The allergic rinosinusopatiya is an inflammatory disease of the allergic nature at which damage of a mucous membrane of a cavity of a nose and one or several okolonosovy bosoms is noted. It is shown by violation of nasal breath, cold, sneezing attacks, headaches, and also symptoms of defeat of bronchopulmonary system. Diagnostics is based on data of clinical examination by the ENT specialist and allergist-immunologist, studying of results of allergologichesky tests, a radiological and endoscopic research of additional bosoms of a nose. Treatment is complex: antihistaminic medicines, anti-inflammatory therapy, elimination of allergens, specific immunotherapy.
Allergic rinosinusopatiya (allergic rinosinusit) – the pathological state caused by allergic damage of a mucous membrane of a cavity of a nose and its additional bosoms, which is shown difficulty of nasal breath, pristupoobrazny rinorey, sneezing and other symptoms. The disease develops at violation of reactivity of an organism, its immune system, seldom proceeds separately and, as a rule, is followed by an allergic inflammation of other bodies and systems (a throat and a throat, bronchial tubes and lungs, eyes, integuments).
The allergic rinosinusopatiya occurs at 10-20% of the population, is more often at children, and also at young people at the age of 18-24 years. In the United States of America more than 35 million people with symptoms of allergic damage of a nasopharynx and okolonosovy bosoms annually ask for medical care, and costs of their treatment make more than seven billion dollars a year. The problem of an allergic rinosinusopatiya, its qualified diagnostics and treatment in Russia and other countries of the former USSR is not less urgent. The timely address to the allergist-immunologist and the otolaryngologist allows to warn complications (transition of a rinosinusit to a chronic form, development of bronchial asthma etc.).
Development of an allergic rinosinusopatiya is often caused by hereditary predisposition (the increased reactivity of immune system on irritants with development of IgE-dependent allergic reaction). In this case it is possible to find existence of allergic states (rhinitis, atopic dermatitis, bronchial asthma) in the patient's relatives.
The main reason for development of an allergic rinosinusopatiya – impact on a mucous membrane of a nasopharynx and okolonosovy bosoms of vegetable allergens (pollen of the blossoming herbs and trees), the pathogenic microorganisms, household dust and various chemicals which are contained in the inhaled air (including means of household chemicals, tobacco burning products etc.). Among possible causal factors it is necessary to consider also food and medicinal allergens.
Quite often allergic rinosinusopatiya develops at long inhalation effect of various irritating substances during the work connected with professional vrednost (miners-coal miners, drillers, workers of foundry shops, the chemical and pharmaceutical companies, painters, etc.).
Allergens, having initially got into airways, cause a sensitization (increase in sensitivity) of a mucous membrane of a cavity of a nose and okolonosovy bosoms. At repeated penetration of the same allergen inflammatory IgE-dependent reaction with infiltration of a mucous nasopharynx develops. The arising hypostasis of a mucous membrane complicates the message of bosoms with a cavity of a nose and causes development of the allergic rinosinusopatiya which is quickly passing into a chronic form. At a long course of disease the increased reactivity begins to develop not only on the arriving allergens, but also on any nasopharynxes of substance irritating a mucous membrane.
On the nature of emergence of symptoms and their duration allocate several forms of an allergic rinosinusopatiya: sharp incidental, seasonal and year-round (persistiruyushchy):
- Sharp rinosinusit. The sharp and quickly passing symptomatology of an allergic inflammation of a cavity of a nose and additional bosoms is observed at incidental (rare) contact with inhalation allergens (more often it is the waste products of animals and birds getting into airways incidentally, once).
- Seasonal rinosinusit. The allergic rinosinusopatiya is characterized by emergence of typical symptoms of damage of a nasopharynx during blossoming of plants.
- Persistiruyushchy rinosinusit. Not less than nine months in a year are shown.
Symptoms of an allergic rinosinusopatiya
Characteristic signs of a rinosinusit are difficulty of nasal breath, pristupoobrazny plentiful allocation of a mucous watery secret from nasal ways and sneezing attacks. At night sneezing decreases, and the congestion of a nose amplifies. Quite often the feeling of weight in the head and in okolonosovy area disturbs.
At a chronic current of an allergic rinosinusopatiya the headache can disturb almost daily, amplifying at a ducking down. Infection of a mucous membrane of the top airways leads to development of sharp inflammatory process in sine (gaymorova of a bosom and a cage of a trellised labyrinth are surprised more often). At the same time there are symptoms of violation of the general state with temperature increase of a body, a fever, the general weakness, a sleep disorder and appetite, irritability, mood swings.
The increased reactivity of immune system with development of hypersensitivity in response to penetration of allergens is the general reaction of an organism that often leads to generalization of process and emergence of the centers of an allergic inflammation in other bodies and fabrics. At the same time quite often along with an allergic rinosinusopatiya symptoms of defeat of bronchopulmonary system – cough the hardly separated phlegm, feeling of shortage of air, suffocation (meet at bronchial asthma). On skin it is possible to reveal emergence of the centers of recurrent urticaria, atopic dermatitis.
Primary clinical examination of the patient by the doctor by the allergist-immunologist and ENT specialist is necessary for identification of an allergic rinosinusopatiya. At the same time the anamnesis, these rinoskopiya, a tool research, allergologichesky tests is studied. At survey of a cavity of a nose in the period of an aggravation hypostasis of the lower nasal sinks is noted, it is frequent – the average nasal course, mucous or mucopurulent allocations. At chronic process polipozny growths in the nasal courses and sine quite often meet.
The X-ray analysis of okolonosovy bosoms reveals existence of a pristenochny thickening of a mucous membrane, unstable decrease in transparency of a bosom, and at a chronic allergic rinosinusopatiya and existence of polyps – resistant blackout of a sine. The diagnostic puncture of a bosom allows to specify character of washing liquid (at allergic process it pure, without signs of a purulent inflammation). The diagnosis of an allergic rinosinusopatiya is confirmed by positive allergologichesky tests (skin allergotesta, a research of specific immunoglobulins). Differential diagnostics is carried out with virus and bacterial rinosinusita, vasomotorial rhinitis.
Treatment of an allergic rinosinusopatiya
Treatment of a rinosinusit of allergic genesis includes carrying out elimination of allergens, medicamentous therapy with use of intranazalny glucocorticosteroids and antihistaminic medicines, and also a specific immunotherapy.
- Eliminative actions, that is ensuring the maximum decrease in contact with allergens, are held at a seasonal rinosinusopatiya by restriction of time of stay out of the room, use of air conditioning systems. The main fight against household and house allergens (dust, insects, waste products of animals, mold mushrooms) is carried out by means of regular cleaning of premises, maintenance of sufficient humidity in rooms.
- Medicinal therapy of an allergic rinosinusopatiya provides application of local (intranazalny) glucocorticosteroids (, , , ), antihistaminic medicines of the second and third generation (a tsetirizin, a loratadin, a feksofenadin, a dezloratadin), kromon (kromoglitsiyevy acid).
- Specific immunotherapy – an effective method of treatment of allergic damages of the top airways. At ASIT paranteralny introduction of gradually increasing allergen doses is carried out (the scheme of introduction is formed individually). Duration of carrying out a specific immunotherapy at an allergic rinosinusopatiya can make from several months to 3-4 years.
At the expressed pathology of okolonosovy bosoms of a nose and a hypertrophy of nasal sinks, inefficiency of conservative treatment surgical intervention can be carried out.
Forecast and prevention
Timely identification and correctly picked up treatment of an allergic rinosinusopatiya allows to eliminate symptoms of a disease and to prevent emergence of complications. At development of the accompanying allergic diseases there can be a question of change of the residence or a profession. The preventive direction consists in an exception of contacts with potential allergens and professional vrednost. At the first symptoms of a respiratory allergy comprehensive allergologichesky inspection is necessary.