Allergic rhinitis ( hay fever) : causes, symptoms , treatment and prevention
Pulmonology / / April 20, 2016
Allergic rhinitis or "hay fever" - an inflammatory disease of the nasal mucosa, which is characterized by impaired breathing, mucous discharge from the nose, sneezing.The basis for all this are the allergic reactions.Also, allergic rhinitis - the reaction of different people in the open or closed allergens.
Open sources of allergic rhinitis include ragweed, grass and tree pollen, and mold spores.Internal sources include: dust mites, pet dander or mold that grows in damp enclosed areas - for example, in the carpets.Outdoor allergens cause seasonal allergic rhinitis (also known as "hay fever").Allergic rhinitis usually emerges and develops during the spring and summer.Indoor allergens can cause long-term chronic allergic rhinitis.
allergic process, called "atopy" (allergic diseases, the development of which belongs to the prominent role of hereditary predisposition to sensitization) occurs when the human body reacts to certain substances (foreign bodies) as "foreign invaders ??".The immune system operat
immunoglobulin E antibodies (IgE) are the key to allergic reactions.When an allergen enters the body, the immune system produces an antibody IgE.These antibodies are then attached to the mast cells, which occur in the nose, eyes, lungs and gastrointestinal tract of humans.
Mast cells (immune highly specialized cells of connective vertebrate tissue analogs blood basophils) is isolated inflammatory chemical mediators - such as for example histamine, which is the cause of atopic dermatitis (diffuse neurodermatitis, endogenous eczema) with symptoms such as sneezing, itching,coughing, wheezing, etc.Mast cells continue to produce more inflammatory chemicals that stimulate the production of IgE more, continuing the allergic process.
There are many types of IgE antibodies and each is associated with a specific allergen.That's why some people are allergic to cat dander, and others may be allergic to pollen.In allergic rhinitis, allergic response begins when an allergen comes into contact with the nasal mucosa.
Allergic rhinitis often "lives" in the family.If one or both parents have allergic rhinitis, there is a high probability that their children will also have the same disease.People with allergic rhinitis have increased risk of developing asthma and other allergies.They are also at risk for developing sinusitis, sleep disorders (including snoring and sleep apnea), nasal polyps and ear infections.
Causes of seasonal allergic rhinitis (hay fever)
Seasonal allergic rhinitis occurs only during periods of heavy traffic pollen or spores.
In general, seasonal allergies are the following sources:
- Ambrosia. Ragweed is the most dominant cause of allergic rhinitis, affects about 75% of people with allergies.One plant can release 1000000 pollen grains per day.Ambrosia, usually before noon can cause the most severe allergies;
- Herbs. herbs affect people from mid-May to late June.Allergy to grass often occurs late in the day;
- Pollen trees. Small pollen grains from certain trees, tend to cause allergy symptoms in late March and early April;
- mold spores. Mold spores that grow on dead leaves and release spores into the air, are common allergens during the spring, summer and fall.Mold spores can reach a maximum in the dry windy days in the afternoon and in the wet or rainy days - early in the morning.
Causes of chronic allergic rhinitis
allergens in the home can cause seizures in people year-round (perennial) allergic rhinitis.Examples of household allergens:
- house dust mites - particularly mite feces coated with enzymes that contain powerful allergens;
- pet hair;
- mold and fungus growing on the wallpaper, plants, carpets and upholstery.
Other causes of chronic nasal rhinitis
- aging process. Older people are at high risk of chronic rhinitis, as the mucous membranes become dry with age.In addition, the nasal passages supporting cartilage weakening that leads to a change in air flow.
Peristaltic rhinitis.Peristaltic rhinitis is caused by an overreaction of the body to such irritants like cigarette smoke or other air pollutants, strong odors, alcohol and exposure to cold.The nasal passages become red, bloodshot.This response - not allergic, although it is also associated with an increased number of white blood cells called "eosinophils".
- Vasomotor rhinitis. Vasomotor rhinitis (chronic nasal disease is associated with impaired nose vascular tone regulating), another type of non-allergic rhinitis caused by hypersensitive blood vessels and nerve cells in the nasal passages - in response to a variety of sources, including smoke, environmental toxins, temperature changes, andhumidity, voltage variation, and even sexual arousal.The symptoms of vasomotor rhinitis are like most of caused by allergies, but the eye irritation does not occur.
- Structural abnormalities of the nose.Some physiological features iakie such as a deviated septum may block the nasal passages.If deviated septum is not straight, but shifted to one side - usually the left.Sometimes a person may develop a so-called "cleft palate" - overgrowth of bones in the nose or tumors that cause nasal obstruction.In such cases, it may be useful for surgical intervention.
- Polyps .This soft tissues that develop from steblepodobnyh structures on the mucous membrane.They prevent the drainage of mucus and restrict airflow.Polyps usually develop from sinus infections, which cause proliferation of mucus membranes in the nose.They do not disappear on their own, they can multiply and cause a significant obstacle for normal breathing.
- Medicines and drugs. number of narcotic drugs can cause a runny nose, or reinforce it in people with health problems such as a deviated septum, allergies or vasomotor rhinitis.Decongestants Excessive use of nasal sprays for treatment of nasal congestion may, over time (3-5 days), cause inflammation in the nasal passages and reinforce rhinitis.Sniffing cocaine also strongly affects the nasal passages and can cause chronic rhinitis.
Other medications that can cause rhinitis include: oral contraceptives, hormone replacement therapy, anti-anxiety drugs (especially Xanax), certain antidepressants, drugs used to treat erectile dysfunction and some medicines for blood pressure, including beta-blockers andvasodilators.
- Estrogen in women. elevated estrogen levels typically increase swelling and mucus production in the nasal passages which can cause overloading of these passages.This effect is most obvious in women during pregnancy and usually disappears after their birth.Oral contraceptives and hormone replacement therapy containing estrogen may also cause nasal congestion in some women.
risk factors of allergic rhinitis
Allergic rhinitis is able to affect people of all ages.Allergy usually appears first in childhood.Allergic rhinitis - the most common chronic disease in children at any age, although it can develop at any age.Almost 20% of cases of allergic rhinitis caused by seasonal allergies, 40% - long-term (chronic) rhinitis, and others - mixed reasons.
- Family history of allergic rhinitis. Allergic rhinitis is likely to have a genetic component.People whose parents have allergic rhinitis, are at increased risk of developing allergic rhinitis in itself.The risk is greatly increased if this diagnosis have both parents.
- environmental effects. Wednesday at home or at work can increase the risk of exposure to allergens (mold spores, dust mites, animal hair) associated with allergic rhinitis.
Symptoms of allergic rhinitis
rhinitis Common symptoms are: runny nose and postnasal drip, when a drop of mucus in the throat goes from the back of the nasal passage, especially in the supine position.Symptoms can vary depending on the cause of rhinitis.Symptoms of influenza and sinusitis must also be differentiated from allergies and colds.
symptoms of allergic rhinitis symptoms occur in two phases: early and late.
symptoms early phase. symptoms appear early phase within a few minutes of exposure to allergens.This phase includes:
- runny nose;
- frequent or repeated sneezing;
- watery or itchy eyes;
- itching in the nose, throat or mouth.
Symptoms late phase - occur within 4-8 hours.This phase may include one or more of the following symptoms:
- and nasal congestion;
- stuffiness in the ears;
- irritability, a slight decrease of concentration, memory loss, slow thinking, and more;
- reduction of smell or taste;
- ear pain;
- bleeding from the nose.
In severe eye allergies may develop dark circles.Lower eyelid may be swollen.
diagnosis of allergic rhinitis
In most cases, the diagnosis is "allergic rhinitis" can be installed ??without testing - on the basis of the patient's symptoms.Allergy testing can be used to confirm the allergic response, the symptoms identified.
doctor may ask the patient the following:
- what time of day and in any season of the year most of the episodes of allergic rhinitis occur;Whether rhinitis associated with pollen allergens and outer.If symptoms occur throughout the year, the doctor suspects perennial allergic or non-allergic rhinitis;
- whether there is a family history of allergies;
- there is a patient history of other medical problems;
- women - whether they are pregnant or are taking there medicines that contain in their composition of estrogen (oral contraceptives, hormone replacement therapy);
- whether the patient uses other drugs, including decongestants, which can cause the opposite effect;
- whether the patient pets;
- whether the patient more unusual symptoms (examples: a bloody nose, obstruction of only one nasal passage, swelling, fatigue, sensitivity to cold, weight gain, depression, symptoms of hypothyroidism).
- Medical examination. doctor may examine the inside of the patient's nose with an instrument - "mirror."It is a painless study allows the doctor to check the redness and other signs of inflammation.Possible physical data of the patient as a result of the inspection may include:
- redness and swelling of the eyes;
- swollen mucous membranes of the nose;
- swollen turbinates or nasal polyps;
- fluid behind the eardrum;
- skin rashes;
- shortness of breath.
- Skin allergy tests. Skin tests - a simple method for the detection of common allergens.Skin tests are seldom required for the diagnosis of allergic symptoms to their treatment in the milder seasons.This kind of test is not suitable for children under 3 years.Importantly, patients should not take antihistamines for at least 12-72 hours before the test.Otherwise, an allergic reaction, even if it is in an organism, may not appear in the test.
Small amounts of suspected allergens are applied to the patient's skin using injection or scratches, or a few cells injected with allergens deep into the skin.Test injections may be more sensitive to the patient than standard injections.If allergy is present in about 20 minutes is formed on the skin of the patient swollen reddened area.
- Nasal swab. doctor may take a swab from the patient's nose.The nasal secretion is examined under a microscope to factors which may indicate the cause of the disease.For example, increasing the number of white blood cells or evidence of high infection eosinophils.High levels of eosinophils indicate an allergic condition, but their low number does not rule out allergic rhinitis.
- Analysis of IgE. may also be made for the production of blood tests it immunoglobulin IgE.New analyzes based on enzymes with IgE antibodies have replaced the old test RAST (radioallergosorbent test).These tests show elevated levels of allergen-specific IgE in response to specific allergens.Blood tests for IgE may be less accurate than the skin test.Tests should be performed only in patients who can not undergo routine testing, or when the skin test results are uncertain.
- Visual examination. patients with chronic rhinitis is very important to exclude sinusitis.Visual studies may be useful if other test results are ambiguous.In this case, may be used:
- computed tomography (CT) - may be useful in some cases, when suspected sinusitis or polyps in the sinuses;
- nasal endoscopy is used for chronic or seasonal rhinitis unconscious, to study every irregularity in the nasal structure.When endoscopy using a tube with a tiny camera on the end, which is inserted into the nose to see him in the aisles.
Treatment of allergic rhinitis
If rhinitis symptoms are caused by non-allergic condition, particularly if there are accompanying symptoms indicating serious problems, the doctor should treat any underlying disorders.If rhinitis is caused by medications decongestants, the patient may need to stop taking them or find alternatives.
A number of factors must be considered when choosing a method of treatment.These include:
- severity of the symptoms;
- frequency of symptoms (seasonal in comparison with the whole year, as well as during the week);
- age of the patient;
- the presence of other related rhinitis with diseases - such as asthma, atopic eczema, sinusitis or nasal polyps;
- patient preference in respect of certain types of treatment;
- type allergens;
- known and potential side effects of medication.
For patients with allergic rhinitis are many available treatment options.For example, such as:
- environmental controls environment (can help reduce exposure to allergens);
- flushing the nose (for some patients can provide great relief of symptoms);
- Various nasal (nasal) spray, including corticosteroids, antihistamines, nasal sprays, nasal spray, nasal cromolyn nasal decongestants and sprays.We do not recommend use of decongestant sprays for more than three consecutive days;
is also worth noting that the majority of sprays for the treatment of rhinitis in the form of ready-made aerosols involve nasal irrigation procedure and not directly wash.Unlike Irrigation washing may reduce a thick consistency nasal secretions, but does not solve the problem with their removal along with harmful bacteria.