26.10.2020

Treatment of year-round rhinitis

Treatment activities for year-round allergic rhinitis include the greatest possible elimination of contact with potential allergens. It is necessary to combat dust and high humidity in the apartment by regular cleaning and ventilation of the premises.

It is recommended to get rid of carpets and carpets that are dust collectors, as well as upholstered furniture, if possible, replacing it with wood and plastic products, items covered with leather or vinyl. You should use air purifiers and modern vacuum cleaners that have special microfilters.

It is necessary to combat ticks and cockroaches, if possible, to give up pets and birds, aquarium fish and house flowers.

  • Drug treatment . Includes the use of antihistamines orally, topically, sometimes – parenterally, as well as stabilizers of mast cell (cromone) membranes. Intranasal glucocorticosteroids are widely used in treatment. Decongestants such as Xylometazoline and Oxymetazoline can be used as symptomatic agents during the exacerbation period for 3-10 days.
  • ASIT . An effective method of treating perennial allergic rhinitis is allergen-specific immunotherapy (ASIT), which makes it possible to stop the progression of the disease and eliminate its clinical manifestations as much as possible. ASIT is carried out by an allergist-immunologist in the absence of contraindications.

Year-round (persistent) allergic rhinitis – inflammation of the nasal mucosa, which develops when allergens that are present in the living room and enter the body with inhaled air when they enter the upper respiratory tract. Symptoms of the disease (itching, nasal congestion, rhinorrhea, sneezing) are observed more than four days a week or more than a month in a row, repeatedly repeated throughout the year. Pathology occurs in 10-20% of the world’s population, has a chronic course, and may be complicated by the development of rhinosinusitis and nasal polyposis. Often violates the general state of health, reduces performance and quality of life. The number of cases of year-round allergic rhinitis is increasing every year, mostly young people are sick. In 50% of patients other allergic diseases are detected: atopic dermatitis, bronchial asthma, allergic conjunctivitis.

Causes of year-round rhinitis

Year-round allergic rhinitis occurs as a result of sensitization to inhaled allergens contained in residential areas: house dust mites, yeast and mold fungi, products of animals, birds and insects, as well as some occupational allergens.

  • House dust allergens . In house dust, consisting of a variety of inorganic and organic substances, one of the most allergenic components is the house tick, and hypersensitivity develops to all parts of the body of the tick, its secretion and waste products (especially to faeces).
  • Allergens of animals . Often the disease occurs when repeated contact with allergens of rodents and domestic animals (cats, dogs). The main allergenic components are secretions of the sebaceous and perianal glands, dandruff, saliva, urine. It has been established that sensitization to animal allergens occurs in 10–30% of the population, and year-round allergic rhinitis becomes one of the earliest manifestations of such hypersensitivity.
  • Fungal allergens . Fungal allergy is another important factor in the development of chronic allergic inflammation of the nasal mucosa, and the most relevant in this case will be the mold fungi Aspergillus and Penicillium, which cause sensitization constantly throughout the year.
  • Other allergens . Less commonly, some professional, food and drug allergens take part in the occurrence of year-round allergic rhinitis. Polysensitization to household and pollen allergens can be observed.
Pathogenesis of year-round rhinitis

The mechanism of disease development is an immediate type of IgE-mediated allergic reaction. The first contact with the allergen leads to an excessive release of allergen-specific IgE immunoglobulins by B lymphocytes. With the repeated interaction of the allergen with antibodies on the surface of mast cells, there is a release of mediators and the development of allergic inflammation of the nasal mucosa.

With year-round allergic rhinitis, almost constant low-dose contact with the allergen persists, which explains the persistent nature of the inflammatory process.

Clinical symptoms of the disease can also provoke some non-specific irritants: cold air, exhaust fumes and tobacco smoke. In such cases, the pathological process is triggered by the mechanism of pseudo-allergy.

Symptoms of year-round rhinitis

A typical complaint of patients suffering from year-round allergic rhinitis is sneezing, starting in the morning shortly after waking up. In addition, patients are concerned about itching in the nose, throat and in the eye area, copious mucous discharge from the nose, difficulty in nasal breathing. Sometimes there are violations of the sense of smell.

Constant nasal congestion often leads to the development of an inflammatory process in the nasopharynx and paranasal sinuses. Allergic rhinitis may be complicated by polyposis. In such cases, there are pains in the projection of the frontal and maxillary sinuses and headaches, aggravated by tilting the head. There may be a long subfebrile condition.

With the flow of secretions from the nasal cavity to the back of the pharynx and into the larynx, chronic irritation of the respiratory tract mucosa occurs, manifested by a dry cough (constant cough). Prolonged disturbance of nasal breathing leads to sleep disorders, snoring, episodes of apnea, voice changes, reduced mental and physical performance.

The transition of the allergic inflammatory process to the mucous membrane of the Eustachian tube contributes to the development of inflammation of the middle ear, the appearance of pain in the ear, hearing loss, and tinnitus.

Diagnosis of year-round rhinitis

The diagnosis of year-round allergic rhinitis is established as a result of studying anamnestic data, clinical examination of an otolaryngologist and an allergist-immunologist, laboratory tests (eosinophilia is detected in a blood test and secretion from the nasal cavity) and instrumental examinations. The number of instrumental techniques includes radiography and computed tomography of the paranasal sinuses, as well as endoscopic examination of the nasal cavity.

A mandatory allergological examination with testing of potential allergens (domestic, fungal, occupational) by skin allergy tests, determination of the level of total and allergen-specific IgE immunoglobulins in serum is necessary. The provocative nasal test is sometimes practiced.

Differential diagnosis of year-round allergic rhinitis is carried out with other allergic rhinitis nature, non-allergic rhinitis (infectious, vasomotor, year-round non-allergic). Given the frequent combination of allergic rhinitis with bronchial asthma, prescribe an appropriate examination, to confirm or exclude the presence of this pathology.

Forecast and prevention of year-round rhinitis

The prognosis of the disease with timely diagnosis and the appointment of adequate treatment is favorable. To prevent symptoms, it is necessary to eliminate or minimize the encounter with a causally significant allergen: house dust, animal hair, mold, professional harm, etc.

Prevention includes conducting preventive courses of antiallergic therapy, dispensary observation of the allergist and compliance with all the recommendations of the doctor.

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