What is allergic rhinitis?

Allergic rhinitis is one of the forms of the local abnormal reaction of the body with high sensitivity to various types of allergenic agents, in which the characteristic symptoms of allergic rhinitis appear in the form of nasal congestion, sneezing, mucus, itching.

Features:

  1. Manifestations of the disease are reversible and able to regress after the cessation of allergens or with ongoing treatment.
  2. Therapy of the pathology is difficult, because, firstly, the complete exclusion of contact with the allergen under normal conditions is impossible, and, secondly, almost all patients are diagnosed with abnormal sensitivity to several allergens at once - polyvalent sensitization.
  3. Today in the definition of allergic rhinitis in medicine there are different terms: allergic, vasomotor rhinosinusopathy, rhinopathy.
  4. In the international classifier, allergic rhinitis code of 10 mcb is indicated by the general index J30, and its types are additionally digitally encoded. So, rhinitis, provoked by pollen of flowering plants, has the code J30.1, seasonal - J30.2, arising for other reasons - J30.3.

Pathology is classified primarily in two basic forms: seasonal and year-round allergic rhinitis.

In addition, two forms of rhinitis are isolated according to the course of the disease:

  1. Intermittent: all symptoms bother the patient less than 4 days in 7 days and generally no longer than 4 weeks per year.
  2. Persistent: manifestations are observed more than 4 days during the week and longer than 4 weeks in 12 months. As a rule, symptoms develop with sensitivity to ticks, cockroaches, dust, urine and dandruff of animals, and persist for more than 2 hours a day or at least 9 months a year.

Severity classification:

  • mild course: there are weak manifestations of the disease, night's sleep is stable, daytime activity persists, symptoms are weak and quickly go away without treatment;
  • moderate or moderate severity: the duration and severity of manifestations are increased, the symptoms are stopped with the help of drugs, sleep is disturbed, performance is impaired, the quality of life is deteriorating;
  • severe form: all signs are intense, are eliminated only with the help of strong pharmacological agents, activity is disturbed during the day, the patient is not able to work normally, sleep at night and rest in the daytime.

Causes of an Allergic Cold

The reasons for which allergic rhinitis develops are not fully defined, there are only reliable hypotheses based on medical practice and statistics.

It is believed that the acute response of the body to irritating agents is due to the influence of adverse environmental factors, toxic substances in the air, the use of a large number of pharmacological agents, the presence of antibiotics in foods, and the use of chlorinated water for drinking.

Common causative factors leading to the development of allergic rhinitis include:

  • hereditary factor;
  • decreased local and general immune defense;
  • the duration or frequency of contact with a concentrated accumulation of allergens;
  • increased permeability of mucosal cells;
  • uncontrolled or long-term use of antibiotics;
  • metabolic disorder;
  • increased blood viscosity;
  • proliferation of polyps in the sinuses and chambers of the nose;
  • frequent diseases of ENT organs;
  • intestinal dysbiosis in children.

Seasonal manifestation

Seasonal attacks of an allergic rhinitis provokes a periodic appearance of irritating allergenic factors, such as:

  • spring flowering of poplar, birch, hazel, willow, alder, oak, hazel, linden, ash;
  • summer and autumn flowering of cereal, meadow and weed grasses: nettle, quinoa, meadow bluegrass, ragweed, feather grass, wheatgrass, timothy grass, wormwood;
  • spore-forming fungal microorganisms during periods of active spore formation: in spring, autumn;
  • microparticles of mowed grass, hay;
  • bursts of reproduction of ticks, including domestic dust - in spring and autumn;
  • low-temperature environment with a diagnosed allergy to cold.

If you ignore the seasonal rhinitis, all the signs become more intense, more difficult to stop, the disease becomes more severe.

Year-round allergy

A year-round form of pathology develops under the action of a variety of stimuli, acting constantly.

Symptoms are caused by:

  • dust (home, book);
  • medicines, mold and other types of fungi;
  • pollen of domestic flowers;
  • household chemicals, varnishes and paints, allocation of furniture and building materials;
  • wool, saliva, feces and urine of animals (including rats, mice, pets), feathers of birds, fish and bird food;
  • excrement of fleas, cockroaches, bugs;
  • perfumes, cosmetics, deodorants, alcohol;
  • industrial pollution;
  • essential oils.

Signs of a runny nose are found in people who are constantly working in the midst of allergens. It is provoked by pharmacological products: latex, flour, elements of the epidermis of birds and animals.

With occupational disease, congestion, mucus, irritation of the nose and eyes bothers patients very often, intensely manifesting themselves when the allergenic substance settles on the mucosa.

Running a year-round runny nose often leads to lung obstruction and asthma.

Symptoms and signs of allergic rhinitis in adults and children

The leading signs in the development of an attack of an allergic rhinitis inherent in patients of any age include:

  • rhinorrhea (copious transparent discharge from the nose);
  • nasal congestion due to inflammation and swelling, shortness of breath;
  • acute prolonged sneezing, which does not bring relief - usually attacks that occur spontaneously;
  • irritation and soreness of the back of the pharynx after sneezing;
  • itching and burning in the nose, reaching pain;
  • lacrimation, itching and burning in the eyes (common with allergic rhinoconjunctivitis);
  • redness and swelling of the skin under the nose;
  • possible itching deep in the ear canals, irritation and itching of the palate and pharynx, the front surface of the neck in the fossa;
  • night snoring, nasal;
  • decrease or loss of sensitivity to odors.

Common nonspecific symptoms with a concentrated dose of an allergic substance or prolonged exposure include:

  • itching throughout the body;
  • dry mouth, thirst;
  • weakness, increased fatigue, drowsiness, distraction;
  • pressing dull headache, sleep disturbance;
  • depressed mood, irritability;
  • loss of appetite.

Additional symptoms of allergic rhinitis:

  • nosebleeds due to active and frequent blowing of the nose;
  • sore throat and sore throat, cough (which indicates concomitant pharyngitis, allergic laryngitis);
  • pain in the ears when swallowing;
  • hearing disorder (a sign of inflammation of the Eustachian tube).

It is interesting: com in the throat: reasons

In pediatrics, it is noted that allergic rhinitis in young children, and especially in infants, is caused not by “volatile” substances settling on the mucosa, but by food allergens.

In infants, in addition to signs of rhinitis, a general expressed malaise is always noted, which is manifested in apathy, lethargy, tearfulness, refusal to breast-feed or a bottle.

A symptom feature in children, especially at a very young age, is the rapid attachment to the symptoms of allergic rhinitis of inflammation in the nasopharynx with signs of laryngitis and pharyngitis. This is dangerous with unpredictable swelling of the respiratory tract - the pharynx, larynx, trachea, which poses a special threat not only to the health, but also to the life of the baby.

Therefore, at the slightest sign of respiratory difficulties, swelling of the face, eyelids, neck, you should immediately call an ambulance.

Accurate laboratory diagnosis of the disease

In addition to analyzing the patient’s symptoms and collecting an anamnesis for suspected allergic rhinitis, diagnostic clinical, instrumental studies are carried out:

  1. Skin tests to detect abnormally high sensitivity to specific types of allergens.
  2. Determination of the concentration of allergen-specific immunoglobulins - IgE in plasma using allergensorbent (RAST) and radioimmunosorbent tests (PRIST).
  3. Clinical blood test for eosinophilia - an increased titer of eosinophils, which is usually found in the phase of exacerbations. Features: the absence of eosinophilia does not mean the absence of allergies.
  4. When cytological examination of secretions or smear of the mucosa, an increased number of eosinophils and mast cells is detected.

During rhinoscopy - examination of the nasal cavity with the help of mirrors or endoscopy, which allows the doctor to examine multiply enlarged areas of inflammation, specific changes are also revealed:

  • there is friability, swelling of the mucous membrane of various degrees;
  • the color of the mucous membrane becomes very pale or bright red with a seasonal form, bluish with a year-round form;
  • in the cavity there is a significant amount of liquid transparent discharge;
  • Often there is hypertrophy (thickening) of the mucosa and polypous growths.

How to treat allergic rhinitis?

Treatment of allergic rhinitis should be only comprehensive, including several groups of drugs that have different therapeutic effects.

The treatment program includes:

  • symptomatic therapy, which involves the use of pharmacological products that relieve or alleviate the symptoms of rhinitis, but do not cure it;
  • hyposensitization aimed at reducing the patient's abnormal hypersensitivity to a specific allergen.

Drug treatment

Symptomatic treatment of the common cold involves the use of different groups of drugs that relieve basic manifestations, such as swelling of the tissues, sneezing, itching, nasal congestion, and lacrimation.

In another way, such treatment is called non-specific hyposensitization, which means a decrease in the body's sensitivity to allergens in general, without isolating specific species.

Groups of medicines:

Antihistamines inside.

Today in the treatment of allergic ENT diseases using means of different generations. New anti-allergic drugs Loratadin, Erius, Zodak, Cetrin, Claritin, Zirtek have fewer adverse reactions than 1st generation drugs: Diphenhydramine, Diazolin, Tavegil, Suprastin, Pipolfen, and do not cause sleepiness during the day.

The choice of a pharmaceutical product is determined taking into account the severity of the patient’s manifestations, age, contraindications and the body's response to the active substance. Therefore, drugs of the 1st generation, which have hypnotic effects, often return to the use of drugs, which is often a positive property in pediatrics or in patients with neurosis on the background of itching.

New anti-allergic drugs such as Erius (desloratadine), Cetrin, Parlazin, Zodak (Cetirizine) have a long-term therapeutic effect, quickly relieve symptoms, but do not help everyone. Therefore, the individual selection of an antihistamine is important.

Levocetirizine (Suprastinex, Xizal, Glencet, Aleron) should be distinguished, which show a 2 times higher degree of histamine receptor blocking than cetirizine.

It should be borne in mind that many of the drugs, for example, Erius are not allowed to be taken by women during the expectation of a child.

Combined antihistamines include Rinopront, available in capsules or in the form of syrup (from 12 months), which simultaneously relieves allergic manifestations, facilitates breathing and reduces inflammation, eliminating congestion, swelling, itching in the nose and eyes for up to 12 hours, heaviness in the head. Orinol Plus acts similarly.

Antiallergic local remedies.

When diagnosing mild to moderate severity of the pathology, sprays and drops for allergic rhinitis are prescribed, which act locally and therefore do not have common undesirable effects that can appear when taken orally. Therapeutic substances of aerosols and drops selectively block the function of H1-histamine receptors, which trigger an inflammatory reaction to the stimulus.

This group of drugs includes:

  • Allergodil in the form of an intranasal spray. The drug does not show a general effect on the body, acts quickly and for a long time, reduces vascular permeability and the volume of secretions, prevents the release of histamine from mast cells, is safe for prolonged use up to 2 months. Allergodil has been shown to be effective for seasonal and year-round rhinitis of mild to moderate severity.
  • Zodak drops (children from 12 months)
  • Vibrocil (from 6 years old). Combined product with an additional vasoconstrictor effect, quickly facilitating nose breathing. Use up to 10 days for quick relief of sneezing, burning, copious discharge.
  • Sanorin-Analergin. Along with the elimination of signs of allergy, it constricts blood vessels. Used in adolescents from 16 years of age and adults no longer than 2 weeks.
  • Tizin-Alergi (levocabastine).

Cromones are stabilizers of the membranes of mast cells and mast cells.

Cromones or cromoglycic acid preparations affect the function of mast cells and mast cells (mast cells), slowing down the release of histamine. However, aerosols Cromohexal, Lomuzol, Kromosol, Cromoglin, powder for inhalation with the nebulizer Ifiral help only with an easily running cold and more likely as a preventive measure, since the therapeutic effect develops with prolonged daily intake.

These features are characteristic of the tablet form of cromons - Ketotifen, Nedocromil sodium, which do not have a pronounced effect and are not able to stop nasal edema. They are often used to prevent and treat only intermittent rhinitis.

However, the almost complete absence of side effects is considered a serious advantage of cromons, which allows their use in the treatment of children and pregnant women.

Glucocorticoids in sprays and drops

Intranasal (injected into the nasal cavity) corticosteroids in aerosols or drops have a pronounced anti-allergic effect, stop inflammation, but are used to reduce the severity of symptoms only in severe rhinitis, when other drugs do not give positive results.

After achieving the therapeutic effect, dose adjustment is possible in the direction of reduction.

Advantages:

  • with regular use, the intensity of the symptoms of allergic rhinitis decreases markedly;
  • at the same time, there is an active suppression of inflammatory phenomena in the nasal cavity and the elimination of polypous growths, which are characteristic of many patients suffering from allergic rhinitis;
  • modern corticosteroid drugs, used by spraying and drip, act only locally, do not affect the body and do not lead to atrophy of the tissue of the nasal mucosa.

Despite the rather high harmlessness and serious therapeutic effect of local hormonal drugs, their use and dosage must be determined by the doctor, since there are a number of contraindications, including atrophic processes and nosebleeds.

Disadvantages:

  • drugs of this group are characterized by a delayed onset of therapeutic effect - a significant therapeutic result is noted after 7 to 20 days. In addition, long-term use of hormones is necessary to achieve a sustainable effect - about 3-6 months.
  • although the systemic effect of local glucocorticoids is minimized, with prolonged treatment, overdose there is a gradual upset in the field of metabolic processes, a decrease in the functions of the immune defense, adrenal glands, and an increased likelihood of developing diabetes.
  • long-term therapy of severe rhinitis with hormones leads to the need not to reduce, but to increase doses or change the drug to a stronger corticoid.
  • The abolition of intranasal drugs should be carried out gradually, since in the case of a sharp decrease in the dose of hormones, a withdrawal syndrome occurs with an increase in all negative manifestations.

The most commonly prescribed hormonal drugs in sprays and drops: Mometasone (from 12 years old), Fluticasone (from 4 years old), Budesonide, Aldetsin, Nasobek (from 6 years old), Flixonase (in children from 4 years old), Nazonex (allowed to be used by pregnant and in pediatrics from 2 years old), Benarin, Avamis (contraindicated for pregnant women and children under 2 years old), Bekonase (from 6 years old), Nazarel.

Antileukotriene preparations.

These drugs are traditionally used in the treatment of asthma with an allergic component, but are also used to relieve seizures of seasonal rhinitis (starting from 2 years) and persistent rhinitis in moderate and severe form.

Their main effect is the suppression of the function of leukotriene receptors, active mediating substances that trigger inflammatory processes under the influence of allergenic agents.

The main ones registered in the Russian Federation are antagonists of leukotrienes: Singular, Singlon (Montelukast), Akolat (Zafirlukast).

Studies of Montelukast, which was received by patients with seasonal allergic rhinitis as a single drug, proved its therapeutic effectiveness, almost equivalent to new antihistamines.

If antileukotriene preparations are used in combination with each other, the treatment results are comparable with the effectiveness of therapy with hormonal intranasal sprays.

Additional medicines.

Vasoconstrictor drops and sprays facilitate breathing through the nose by narrowing the vessels and eliminating edema.

Since the long-term use of these medicines leads to addiction, drying out and atrophic phenomena in the mucosa, their use should be very careful, in minimal doses, giving a positive effect.

It is advisable not to resort to them constantly, but to apply one-time, occasionally, with severe nasal passages, it is better before bedtime or before classes at school, at work. At the time of exacerbation of all symptoms: sneezing, rhinorrhea (mucus), swelling of the tissues of the nasal cavity - vasoconstrictor drops will not bring relief. They will provide real help only after the abatement of acute manifestations.

Short-acting drugs based on naphazoline have a quick but short action (2 to 3 hours), dry the mucous membrane and quickly stop helping. The main ones: Betadrin, Naphthyzin, Polynadim, Nafazolin, Diabenil, Sanorin, Allergofthal.

Drops and aerosols, the therapeutic basis of which is phenylephrine, are suitable for the treatment of preschoolers, including infants: Nazol and Nazol Baby, Rinza, Adrianol, Polydex with phenylephrine.

Drugs with an average duration of effect (up to 10 hours) act more gently compared to naphazoline.

Medicines with xylometazoline: Galazolin, Snoop, Otrivin, Rinonorm-Teva, Xylen, Tizin-xilo, Rinostop, Ximelin, Farmazolin, Fornos, Rinorus, Suprim-Noz.

Trimazolin-based products: Lazolnazal plus, Rinospray, Adrianol.

Long-acting vasoconstrictor medicines (up to 16 hours) with oxymetazoline: Nazol, Vicks Asset, Afrin, Sialorrino, Noxspray, Nesopin, Nazivin.

With strong mucus from the nose, Rinofluimucil helps, facilitating the outflow of mucus and combining vasoconstrictive and anti-inflammatory properties.

Barrier preparations

Means are intended to prevent the contact of allergens (pollen, fungi, dust mites, elements of the epidermis and hair of animals and birds) with the mucosa and reduce the severity of the manifestations of the common cold.

These pharmacological products include spray Nazaval, Prevalin. When spraying, the active component interacts with the mucus, forming a thin and strong protective film, preventing the development of seizures.

Substances do not penetrate into the bloodstream, do not give undesirable reactions and therefore are indicated for the treatment of rhinitis in children, as well as women during breastfeeding and pregnancy.

Moisturizers

Salt water preparations for washing:

  • actively moisturize the inflamed mucosa;
  • relieve swelling;
  • wash all kinds of allergens and dust;
  • stimulate local immunity of the mucosa;
  • contribute to the neutralization of side effects from vasoconstrictive drops, hormonal sprays.

Due to its safety, it is used in all age groups of patients, including infants, pregnant and lactating women: Aquamaris, Vivasan, Humer, Dolphin, Aqualor with different salt concentrations (Soft, Baby, Forte), Salin.

Enterosorbents

These funds are necessarily included in the complex treatment of allergic rhinitis, since they help to remove not only decay products, poisons, toxins, but also allergens, which increases the effectiveness of other drugs: Polysorb, Polyphepan, Enterosgel, Filtrum.

Their intake is limited to courses of 7-12 days with a 3-week break.

Allergen - specific immunotherapy for allergic rhinitis

How to treat allergic rhinitis if the patient does not tolerate hormonal and antihistamine drugs or they do not work.

Hyposensitizing (reducing the sensitivity of the body) therapy to certain allergens is a separate type of treatment, which is widely used in the case of identifying a specific allergen provocateur by means of specific allergy tests.

If antihistamines and hormones are contraindicated or show low therapeutic efficacy, allergen-containing substances are administered subcutaneously in strictly calculated minimum doses, which increase very slowly. As a result, the body develops immunity to this substance.

Well-chosen immunotherapy:

  • shows a high therapeutic effect;
  • reduces sensitization (sensitivity) to a specific allergen;
  • relieves or eliminates symptoms;
  • reduces the need for hormonal and other anti-allergic drugs;
  • long-term (for several years) retains a positive effect;
  • prevents the transition of pathology into a severe protracted form and the transition of allergic rhinoconjunctivitis to bronchial asthma.

The younger the patient, the more pronounced the result is obtained with specific immunotherapy.

Usually this type of therapy lasts from 1 year to 5 years. A full therapeutic effect is noted after 3 to 5 courses of therapy, but often significant positive changes occur after the initial course, especially if therapy is started at an early stage.

Plasmapheresis

This is a mechanical cleansing of the blood of allergens on a special device, which has a serious therapeutic effect in severe forms of the disease, especially if rhinitis occurs against asthma, urticaria, dermatoses of an allergic origin.

The method has its contraindications and has a short-term effect.

VLOK - intravenous laser blood irradiation

This method was developed in the framework of a new direction - quantum medicine. During the procedure, a laser pulse is transmitted through an optical waveguide connected to an intravenous needle that has the characteristics precisely specified by the doctor.

Treatment of allergic rhinitis with folk remedies

In allergic rhinitis, traditional medicine is urged to treat traditional medicine recipes with extreme caution, especially when treating young patients and pregnant women.

The patient tolerates any type of allergy, including rhinoconjunctivitis, against the background of an abnormally high sensitivity to plant allergens and medicinal products. Honey, pollen, propolis, and perga contain a lot of histamine, triggering an abnormal reaction in case of allergies.

Therefore, most often, rhinitis treatment regimens with home remedies, in addition to side effects, cause exacerbation of allergic rhinitis and possible complications in the form of bronchospasm and laryngeal edema, which is deadly, especially for babies.

Any essential oils, including eucalyptus, fir and others, are completely prohibited during allergies.

The same goes for plants. Sometimes the reaction to them may be mild, but prolonged use of infusions, decoctions or inhalation of vapors can lead to a sharp increase in all manifestations.

The only thing allowed is washing the nose with salt water with food or sea salt, but strictly in the ratio of 1 teaspoon (not more) to 2 cups of boiled water, so as not to cause irritation of the mucosa. In essence, this method is a home substitute for pharmacy moisturizing aerosols, which are more convenient to use and cause less discomfort when used.

Prevention

Measures to prevent allergic rhinitis include:

  1. The exception, if possible, contact with allergens.
  2. Compliance with a hypoallergenic diet.
  3. Change of professional activity and transition to a place of work without the presence of professional allergens in the environment.
  4. Taking medications as indicated.
  5. Natural feeding of the baby up to 6 months of life. The introduction of complementary foods only from 5 to 6 months.
  6. Tracking the environment. In dry and warm weather, all manifestations of allergies intensify. Grasses, trees, flowers intensively distribute pollen in the morning.
  7. Prophylactic use of antihistamines and “barrier” aerosols until possible contact with the allergen.
  8. Prevention of respiratory infections, treatment of dermatoses of any nature.
  9. The use of air purifiers, properly working air conditioners, reducing the concentration of dust and fungi.
  10. Frequent wet cleaning.

It should be taken into account that in the middle of summer you should not rest in areas of forests and mountains, where the flowering of plants is very long. It is necessary to exclude lawn mowing and grass mowing. Before traveling, it is worth analyzing the flowering calendar of plants in the travel area.

Related:More from the author: