Causes, symptoms and treatment of allergic rhinitis

Allergic rhinitis( rhinitis) is an inflammation of the nasal mucosa caused by the action of allergens. Its main manifestations are sneezing, mucus secretion, edema and nasal congestion. When the stimulus is eliminated or after treatment, the symptoms disappear, but they reappear with the next contact with the allergen. The disease affects about a quarter of the population of Russia, and the number of sufferers from it is constantly growing.

• reasons
• Symptoms
• Classification
• Complications
• Diagnostics
• Treatment
• Limiting exposure to allergens
• common action Preparations
• Local treatment
• Specific immunotherapy( SIT)
• Operation
• Breathing exercises
• Folk remedies
• Diet
• have
• children during pregnancy
• Prevention

Causes of

Some people experience sensitization - an increased sensitivity of the body to stimuli. Their immune system mistakenly takes normally harmless substances for enemy agents and begins to develop antibodies to fight them. When antibodies interact with allergens, histamines and other chemicals that cause symptoms of allergic rhinitis are secreted into the blood.

First, the mucous membrane of the nose reacts to the stimulus-edema and the production of a large amount of mucus. These secretions, which contain a large number of allergens, flow down the posterior wall of the pharynx, swallow and enter the intestine, and then into the blood.

Irritants can be:

• plant pollen;
• dust - home or library;
• mites living in house dust, cockroaches and other insects;
• wool, saliva or the secretion of animals;
• feather pillows;
• spores of mold fungi - can reproduce in damp dark rooms( bathroom), as well as in the air conditioning system, on wallpaper, upholstery furniture, carpets;
• tobacco smoke;
• medications;
• household chemicals;
• some food.

Factors enhancing sensitization:

• genetic predisposition;
• mother's smoking during pregnancy;
• prematurity of the child;
• excessive physical and psychological stress, stress;
• frequent infectious diseases;
• presence of chronic rhinitis;
• increased blood coagulability, low blood pressure, leukopenia, eosinophilia;
• diseases of the gastrointestinal tract, especially the liver;
• structural anomalies and deformities of the nose, polyps;
• poor environmental conditions, polluted air;
• presence of food allergy;
• pregnancy, oral contraceptive use, menopausal replacement therapy;
• weather conditions - cold;
• age changes - the aging process causes dryness of the mucous membranes of the nose, the weakening of the cartilage supporting the nasal septums.

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Symptoms of

At the heart of the disease is immediate type hypersensitivity, which means that the allergic reaction develops instantaneously - with an interval of several seconds to half an hour from the moment the irritant contacts the nasal mucosa. However, with prolonged exposure to the allergen, the symptomatology may change.

Symptoms of allergic rhinitis:

• itching in the nose, sneezing( often - bouts);
• rhinorrhea( runny nose) - the appearance of transparent mucous or watery discharge from the nose;
• the need to constantly blow your nose leads to reddening of the wings of the nose, can flake lips, there may be nosebleeds;
• edema and nasal congestion, nasal congestion, sniffing, breathing with the mouth;
• itching of throat and palate, cough;
• the flow of mucus down the back wall of the pharynx;
• decreased taste and smell;
• stuffiness of the ears;
• itching and redness of the eyes, lacrimation, photophobia;
• headache;
• poor sleep, irritability, loss of strength;
• dark circles under the eyes - allergic bruises;
• rubbing the nose, creating a crease on the bridge of the nose - allergic fold;
• rubbing the nose with the palm of the bottom up to reduce itching and expand the nasal passages - allergic salute.

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Classification of

Depending on the severity of the symptoms, allergic rhinitis happens in the following degrees:

• Easy - the manifestations of the disease are insignificant, do not interfere with proper rest and do not decrease the capacity for work. Remedial measures are not necessary.
• The is of moderate severity - it causes a moderate decrease in the quality of sleep and daytime activity, and requires medical treatment.
• Heavy - characterized by severe symptoms, significantly worsens sleep and hampers daily activities. Without treatment, the patient can not fully rest, work, study, play sports.

Depending on the duration of manifestations of allergic rhinitis, the following are distinguished:

• Intermittent ( episodic) - duration of symptoms is less than 4 weeks per year or less than 4 days per week.
• Persistent ( persistent) - the manifestations of the disease cause anxiety more than 4 weeks per year or more than 4 days a week.

According to the periods of manifestations, allergic rhinitis is divided into the following types:

• Seasonal ( pollinosis or hay fever) is an intermittent form that occurs during the flowering of plants that cause allergies. From the end of March to May, irritants are such wind-pollinated plants as birch, cherry, oak, willow, alder, poplar, dandelion. In June-July, a reaction to cereals - arzhanets, bluegrass, wheatgrass, wheat, rye - is possible. In August-September, the danger is represented by weeds and Compositae - ambrosia, hemp, nettle, quinoa, sunflower, wormwood.
• Year-round - corresponds to a persistent form. Symptoms of the disease can occur throughout the year. Allergens are dust, animal hair, fungus, food.
• Professional is a separate category of allergic rhinitis, when characteristic symptoms appear at work, by inhalation of certain substances( chemical compounds, vapors, tar, wood dust).
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The last classification is conditional, since cases of a combination of different types of allergies are not uncommon, for example, on pollen of plants and on animal wool. Also, sensitization can be exacerbated by the influence of certain factors - air temperature or humidity, the state of the human immune system.

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Complications of

The absence of treatment for allergic rhinitis can have negative consequences for the body:

• Significant deterioration in the quality of human life - the disease affects sleep, appearance, causes psychological problems( unwillingness to go out, communicate with people, depression).
• High risk of other allergic reactions - rhinitis often combines with bronchial asthma, skin manifestations( atopic dermatitis, eczema, diathesis) and is able to intensify their attacks.
• Hypertrophy( chronic edema) of the nasal ducts - accompanied by permanent nasal congestion, headaches, and may require surgical intervention.
• The disease reduces immunity and makes the nasal mucosa more vulnerable, which is why it is possible to develop infectious rhinitis or inflammation of the paranasal sinuses( sinusitis, sinusitis).The accumulation of mucus can lead to ear inflammation( otitis).

Nasal congestion with allergic rhinitis leads to oral breathing, which also has a number of consequences:

• lack of air filtration - this function in the nose is performed by a lot of hairs on which dust and microbes accumulate;
• inhalation of cold air - in contrast to the nose, the mouth does not warm and humidify the air;
• occurrence of snoring;
• speech impairment - nasal;
• hypoxia - reduced blood saturation with oxygen.

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Diagnosis

To make a diagnosis it is necessary to visit an allergist or an ENT specialist( ENT).

The procedure includes the following steps:

• Analysis of patient complaints and the collection of an anamnesis - a survey is conducted on the nature of the symptoms, the frequency and the period of their occurrence. Also, the doctor asks about the drugs taken, the presence of pets, the effectiveness of previous treatment, possible allergic manifestations in relatives.
• General inspection of - with external examination visible swelling of the nose, redness and tear of the eyes, irritated skin of the wings of the nose.
• Rhinoscopy - examination of the nasal cavity by nasal mirrors( dilators) and nasopharyngeal mirrors. Allows you to see the swelling of the mucous membrane, its pallor or cyanosis, sometimes with reddish spots, mucous discharge in the nasal passages.
• Smear on eosinophils - cells that indicate an allergic reaction in the body. It is taken from the nasal cavity.
• Biochemical blood test - shows an increase in allergy markers: specific immunoglobulin E( IgE) and eosinophils.
• Skin tests. Apply a small amount of several allergy substances to the skin of the forearm, after which the skin is punctured with a thin needle( prik test) or scratched( scarification test) at this point. By changing the condition of the skin, the result is evaluated - usually within 20 minutes it forms a reddened edematous area.
• Intranasal provocative test - conducted with questionable results of skin tests. It consists in instilling in the patient's nose a solution with a probable allergen - if symptoms of allergic rhinitis appear, the reaction is considered positive.
• Computed Tomography( CT) - is used for suspected polyps in the sinuses of the nose or the development of sinusitis.

Differential diagnosis is performed to distinguish it from other forms of rhinitis. So, with the diagnosis of "vasomotor", "infectious" or "rhinitis due to anatomical abnormalities," treatment or surgery is often prescribed without considering the allergic nature of the disease, which can lead to its progression and the development of bronchial asthma.

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Treatment of

The objectives of therapy for allergic rhinitis are: alleviation of symptoms with the developed reaction and prevention of repeated episodes of the disease.

For this, the following methods are used:

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Limitation of contact with allergens

The concentration of irritants in the air depends on the severity of the clinical picture. Therefore, interaction with them must be minimized, for example:

• for allergy to dust - as often as possible to conduct wet cleaning;
• when reacting to feather birds - replace feather pillows with hypoallergenic with synthetic filler;
• if the irritant is the pollen of the plants - keep the windows closed or hang them with a damp cloth, when going out, put on a cotton-gauze dressing and sunglasses;
• at home use ionizers and air purifiers - these devices help filter dust and pollen allergens, spores of fungi.

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General preparations

In cases where contact with the allergen can not be completely eliminated, treatment with medication is performed:

• Antihistamine( antiallergic) agents. Usually used drugs in tablets - Desloratadine, Zirtek, Ketotifen, Claritin, Loratadine, Suprastin, Fenistil, Erius.
• Glucocorticosteroids ( hormonal preparations).Have anti-allergic activity, relieve inflammation. They are used in severe cases, with severe symptoms. In addition to tablets, solutions for intramuscular or intravenous injections, dexamethasone, can be used.
• Leukotriene Receptor Antagonists. Resist the narrowing of the respiratory tract and the production of mucus, except for allergic rhinitis are used for bronchial asthma - Zafirlukast, Montelukast, Singular.
• Means for the removal of toxins and toxins. Improve the general resistance of the body to irritant substances in the purification of the stomach and liver. Appointed Karsil, Gepabene, Essentiale, activated carbon, Lactofiltrum and others.
• Probiotics ( preparations with lacto- and bifidobacteria).Useful intestinal flora fights against allergens and significantly reduces their penetration into the blood. Appointed Bifidumbacterin, Bifiform, Lineks and so on.

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Topical treatment

• Nasal washes based on sterile sea water. Wash allergens from the nasal cavity and reduce inflammation - Akvalor, Aquamaris, Dolphin, Marimer, No-Sol and so on.
• Nasal antihistamine sprays. Used for mild rhinitis - Azelastin, Cromoglin, Opatanol.
• Nasal sprays with corticosteroids. Gold standard of treatment, have proven effectiveness and safety, are practically not absorbed into the blood, do not affect the hormonal background, do not cause habituation even with prolonged use - Avamis, Baconaz, Nazakort, Nazonex, Rhinocort, Flix, Floninase, Flonaz.
• Antidiarrheal anti-inflammatory nasal sprays. Assigned short courses, with severe nasal congestion and lacrimation - Vibrocil, Nazivin.
• Eye drops. Reduces redness and itching in the eyes. They can be antihistamine( Azelastnin, Patanol), decongestants( Vizin, Naphthyzinum), corticosteroid( Alrex, Loteprednol), anti-inflammatory( Akular).
• Inhalations. Promote the elimination of edema, moisturize and clean the nasal mucosa. Performed with saline, mineral water, hypertonic( saline) solution. For better dispersion and delivery of the drug, it is preferable to use a nebulizer.

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Specific immunotherapy( SIT)

The method is often called allergovaccination or injections of allergies. It is used in case of insufficient effect from drug therapy with moderate or severe symptoms. It is an adaptation of the body to irritant substances. In the patient's body gradually increasing doses of allergen extracts are introduced, causing addiction to it and reducing sensitivity. Procedures are performed during remission and are performed in a hospital, under the supervision of a doctor.

Advantages of the method are:

• directed to a specific stimulus;
• effect on the immunological nature of allergy - SIT does not simply suppress the symptoms of the disease, but eliminates its underlying cause;
• long( up to several years) effect;
• prophylaxis of expanding the spectrum of allergens, as well as the development of more severe secondary diseases, for example, bronchial asthma.

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Operation

In some cases, the disease requires surgical intervention.

Indications for him are:

• anomalies of the structure of the nose - for example, pronounced curvature of the nasal septum, which worsens nasal breathing and aggravates the course of allergic rhinitis;
• defeat of the paranasal sinuses - cysts, chronic inflammation of the mucosa;
• inefficiency of conservative treatment of - in this case, a gentle submucous operation is performed on the nasal conchae.

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Respiratory gymnastics

The Strelnikova method is a complex of exercises for the prevention and treatment of respiratory diseases, the restoration of the singing voice.

For allergic rhinitis, the following techniques are recommended:

• Ladies .Standing or sitting with a straight back, bend your arms in the elbows and lift them upwards so that your hands are just above the shoulders and face the viewer. Make a sharp noisy breath, while squeezing your hands into a fist, then easily and relaxedly exhale, loosening your fists.
• Drives of .Stand up straight with your arms slightly bent at the elbows and clenched fists in front of your waist. Drawing a deep breath, sharply straighten your arms, pointing them strictly down. At the same time, you should tighten your shoulders, unclench your fists and spread your fingers out in a fan. With exhalation return to the starting position.
• Pump .With your legs slightly wider than your shoulders, lean forward slightly. In this case the shoulders should be lowered, the hands - freely hanging, and the relaxed back - get a rounded shape. Make a small bow, while making a strong breath, as if trying to sniff the flower, and then a little straight, easily exhaling.
• Hug the shoulders of .The starting position is standing, legs are shoulder width apart, arms are bent at the elbows and located at the chest level. Brushes with slightly bent fingers are directed towards each other. Doing a short, powerful breath, make a movement with your hands, hugging your shoulders. With a slight passive exhalation weaken hands, slightly diluting them, but not to the original position. During the exercise, the same hand must always be above the other( for example, just the right hand over the left).
• Large pendulum .Combination of exercises "Pump" and "Hug Shoulders."Leaning forward, take an energetic breath, then straighten up, gently exhale and bend back a little, clasping himself by the shoulders and making another strong breath.
• Cat .Put your feet slightly wider than your shoulders, relax your arms down. At the inhalation, sit down for a while, while turning the head and the body to the right. Brushes of hands at the same raise to the level of the belt and make them a light dropping motion. On exhalation return to the starting position. Then repeat the action with turning the housing to the left.

General rules for performing the exercises:

• Each exercise should have 96 breaths, it is desirable to break them into 3 approaches - 32 breaths each, with breaks of 3-5 seconds. For beginners such breaks can be done more often - every 4-8 breaths.
• Breaths should be as sharp and powerful as possible, performed through the nose. Exhales need to be done freely and smoothly through the nose or mouth.
• It is advisable to do exercises standing, but if it is inconvenient, it is permissible to perform the complex sitting and even lying down.

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Folk remedies

To alleviate the symptoms of allergic rhinitis helps folk medicine:

• Nasal saline - dissolve 1 teaspoon of salt in 1 liter of boiled water, pour the product into one nostril until it flows from the other nostril or from the mouth. It is advisable to perform the procedure every 3-4 hours. The same solution is recommended to gargle - for cleaning and removing mucus from allergens.
• Aloe juice - relieves edema, improves nasal breathing. Bury in the nasal passages 4 times a day.
• Dandelion juice - fresh plant grass to pass through a meat grinder, squeeze in gauze, mix with an equal amount of water and use for instillation in the nose. The product is contraindicated in allergies to plant pollen.
• Eucalyptus oil - used to remove the common cold. Add 5 drops of oil in 1 liter of boiling water, deeply inhale the fragrant steam for 5 minutes. You can also do similar inhalation with pine buds - take 1 tablespoon of raw material for 1 liter of boiled water.
• Beeswax( wax) - increases the body's resistance to allergens. With prolonged( at least 3 months) use, there is a significant relief of symptoms.

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Diet

Therefore it is important to limit consumption or completely exclude from the diet possible irritants:

• rich meat broths, liver, sausages;
• fish, caviar, seafood;
• hot and melted cheeses, fatty cottage cheese, whole milk, sour cream, ice cream, margarine;
• salted, spicy, spicy, smoked, fried dishes;
• shop sauces;
• products that have undergone industrial processing and contain dyes, flavors, flavors;
• eggs;
• nuts, mushrooms;
• some vegetables - Bulgarian pepper, tomatoes, pickled cucumbers, sauerkraut, radish, radish, sorrel, spinach, garlic;
• citrus, pineapple, kiwi, melon, watermelon, pomegranates, grapes, strawberries, raspberries;
• carbonated drinks, coffee, cocoa, chocolate.

The diet should include:

• lean meat - beef, rabbit, chicken, turkey;
• fish rich in omega-3 fatty acids;
• groats( except semolina);
• sour-milk products, preferably at home - kefir, yoghurts;
• mild cheeses;
• vegetables and fruits of green and yellow color - cabbage, zucchini, pumpkin, parsley, dill, peas, beans, green and white apples, pears, cherries and plum of light varieties, white and red currants, gooseberries;
• vegetable oils - linseed, olive, sunflower, corn;Second-grade wheat bread, cereals.

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In children

Allergic rhinitis occupies a leading position among the total number of allergic diseases in children older than 6 years - it accounts for 70% of cases. In children under 3 years old, the disease is rarely diagnosed.

In addition to factors characteristic of adults, the impact on the development of the disease in children has:

• heredity;
• the presence of allergic rhinitis in the mother during pregnancy;
• metabolic disorders, in particular, rickets;
• immaturity of the nervous and endocrine systems, so rhinitis often occurs in boys before puberty, and in girls - after;
• frequent unreasonable treatment of colds with antibiotics;
• in infants usually causes food allergens, in preschool and school children - inhalation( transmitted through the air).

If a child develops a symptom of allergic rhinitis, the child should immediately consult a doctor. Ignoring the disease can lead to serious complications:

• transformation into bronchial asthma or allergic conjunctivitis;
• spasm of the glottis;
• change in the shape of the skull in the child - with nasal congestion and constant mouth breathing, it is possible to form an adenoid type of face, this condition is irreversible;
• apnea - stopping breathing during sleep;
• dysmenorrhea( pain during menstruation) in adolescent girls;
• epileptic seizures.

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In pregnancy

Allergic rhinitis can occur even in those pregnant women who have not previously been exposed to this disease. The causes are weakened immunity and an increase in the level of the hormone estrogen, which increases swelling and mucus production in the nasal passages.

Ignore unpleasant manifestations in no case it is impossible - a harmless, at first sight, runny nose can lead to undesirable consequences:

• The deterioration of the physical and emotional state of the mother.
• Hypoxia of the fetus( lack of oxygen) - can develop due to difficult nasal breathing. Such a state is dangerous by a delay in growth and development, by heavy births, and in rare cases - by fetal death.
• Even after eliminating the allergen( eg, stopping the flowering of the irritating plant), the symptoms of rhinitis often remain until the time of delivery, that is, allergic rhinitis develops into a vasomotor.

Prescribing treatment should be a doctor, he will choose drugs that are safe for the mother and child.

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Prevention of

To prevent the development or exacerbations of allergic rhinitis, the following recommendations should be observed:

• identify the allergen and try to avoid contact with it;
• use suitable remedies prescribed by a doctor to eliminate symptoms, do not self-medicate;
• , when pollen allergies are less likely to go out during the flowering period, and when you come home - wash your hair, change clothes, wash your nose and rinse your throat;
• conduct regular wet cleaning of the premises, reduce the use of the vacuum cleaner, monitor the humidity - it should not exceed 50-70%;
• use air purifier, air conditioners with high efficiency of air purification from microparticles( HEPA filters);
• limit exposure to tobacco smoke, exhaust gases, chemical vapors;
• eat right, get the necessary complex of vitamins and minerals;
• monitor your health, strengthen your immune system.