Shapiro G G
Northwest Asthma and Allergy Center, University of Washington School of Medicine, Seattle.
J Allergy Clin Immunol. 1988 Nov;82(5 Pt 2):935-40. doi: 10.1016/0091-6749(88)90036-x.
Allergic rhinitis in children is often complicated by bacterial sinusitis, which can lead to chronic illness and dysfunction. Sinus disease manifests differently in children than in adults, with cough, rhinorrhea, and middle ear disease being common and pain, headache, and fever being uncommon. Sinusitis may exacerbate asthma, and as many as 70% of children with allergy and chronic rhinitis have abnormal findings on sinus x-ray studies. Nasal cytologic specimens showing large numbers of polymorphonuclear cells with intracellular bacteria are also evidence of sinusitis. Obstruction of the nasal airways by allergic rhinitis or enlarged adenoids can lead to deviations in facial growth, specifically increased facial length. With the removal of the obstruction and a return to nasal breathing, facial length may become more normal. Sinusitis in children is treated with antibiotics, usually for 3 to 4 weeks, to eliminate the infection. Adjunctive therapy with antihistamines, decongestants, cromolyn, and corticosteroids may also be helpful. Topical steroids, such as flunisolide and beclomethasone, can be very useful in pediatric patients. These steroids decrease edema and prevent the release of allergic mediators that may be responsible for an environment favoring the bacterial infection causing sinusitis.
儿童过敏性鼻炎常并发细菌性鼻窦炎，可导致慢性病和功能障碍。鼻窦疾病在儿童中的表现与成人不同，咳嗽、流涕和中耳疾病较为常见，而疼痛、头痛和发热则不常见。鼻窦炎可能会加重哮喘，多达70%的过敏和慢性鼻炎儿童鼻窦X光检查有异常发现。鼻细胞学标本显示大量含细胞内细菌的多形核细胞也是鼻窦炎的证据。过敏性鼻炎或腺样体肿大引起的鼻气道阻塞可导致面部生长偏差，特别是面部长度增加。去除阻塞物并恢复鼻呼吸后，面部长度可能会变得更正常。儿童鼻窦炎通常用抗生素治疗3至4周以消除感染。抗组胺药、减充血剂、色甘酸和皮质类固醇的辅助治疗也可能有帮助。局部用类固醇，如氟尼缩松和倍氯米松，对儿科患者可能非常有用。这些类固醇可减轻水肿并防止可能导致有利于引起鼻窦炎的细菌感染的环境的过敏介质释放。
