Allergic rinokonjyunktivit - it is the damage of a mucous membrane of a nose and a conjunctiva arising owing to contact with causal and significant allergen and which is characterized by development of the IgE-mediated reaction of the first type. The main manifestations – existence of mucous allocations from a nose, the complicated nasal breath, an itch and burning in nose cavities, dacryagogue and reddening of a conjunctiva, decrease in sense of smell. Treatment: allergen elimination, use of antihistaminic medicines, kortikosteroidny hormonal means, stabilizers of corpulent cages and vasoconstrictive medicines, allergen - a specific immunotherapy.
Allergic rinokonjyunktivit – a chronic inflammatory disease of an allergic etiology at which the mucous membrane of a cavity of a nose and a conjunctiva of an eye is surprised. Depending on the etiologichesky factor leading to development of a disease allocate two forms: seasonal (intermittiruyushchy) and year-round (persistiruyushchy). Prevalence of a disease grows every year, now it occurs at every 5-7th adult inhabitant of the planet and at every 3rd child. The long chronic current increases risk of development of rinosinusit, chronic otitises and bronchial asthma, significantly limits social communication, creating difficulties for successful education and professional activity.
The list of the allergens capable to cause development of an allergic rinokonjyunktivit is rather extensive. For a seasonal form of a disease (arises mainly during the spring and summer period) it is vegetable pollen allergens which appear during the certain periods coinciding with blossoming of trees, meadow and weeds. Clinical manifestations amplify in dry hot weather and decrease in rainy days with high humidity of air.
At a year-round (persistiruyushchy) form of a disease of the main allergens leading to development of inflammatory process in a cavity of a nose and on an eye conjunctiva mold fungi, pincers of house dust, and also the aero allergens influencing the patient's organism in the course of his professional activity are.
The IgE-mediated reaction of immediate type is the cornerstone of the mechanism of development of an allergic rinokonjyunktivit. At the first contact with allergen there is an expressed emission of the immunoglobulins of a class E specific to this proteinaceous component. Repeated hit of allergen in an organism and its interaction with IgE leads to massive emission of mediators of an inflammation and development of pathological process on mucous membranes of a cavity of a nose and an eye. At a persistiruyushchy form the inflammation remains almost constantly even in the absence of direct contact with causal and significant allergen or at its receipt in the minimum concentration.
Depending on the frequency of an aggravation distinguish an intermittiruyushchy (seasonal) and persistirushchy (year-round) form of a disease. On weight of a current allocate:
- easy form of an allergic rinokonjyunktivit (symptoms insignificant, do not break working capacity, if necessary it is possible to do without drug treatment)
- medium-weight form (the sleep and day activity are interrupted, quality of life decreases)
- severe form (violation of working capacity and a problem in communication are noted, the continuous supporting treatment is necessary for elimination of symptoms of a disease).
Symptoms of an allergic rinokonjyunktivit
The clinical picture differs at a seasonal and year-round form of a disease. The Intermittiruyushchy option is characterized by sudden emergence of plentiful watery allocations from a nose, attacks of sneezing, dacryagogue, itch in a cavity of a nose and in eyes, a photophobia, a periodic congestion of a nose. The symptomatology develops in the spring and summer period and amplifies in dry hot weather.
Symptoms of a disease are present at a persistiruyushchy form almost all the year round, but have less expressed character in comparison with a seasonal form. Are noted the constant congestion of a nose amplifying at night, dense mucous allocations from a nose and periodic attacks of sneezing. As a rule, decrease or lack of sense of smell (anosmiya) and existence of allocations from eyes in the form of mucous threads are observed. Quite often the disease is complicated by development of a chronic rinosinusit and bronchial asthma. Exacerbations of a disease are connected with weather factors (overcooling, sharp temperature drops), and also with living conditions and contacts with pets.
The diagnosis is established on the basis of careful collecting the anamnesis, clinical examination of the patient by the otorhinolaryngologist, ophthalmologist and allergist-immunologist. Survey of a cavity of a nose reveals pallor and puffiness of a mucous membrane, and also existence of a plentiful watery secret. At a laboratory research of a secret the increased maintenance of eosinophils is defined. At ophthalmologic survey the hyperemic, edematous and loosened conjunctiva is visible. Availability of the lasting mucous threads, increase in follicles, hyperaemia and puffiness is noted a century. In hard cases it is found .
In the course of diagnostics the laboratory researches and tests used in clinical allergology are appointed. The skin testing with the main atopic allergens (household, fungal, epidermalny) which is carried out in the form of intracutaneous and skarifikatsionny tests is carried out. As for testing with inhalation allergens, for skin allergoprob they are not recommended according to recommendations of the European allergists. It is possible to obtain reliable data about a causal relationship of an allergic rinokonjyunktivit with concrete allergens when determining allergen - specific IgE immunoglobulins (identification to 120 allergens in one test of blood at test Allergochip). The received results further it is possible to use at appointment and carrying out allergen - a specific immunotherapy.
Differential diagnostics is performed with other types of allergic defeats, virus, bacterial and chlamydial rinokonjyunktivita, rinosinusita, eye "office" syndrome and other diseases.
Treatment of an allergic rinokonjyunktivit
The basic principles of treatment of allergic rinokonjyunktivit include elimination of allergens, carrying out pharmacotherapy and an allergenspetsifichesky immunotherapy. For the maximum elimination of contact with potential and causal and significant allergens at a seasonal form of a disease it is necessary to limit the stay period in the open air, especially in places of intensive blossoming of herbs and trees, and also in dry hot weather. At a year-round form special attention is paid to questions of elimination of household allergens in premises (regular cleaning and airing of rooms, use of modern vacuum cleaners and air purifiers, extermination of domestic ticks and cockroaches, refusal of pets and birds).
Drug treatment at an allergic rinokonjyunktivit includes use of antihistamines for oral and local application, glucocorticosteroids in the form of intranazalny sprays and eye drops, stabilizers of membranes of corpulent cages and vasoconstrictive medicines. Sometimes use of m-holinoblokatorov, antileykotriyenovy medicines and immunomodulators practices. In each case the optimum method of pharmacotherapy considering a form of a rinokonjyunktivit, weight of its current, existence of associated diseases, age of the patient and risk of possible side effects is selected.
The principle of application of an allergenspetsifichesky immunotherapy is based on introduction to the patient of the allergen which caused development of an allergic rinokonjyunktivit. Introduction is begun with the minimum doses, and then gradually increase concentration to achieve decrease in sensitivity of an organism. The immunotherapy for a long time (not less than 1-3 years) is carried out by the allergologist in medical institution where conditions for rendering the qualified emergency aid in case of development of collateral reactions and complications are created. At the correct use allergen - the specific immunotherapy is a highly effective method of treatment of various allergic diseases.