Allergic rhinitis – a disease which develops as a result of contact of allergens from a mucous cavity of a nose. Main symptoms of a disease: an itch in a nasal cavity, sneezing, the complicated nasal breath, mucous allocations from a nose. Within diagnostics of the reasons of allergic rhinitis consultations of experts (the allergist-immunologist, the otolaryngologist), skin tests, definition of the general and specific IgE (allergologichesky panels), a rinoskopiya are held. Treatment by antihistaminic medicines, intranazalny glucocorticoids or the termination of an exposition of allergen leads to bystry disappearance of symptoms of a disease.
Allergic rhinitis – inflammatory reaction of a mucous membrane of a nose to effect of allergen, manifestation of a pollinoz. Can proceed seasonally or all the year round. It is shown by a congestion, puffiness, an itch and tickling in a nose, the plentiful expiration of slime, sneezing, dacryagogue, decrease in sense of smell. The long current can lead to development of allergic sinusitis, polyps in a nose, otitis, nasal bleedings, permanent violation of sense of smell, bronchial asthma.
Allergic rhinitis is widespread. According to various data, from 8 to 12% of all inhabitants of Earth suffer from this form of an allergy. Usually develops at young age (10-20 years). At advanced age expressiveness of manifestations can decrease, however completely patients, as a rule, do not recover.
Classification of allergic rhinitis
Allocate two main forms of a disease:
- Seasonal allergic rhinitis. The most common form. Usually demonstrates at young age. Symptoms of a disease appear in a certain season and are most often caused by contact with pollen of certain plants.
- Year-round allergic rhinitis. Women of mature age suffer mainly. Symptoms of a disease are expressed for all year or periodically arise regardless of a season. The disease is caused by allergens which constantly are present at the environment.
The contributing factors and the reasons of development
Usually allergic rhinitis develops at people with hereditary predisposition to allergic diseases. Bronchial asthma, an allergic small tortoiseshell, diffusion neurodermatitis and other atopic diseases which suffered one or several family members is often mentioned in family history of patients.
The most frequent reason of development of seasonal rhinitis of an allergic etiology – pollen of herbs (family marevy, slozhnotsvetny, cereal) and trees. In certain cases seasonal allergic rhinitis is caused by disputes of mushrooms. Quite often patients believe that the disease is caused by poplar down. However, actually rhinitis is usually provoked by pollen of plants which blossoming coincides on time with the advent of poplar down. Seasonality of an annual demonstration of a disease depends on climatic features of the region and from year to year practically does not change.
Year-round allergic rhinitis arises at continuous contact with parts of epidermis of animals, various chemical compounds and household dust which contains micropincers.
Symptoms of allergic rhinitis
The long attacks of sneezing arising in the mornings and at the time of contact with allergen are characteristic of allergic rhinitis. Because of an ongoing itch patients constantly scratch a nose tip from what over time on a nose back the cross fold sometimes appears. The constant congestion of a nose at development of allergic rhinitis leads to the fact that patients breathe mainly through the mouth. Allergic rhinitis is accompanied separated from a cavity of a nose of watery character, by dacryagogue and unpleasant feelings in eyes. Chronic stagnant processes lead to decrease in sense of smell and loss of flavoring feelings.
Mucous nose cavities at allergic rhinitis pale and friable. Hyperaemia and a peeling of skin in nostrils is not observed. Reddening of a conjunctiva is in certain cases noted. Changes of a throat are not characteristic of this disease, but insignificant or moderate hyperaemia is sometimes noted.
Year-round allergic rhinitis often is complicated by the secondary infection caused by obstruction of additional bosoms because of hypostasis of mucous. Development of otitis or sinusitis is possible. At seasonal rhinitis similar complications arise extremely seldom. At the long course of a disease polyps of a mucous nasal cavity which cork openings of additional bosoms even more quite often develop, complicating breath and making heavier the course of the accompanying sinusitis.
Diagnosis of allergic rhinitis
In the course of diagnosis of seasonal allergic rhinitis detailed collecting the anamnesis is of great importance. The periodic demonstration of symptoms of a disease connected on time with the period of blossoming of certain trees and herbs is celebrated.
At diagnosis of year-round allergic rhinitis anamnestichesky data have smaller value. The frequent contact with allergen leads to the fact that symptoms of allergic rhinitis are expressed constantly therefore to establish what allergen served as a cause of illness, usually is not possible. Sometimes allergic reaction to certain irritants is shown by a number of differences in a clinical picture of a disease that allows to define character of allergen previously.
Patients with estimated allergic rhinitis have to have examination of the otolaryngologist and consultation of the allergist, and also a rinoskopiya. The simplest test allowing to define precisely the allergy reason is the skin allergoproba. The research is based on linkng of an irritant with corpulent cages. There are two types of skin tests – skarifikatsionny and punktatsionny. It is necessary to consider that in certain cases when conducting skin test the false positive result is possible.
At negative skin test and existence of the anamnestichesky data confirming an organism sensitization to allergen intracutaneous test sometimes is carried out. Reliability of result of intracutaneous test is lower because of the possible accompanying nonspecific irritation in the place of an injection.
The allergic nature of rhinitis is confirmed at detection of quantity of eosinophils in blood test and nasal dab. Increase in quantity of neutrophils in blood tests and separated from a nasal cavity testifies to a secondary infection. Carrying out the immunosorbentny analysis with a fermental tag for determination of level of the antibodies developed to certain allergens is possible.
Year-round rhinitis of the allergic nature quite often should be differentiated with usual vasomotorial rhinitis. The clinical picture of diseases has much in common, however vasomotorial rhinitis, unlike allergic develops at contact and nonspecific irritants.
In certain cases the symptoms similar to a clinical picture of year-round allergic rhinitis cause some diseases of the top airways of the infectious nature, anatomic defects, inhalation of a number of substances, constant use of medicines for treatment of cold, treatment of estrogen and β-adrenoblokator.
Prevention of allergic rhinitis
The only really effective preventive measure at allergic rhinitis – fuller elimination of contact with allergen which became the reason of development of a disease. At the allergic rhinitis caused by cells of leather of animals it is necessary to remove an animal from the house, at the allergy provoked by pollen of herbs and disputes of mushrooms change of the residence or installation of air filters indoors will be required.
Patients with the allergic rhinitis caused by dust micropincers should provide the lowered humidity of air in the apartment, to remove from the house of a portiere and carpets, to close pillows, mattresses and quilts plastic covers. All patients with allergic rhinitis are recommended to exclude contacts with the nonspecific irritating substances (tobacco smoke, pungent smells, limy dust).
Treatment of allergic rhinitis
Therapy at allergic rhinitis is defined by weight and a form of a disease. At slight allergic rhinitis appoint antihistaminic medicines (, , , etc.) or intranazalny glucocorticoids (, etc.). At heavy allergic rhinitis and a disease of moderate severity of the main therapeutic means there are intranazalny glucocorticoids in combination with medicines of antagonists of leykotriyen (, sodium) or antihistamines. At reception of antihistamines of the first generation it is necessary to consider collateral M-holinoblokiruyushchee (arrhythmia, an urine delay, a sight illegibility) and sedative effect of medicines.
The expressed congestion of a nose is the indication to purpose of vasoconstrictive medicines of local action, however to patients do not recommend to abuse medicines of this group because of danger of development of medicinal rhinitis. To patients with some forms of allergic rhinitis recommend to keep to a special diet. So, for example, patients with an allergy to pollen of a filbert have to exclude from a diet a filbert and hazelnuts, patients with allergic rhinitis, caused by birch pollen – apples, etc. The diet is caused by a possibility of cross reaction.
In the presence of contraindications to reception of medicines and insufficient effect of treatment the hyposensitization to certain allergens (ASIT) is possible. Treatment consists in maintaining under skin of the patient of gradually increasing allergen extract doses. The full course of desensitization proceeds from 3 to 5 years.
Injections of allergens are made once in 1-2 weeks. Because of danger of development of anaphylactic reaction watch the patient within 20 minutes after an injection. Local reaction to introduction which is shown in the form of consolidation or an eritema is possible. Desensitization is contraindicated at heavy bronchial asthma and a number of cardiovascular diseases.
At inefficiency of conservative methods of treatment of allergic rhinitis and its persistent current carrying out surgical intervention on nasal sinks - vazotomiya is possible. Operation is performed by chreznosovy access under local anesthesia.