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[变应性血管运动性鼻炎的治疗:诊断问题与局部免疫疗法]

[The treatment of allergic vasomotor rhinitis: diagnostic problems and local immunotherapy].

作者信息

Motta G, Salzano F A, Motta S

机构信息

Istituto di Patologia e Clinica Otorinolaringoiatrica, Foniatria della Facoltà di Medicina e Chirurgia dell'Università di Napoli Federico II.

出版信息

Acta Otorhinolaryngol Ital. 1995 Jun;15(3 Suppl 48):1-24.

PMID:8561027
Abstract

Treatment of allergic vasomotor rhinitis is to be regarded with the factors that modify the symptomatology. In fact must be considered the morphological changes (septum deviation, adenoids, turbinates hypertrophy, polyps) infections (bacteria, chlamydiae, micetes) and specific allergens. Identification of allergens and sensitization threshold is to be studied; then specific hyposensitization will be assessed. In the present study, 68 subjects having nasal reactivity have been observed and underwent to different ways of treatment: 18 with permanent stenosis identified by rhinomanometry and not modified with vasoconstrictors were operated; 25 of the 50 patients with normal nasal cavities showed contemporary infections: after a specific antimicrobic or antimycotic treatment, a clear improvement was obtained documented by rhinomanometry before and after nasal stimulations. The 50 patients with normal morphology underwent a local hyposensitization against the allergens. As a matter of fact: a) in all cases a clear improvement was obtained in phase of increasing; b) after one year of maintainance just 13 over 50 (26%) returned to previous conditions. The Authors remark how local immunotherapy by the nasal way give good possibilities in a high percentage of cases in the following conditions: correct clinical evaluation, especially concerning the identification of factors determining vasomotor rhinitis; employment of precise techniques for diagnosis; observation of clinical data and results turning out from instrumental investigations, especially concerning the nasal provocation test evaluated by rhinomanometry.

摘要

变应性血管运动性鼻炎的治疗应考虑改变症状的因素。事实上,必须考虑形态学改变(鼻中隔偏曲、腺样体、鼻甲肥大、息肉)、感染(细菌、衣原体、真菌)以及特异性变应原。要研究变应原的鉴定和致敏阈值;然后评估特异性减敏治疗。在本研究中,观察了68名有鼻反应性的受试者并对其进行了不同的治疗:18名经鼻阻力测定确定有永久性狭窄且用血管收缩剂不能改善的患者接受了手术;50名鼻腔正常的患者中有25名同时存在感染:在进行特异性抗微生物或抗真菌治疗后,鼻刺激前后经鼻阻力测定记录显示有明显改善。50名形态正常的患者接受了针对变应原的局部减敏治疗。事实上:a)在所有病例中,在递增阶段均有明显改善;b)维持一年后,50名患者中只有13名(26%)恢复到先前状态。作者指出,在以下情况下,经鼻局部免疫疗法在高比例病例中具有良好的可能性:正确的临床评估,特别是关于确定血管运动性鼻炎的因素的鉴定;采用精确的诊断技术;观察临床数据以及仪器检查得出的结果,特别是关于经鼻阻力测定评估的鼻激发试验。

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