulins specific to this protein component. Repeated ingestion of the allergen into the body and its interaction with IgE leads to a massive release of inflammatory mediators and the development of a pathological process on the mucous membranes of the nasal cavity and eyes. With a persistent form, inflammation persists almost constantly even in the absence of direct contact with a causally significant allergen or when it is received in minimal concentrations.
Classification
Depending on the frequency of exacerbation, there are intermittent (seasonal) and persistent (year-round) forms of the disease. According to the severity of the course, there are:
- a mild form of allergic rhinoconjunctivitis (symptoms are minor, do not interfere with performance, if necessary, you can do without medication)
- moderate form (sleep and daytime activity are disrupted, the quality of life decreases)
- severe form (impaired performance and communication problems are noted, constant supportive treatment is necessary to eliminate the symptoms of the disease).
Symptoms of allergic rhinoconjunctivitis
The clinical picture differs with seasonal and year-round forms of the disease. The intermittent variant is characterized by the sudden appearance of copious watery discharge from the nose, sneezing attacks, lacrimation, itching in the nasal cavity and in the eye area, photophobia, periodic nasal congestion. Symptoms develop in the spring-summer period and intensify in dry hot weather.
With a persistent form, signs of the disease are present almost year-round, but have a less pronounced character in comparison with the seasonal form. There is a constant nasal congestion, which increases at night, thick mucous discharge from the nose and periodic sneezing attacks. As a rule, there is a decrease or absence of sense of smell (anosmia) and the presence of secretions from the eyes in the form of mucous filaments. Often the disease is complicated by the development of chronic rhinosinusitis and bronchial asthma. Exacerbations of the disease are associated with weather factors (hypothermia, sudden temperature changes), as well as with housing conditions and contact with pets.
Diagnostics
The diagnosis is established on the basis of a thorough history collection, clinical examination of the patient by an otorhinolaryngologist, ophthalmologist and allergist-immunologist. Examination of the nasal cavity reveals pallor and swelling of the mucous membrane, as well as the presence of abundant watery secretions. During laboratory examination of the secret, an increased content of eosinophils is determined. During ophthalmological examination, hyperemic, edematous and loosened conjunctiva is visible. There is the presence of stretching mucous filaments, an increase in follicles, hyperemia and swelling of the eyelids. In severe cases, blepharospasm is detected.
In the process of diagnosis, laboratory tests and tests used in clinical allergology are prescribed. Skin testing is carried out with the main atopic allergens (household, fungal, epidermal), carried out in the form of intradermal and scarification tests. As for testing with inhaled allergens, they are not recommended for skin allergy tests in accordance with the recommendations of European allergists. Reliable data on the causal relationship of allergic rhinoconjunctivitis with specific allergens can be obtained by determining allergen-specific IgE immunoglobulins (detection of up to 120 allergens in one blood sample during the Allergochip test). The results obtained can be further used in the appointment and conduct of allergen-specific immunotherapy.
Differential diagnosis is carried out with other types of allergic lesions, viral, bacterial and chlamydial rhinoconjunctivitis, rhinosinusitis, ocular “office” syndrome and other diseases.
Treatment of allergic rhinoconjunctivitis
The basic principles of the treatment of allergic rhinoconjunctivitis include the elimination of allergens, pharmacotherapy and allergen-specific immunotherapy. To maximize the elimination of contact with potential and causally significant allergens in the seasonal form of the disease, it is necessary to limit the period of outdoor exposure, especially in areas of intense flowering of grasses and trees, as well as in dry hot weather. In the year-round form, special attention is paid to the elimination of household allergens in the living room (regular cleaning and airing of rooms, the use of modern vacuum cleaners and air purifiers, the destruction of domestic ticks and cockroaches, the rejection of pets and birds).
Drug treatment for allergic rhinoconjunctivitis includes the use of antihistamines for oral and topical use, glucocorticosteroids in the form of intranasal sprays and eye drops, mast cell membrane stabilizers and vasoconstrictors. Sometimes the use of m-holinoblockers, antileukotriene drugs and immunomodulators is practiced. In each case, the optimal method of pharmacotherapy is selected, taking into account the form of rhinoconjunctivitis, the severity of its course, the presence of concomitant diseases, the age of the patient and the risk of possible side effects.
The principle of using allergen-specific immunotherapy is based on the introduction of an allergen to the patient that caused the development of allergic rhinoconjunctivitis. The administration begins with minimal doses, and then gradually increases the concentration in order to reduce the sensitivity of the body. Immunotherapy for a long time (at least 1-3 years) is carried out by an allergist in a medical institution where conditions are created for the provision of qualified emergency care in case of adverse reactions and complications. When used correctly, allergen-specific immunotherapy is a highly effective method of treating various allergic diseases.
