Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
JAMA. 2024 Mar 12;331(10):866-877. doi: 10.1001/jama.2024.0530.
Allergic rhinitis affects an estimated 15% of the US population (approximately 50 million individuals) and is associated with the presence of asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches.
Allergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE. Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat. In an international study, the most common symptoms of allergic rhinitis were rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis present primarily with nasal congestion and postnasal drainage frequently associated with sinus pressure, ear plugging, muffled sounds and pain, and eustachian tube dysfunction that is less responsive to nasal corticosteroids. Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates. Patients with perennial allergic rhinitis typically have erythematous and inflamed turbinates with serous secretions that appear similar to other forms of chronic rhinitis at physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens. Intermittent allergic rhinitis is defined as symptoms occurring less than 4 consecutive days/week or less than 4 consecutive weeks/year. Persistent allergic rhinitis is defined as symptoms occurring more often than 4 consecutive days/week and for more than 4 consecutive weeks/year. Patients with allergic rhinitis should avoid inciting allergens. In addition, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine), whereas patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine. In contrast, first-line therapy for patients with nonallergic rhinitis consists of an intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid.
Allergic rhinitis is associated with symptoms of nasal congestion, sneezing, and itching of the eyes, nose, and throat. Patients with allergic rhinitis should be instructed to avoid inciting allergens. Therapies include second-generation H1 antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine), intranasal antihistamines (eg, azelastine, olopatadine), and intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) and should be selected based on the severity and frequency of symptoms and patient preference.
过敏性鼻炎影响估计美国人口的 15%（约 5000 万人），并与哮喘、湿疹、慢性或复发性鼻窦炎、咳嗽以及紧张性和偏头痛有关。
当上皮屏障的破坏允许过敏原穿透鼻道的粘膜上皮时，就会发生过敏性鼻炎，引起辅助性 T 细胞 2 型炎症反应和过敏原特异性 IgE 的产生。过敏性鼻炎通常表现为鼻塞、流涕、鼻后滴注、打喷嚏和眼睛、鼻子和喉咙发痒。在一项国际研究中，过敏性鼻炎最常见的症状是流涕（90.38%）和鼻塞（94.23%）。非过敏性鼻炎患者主要表现为鼻塞和鼻后滴注，常伴有窦压、耳塞、闷声和疼痛，以及咽鼓管功能障碍，对鼻用皮质类固醇反应较差。季节性过敏性鼻炎患者通常在体格检查时发现鼻甲水肿和苍白。常年性过敏性鼻炎患者通常鼻甲呈红斑和炎症，有浆液性分泌物，在体格检查时与其他形式的慢性鼻炎相似。非过敏性鼻炎患者的特异性 IgE 变应原检测结果为阴性。间歇性过敏性鼻炎定义为症状每周出现少于 4 天/周或每年少于 4 周。持续性过敏性鼻炎定义为症状每周出现超过 4 天/周，每年超过 4 周。过敏性鼻炎患者应避免接触过敏原。此外，轻度间歇性或轻度持续性过敏性鼻炎的一线治疗可能包括第二代 H1 抗组胺药（如西替利嗪、非索非那定、地氯雷他定、氯雷他定）或鼻内抗组胺药（如氮卓斯汀、奥洛他定），而持续性中重度过敏性鼻炎患者应初始接受鼻内皮质类固醇（如氟替卡松、曲安奈德、布地奈德、糠酸莫米松）治疗，单独使用或与鼻内抗组胺药联合使用。相比之下，非过敏性鼻炎患者的一线治疗包括鼻内抗组胺药单药治疗或与鼻内皮质类固醇联合治疗。
过敏性鼻炎与鼻塞、打喷嚏和眼睛、鼻子和喉咙发痒的症状有关。过敏性鼻炎患者应被告知避免接触过敏原。治疗包括第二代 H1 抗组胺药（如西替利嗪、非索非那定、地氯雷他定、氯雷他定）、鼻内抗组胺药（如氮卓斯汀、奥洛他定）和鼻内皮质类固醇（如氟替卡松、曲安奈德、布地奈德、糠酸莫米松），应根据症状的严重程度和频率以及患者的偏好选择。
