过敏性鼻炎影响估计15%的美国人口(约5000万人),并与哮喘的存在有关。湿疹,慢性或复发性鼻窦炎,咳嗽,紧张和偏头痛。
■当上皮屏障的破坏使过敏原穿透鼻道的粘膜上皮时,就会发生过敏性鼻炎,诱导T辅助型2型炎症反应和过敏原特异性IgE的产生。过敏性鼻炎通常表现为鼻充血的症状,鼻漏,鼻后引流,打喷嚏,眼睛瘙痒,鼻子,和喉咙。在一项国际研究中,过敏性鼻炎最常见的症状是鼻漏(90.38%)和鼻塞(94.23%)。非过敏性鼻炎患者主要表现为鼻充血和鼻后引流,通常与鼻窦压力有关。耳塞,低沉的声音和疼痛,和咽鼓管功能障碍,对鼻皮质类固醇反应较差。患有季节性过敏性鼻炎的患者通常具有水肿和苍白鼻甲的体格检查结果。常年性变应性鼻炎患者通常具有红斑和发炎的鼻甲,在体格检查中表现出与其他形式的慢性鼻炎相似的浆液性分泌物。非过敏性鼻炎患者的特异性IgE过敏原检测结果为阴性。间歇性过敏性鼻炎定义为连续4天/周或连续4周/年以下的症状。持续性过敏性鼻炎被定义为连续4天/周和连续4周/年以上的症状。过敏性鼻炎患者应避免诱发过敏原。此外,轻度间歇性或轻度持续性过敏性鼻炎的一线治疗可能包括第二代H1抗组胺药(例如,西替利嗪,非索非那定,地氯雷他定,氯雷他定)或鼻内抗组胺药(例如,氮卓斯汀,奥洛他定),而患有持续性中度至重度过敏性鼻炎的患者最初应使用鼻内皮质类固醇治疗(例如,氟替卡松,曲安奈德,布地奈德,莫米松)单独或与鼻内抗组胺药联合使用。相比之下,非过敏性鼻炎患者的一线治疗包括鼻内抗组胺药作为单一治疗或与鼻内皮质类固醇联合治疗.
■过敏性鼻炎与鼻塞症状有关,打喷嚏,眼睛瘙痒,鼻子,和喉咙。应指示患有过敏性鼻炎的患者避免引起过敏原。治疗包括第二代H1抗组胺药(例如,西替利嗪,非索非那定,地氯雷他定,氯雷他定),鼻内抗组胺药(如,氮卓斯汀,奥洛他定),和鼻内皮质类固醇(例如,氟替卡松,曲安奈德,布地奈德,莫米松),应根据症状的严重程度和频率以及患者的偏好进行选择。
Allergic rhinitis affects an estimated 15% of the US population (approximately 50 million individuals) and is associated with the presence of asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches.
Allergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE. Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat. In an international study, the most common symptoms of allergic rhinitis were rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis present primarily with nasal congestion and postnasal drainage frequently associated with sinus pressure, ear plugging, muffled sounds and pain, and eustachian tube dysfunction that is less responsive to nasal corticosteroids. Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates. Patients with perennial allergic rhinitis typically have erythematous and inflamed turbinates with serous secretions that appear similar to other forms of chronic rhinitis at physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens. Intermittent allergic rhinitis is defined as symptoms occurring less than 4 consecutive days/week or less than 4 consecutive weeks/year. Persistent allergic rhinitis is defined as symptoms occurring more often than 4 consecutive days/week and for more than 4 consecutive weeks/year. Patients with allergic rhinitis should avoid inciting allergens. In addition, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg,
cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine), whereas patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine. In contrast, first-line therapy for patients with nonallergic rhinitis consists of an intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid.
Allergic rhinitis is associated with symptoms of nasal congestion, sneezing, and itching of the eyes, nose, and throat. Patients with allergic rhinitis should be instructed to avoid inciting allergens. Therapies include second-generation H1 antihistamines (eg,
cetirizine, fexofenadine, desloratadine, loratadine), intranasal antihistamines (eg, azelastine, olopatadine), and intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) and should be selected based on the severity and frequency of symptoms and patient preference.