27.10.2020

Treatment of allergic rhinoconjunctivitis

The basic principles of the treatment of allergic rhinoconjunctivitis include the elimination of allergens, pharmacotherapy and allergen-specific immunotherapy. For maximum elimination of contact with potential and cause-significant allergens in case of seasonal form of the disease, it is necessary to limit the period of being outdoors, especially in areas of intensive flowering of grasses and trees, as well as in dry hot weather.

In the year-round form, special attention is paid to the elimination of household allergens in the residential area (regular cleaning and airing of rooms, the use of modern vacuum cleaners and air purifiers, the destruction of domestic ticks and cockroaches, the abandonment of domestic animals and birds).

Drug treatment for allergic rhinoconjunctivitis includes the use of antihistamines for oral and topical administration, glucocorticosteroids in the form of intranasal sprays and eye drops, mast cell membrane stabilizers and vasoconstrictor preparations.

Sometimes it is practiced to use m-holinoblokatorov, anti-leukotriene drugs and immunomodulators. In each case, the optimal method of pharmacotherapy is selected, taking into account the form of rhinoconjunctivitis, the severity of its course, the presence of comorbidities, the patient’s age and the risk of possible side effects.

The principle of using allergen-specific immunotherapy is based on administering to the patient an allergen that caused the development of allergic rhinoconjunctivitis. Administration begins with minimal doses, and then gradually increases the concentration in order to reduce the body’s sensitivity. Immunotherapy for a long time (at least 1-3 years) is carried out by an allergist in a medical institution, where conditions are created for the provision of qualified emergency care in the event of adverse reactions and complications. With proper use of allergen-specific immunotherapy is a highly effective method of treating various allergic diseases.

Allergic rhinoconjunctivitis is a chronic inflammatory disease of an allergic etiology that affects the mucous membrane of the nasal cavity and conjunctiva of the eye. Depending on the etiological factor leading to the development of the disease, there are two forms: seasonal (intermittent) and year-round (persistent). The prevalence of the disease is increasing every year, now it is found in every 5-7th adult inhabitant of the planet and in every 3rd child. A long-term chronic course increases the risk of developing rhinosinusitis, chronic otitis media and bronchial asthma, significantly limits social communication, creating difficulties for successful education and professional activity.

Causes of Allergic Rhinoconjunctivitis

The list of allergens that can cause the development of allergic rhinoconjunctivitis is quite extensive.

For the seasonal form of the disease (occurs mainly in the spring-summer period), these are plant pollen allergens that appear during certain periods, coinciding with the flowering of trees, meadow and weeds. Clinical manifestations increase in dry hot weather and decrease on rainy days with high humidity of the surrounding air.

In the year-round (persistent) form of the disease, the main allergens leading to the development of the inflammatory process in the nasal cavity and on the conjunctiva of the eye are mold fungi, house dust mites, as well as aeroallergens that affect the patient during his professional activity.

Pathogenesis of allergic rhinoconjunctivitis

The basis of the mechanism of development of allergic rhinoconjunctivitis is an IgE-mediated reaction of the immediate type. At the first contact with the allergen, a pronounced release of class E immunoglobulins specific to this protein component occurs.

Repeated ingress of the allergen into the body and its interaction with IgE leads to a massive release of inflammatory mediators and the development of the pathological process on the mucous membranes of the nasal cavity and eyes. With a persistent form, inflammation remains almost constant even in the absence of direct contact with a causally significant allergen or when it arrives in minimal concentrations.

Classification of allergic rhinoconjunctivitis

Depending on the frequency of exacerbations, there is an intermittent (seasonal) and persistent (year-round) form of the disease.

By severity of flow emit:

  • mild form of  allergic rhinoconjunctivitis (minor symptoms, do not affect performance, if necessary, you can do without drug treatment)
  • moderate form  (disturbed sleep and daytime activity, reduced quality of life)
  • t yazheluyu forms y (marked malfunction and communication problems, need constant maintenance treatment to eliminate the symptoms of the disease).
Symptoms of allergic rhinoconjunctivitis

The clinical picture varies with the seasonal and year-round form of the disease. The intermittent variant is characterized by the sudden appearance of abundant watery nasal discharge, sneezing, tearing, itching in the nasal cavity and in the eye area, photophobia, and periodical nasal congestion. Symptomatology develops in the spring and summer and increases in dry hot weather.

In the persistent form, the symptoms of the disease are present almost year-round, but are less pronounced in comparison with the seasonal form. There is a constant nasal congestion, aggravated at night, thick mucous discharge from the nose and periodic sneezing.

As a rule, there is a decrease or absence of smell (anosmia) and the presence of discharge from the eyes in the form of mucous filaments. Often the disease is complicated by the development of chronic rhinosinusitis and bronchial asthma. Exacerbations of the disease are associated with weather factors (hypothermia, sudden temperature changes), as well as with housing conditions and contacts with pets.

Diagnosis of allergic rhinoconjunctivitis

The diagnosis is established on the basis of a thorough history taking, a clinical examination of a patient by an otolaryngologist, an ophthalmologist, and an allergist-immunologist. Examination of the nasal cavity reveals the pallor and swelling of the mucous membrane, as well as the presence of abundant watery secretion. In a laboratory study of the secret is determined by the high content of eosinophils. When ophthalmological examination visible hyperemic, edematous and loosened conjunctiva. The presence of stretching mucous filaments, an increase in follicles, hyperemia and swelling of the eyelids. In severe cases, blepharospasm is detected.

In the process of diagnosis, laboratory tests and tests used in clinical allergology are prescribed. Carried out skin testing with the main atopic allergens (domestic, fungal, epidermal), carried out in the form of intradermal and scarification samples. As for testing with inhaled allergens, they are not recommended for skin allergy tests in accordance with the recommendations of European allergists.

Reliable data on the causal relationship of allergic rhinoconjunctivitis with specific allergens can be obtained by determining allergen-specific IgE immunoglobulins (identification of up to 120 allergens in one blood sample during the Allergochip test). The results obtained in the future can be used in the appointment and conduct of allergen-specific immunotherapy.

Differential diagnosis is carried out with other types of allergic lesions, viral, bacterial and chlamydial rhinoconjunctivitis, rhinosinusitis, ocular “office” syndrome and other diseases.

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