Liang Meijun, Xu Rui, Xu Geng
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Feb;29(3):202-6.
Allergic rhinitis (AR) clinically expressed by sneezing, rhinorrhea, nasal itching and congestion is an allergen-driven mucosal inflammatory disease which is modulated by immunoglobulin E. Epidemiological studies have indicated that prevalence of AR continues to increase, and it has been a worldwide health problem that places a significant healthcare burden on individuals and society. Given the evolving understanding of the process by which an allergen is recognized and the roles of mediators which account for AR progress, the pathogenesis of AR has become clearer. Current studies have demonstrated local allergic rhinitis (LAR) that patients with both sug- gestive symptoms of AR and a negative diagnostic test for atopy may have local allergic inflammation is a prevalent entity in patients evaluated with rhinitis, but further research remains needed. Management of AR includes aller- gen avoidance, pharmacological treatment and allergen-specific immunotherapy. Recently montelukast has exhibited previously undocumented anti-inflammatory properties, leukotriene receptor antagonists therefore may serve a more important role in the treatment of AR. Not only has immunotherapy proved its efficacy, but also been able to alter disease course and thereby mitigate progression to asthma. Thus immunotherapy can be initiated while receiving pharmacotherapy, especially in children with AR. As clinical guidelines, the ARIA (Allergic Rhinitis and its Impact on Asthma) provides basic principles of effective treatment of AR. Besides, choosing an appropriate treatment strategy should be based on the severity and chronicity of patient's symptom. The aim of this review was to provide an update mainly on the pathophysiology, epidemiology, and management of AR.
变应性鼻炎(AR)临床上以打喷嚏、流涕、鼻痒和鼻塞为表现,是一种由变应原驱动的黏膜炎症性疾病,由免疫球蛋白E介导。流行病学研究表明,AR的患病率持续上升,它已成为一个全球性的健康问题,给个人和社会带来了沉重的医疗负担。鉴于对变应原识别过程以及介导AR进展的介质作用的认识不断发展,AR的发病机制已变得更加清晰。目前的研究表明,局部变应性鼻炎(LAR),即有AR提示症状且特应性诊断试验阴性的患者可能存在局部变应性炎症,在鼻炎评估患者中是一种常见情况,但仍需进一步研究。AR的治疗包括避免接触变应原、药物治疗和变应原特异性免疫治疗。最近,孟鲁司特展现出了前所未有的抗炎特性,因此白三烯受体拮抗剂可能在AR治疗中发挥更重要的作用。免疫治疗不仅已证明其有效性,还能够改变疾病进程,从而减轻向哮喘的进展。因此,免疫治疗可在接受药物治疗时启动,尤其是对于患有AR的儿童。作为临床指南,ARIA(变应性鼻炎及其对哮喘的影响)提供了有效治疗AR的基本原则。此外,应根据患者症状的严重程度和慢性程度选择合适的治疗策略。本综述的目的主要是提供关于AR的病理生理学、流行病学和治疗的最新信息。