变应性鼻炎

Allergic Rhinitis变应性鼻炎,Lai he 赖荷E.N.T department The second affiliated hospitalGuangzhou medical college广医二院耳鼻咽喉教研室,General information,Definition定义 Allergic rhinitis can be defined as a disease giving rise to two or three of the following symptoms: sneezing attacks serous hypersecretion（高分泌） and nasal blockage due to a swollen nasal mucosa.2.Morbidity （发病率） 10%-40%,General information,3.Classification 分类 Perennial allergic rhinits 常年性变应性鼻炎 Seasonal allergic rhinitis 季节性变应性鼻炎 ( pollinosis)4.Atopic type特应型个体 It is a individual who brings the genes which have relation with allergic rhinitis (familial or hereditary nature) 带有与变应性鼻炎发病有关的基因的个体,Pathophysiology病理生理,type allergy 一型变态反应 It is an inflammatory disorder characterized by an immunoglobulin E(IgE) mediated hypersensitivity to allergens 由IgE介导的机体对变应原超敏反应而引起的炎症性损害,Pathophysiology病理生理,1.Sensitization 致敏 contactAntigens Respiratory mucosa 呼吸道粘膜 activate CD4+ T Lymphocyte Th2 cell secrete Deliver signal IL-4,IL-5,IL-6,IL-10,IL-13 (Mediators炎症介质) activate B cell Hemaendotheliocyte 血管内皮细胞 ICAM-1(intercellular adhesion molecule-1细胞间粘附分子-1) produce attach Eosinophil嗜酸细胞 IgE Mast cell 肥大细胞 go to nasal mucosa receptor on basophil嗜碱细胞 T lymphocyte淋巴细胞,Pathophysiology病理生理,2. Allergy contact nasalAntigen bridging of antigen molecule and IgE mucosa again mast cell derganulation 脱颗粒 release Histamine 组织胺 and other mediators contraction of high excitability increasing in hypersensitivity resistant vessel parasympathetic vascular permeability of sensory nerve& dilatation of nerve 副交 通透性 感觉神经capacity vessel 感神经阻力血管收缩和容量血管扩张 increasing mucosal nasal itchingpale &purple glandulous secretion edema sneezing Nasal Mucosa 粘膜水肿 鼻痒、打喷嚏blockage watery discharge,Clinical Presentation 临床表现,nasal itching sometimes itching of eyes 鼻痒 conjunctival injection 结膜充血2. Sneezing attacks 阵发性打喷嚏3. Nasal discharge 流涕 watery4. Nasal blockage 鼻塞5. Hyposmia 嗅觉减退,Examination 检查,1.Nasal examination: light blue , congestive 鼻腔检查 or pale mucosa, mucosal edema 水肿 especially inferior turbinate 下鼻甲2.Nasal discharge exam: a lot of eosinophil 鼻分泌物 嗜酸细胞3.Serum total IgE determination 血清总IgE检查,Examination,2. Finding allergen 寻找抗原 commom allergen: page 58 Perennial: house dust 屋尘；mite 螨虫 fungus真菌；pollen 花粉 chemical material Seasonal: pollen ( sun flower,corn ,glass),Examination检查,2. Finding allergen 寻找抗原 a. Special IgE examination 特异性IgE检查 Skin testing: prick test 点刺试验 intracutaneous test 皮内试验 Serum special IgE determination 血清特异性IgE检查 b. Nasal allergen challenge test 鼻激发实验,Diagnosis诊断,1.History 病史2.Clinical manifestation临床表现3.allergy diagnosis变应原诊断,Differential Diagnosis鉴别诊断,1.Nonallergic rhinitis with eosinophilia 嗜酸粒细胞增多性非变应性鼻炎2.Vasomotor rhinitis 血管运动性鼻炎,Complication并发症,Allergic nasal sinusitis 变应性鼻窦炎2. Asthma 支气管哮喘Secretory otitis media 分泌性中耳炎,Treatment治疗,1.Pharmacotherapy 药物治疗 a. Steroid : topicalnasal spray 鼻喷雾剂 类固醇 general 全身用药b.Antihistamines: H1-receptor antagonist H1受体拮抗剂 抗组胺药 First-generation第一代: toldrin 朴尔敏 second-generation:clarity (dont cross the blood- 第二代 brain barrier 不能通过血脑屏障)c.Mast cell stabilizing drug:disodium cromoglycate 肥大细胞膜稳定剂 色甘酸钠,Treatment治疗,d. Decongestants 血管减充剂 typical: short terme.Anticholinergic drug: 抗胆碱药f.Others: reduce sensitivity of nasal mucosa inferior turbinate-lazar,crymotherapy 冷冻 microwave 微波 surgery :vidian neurectomy 翼管神经切断术 手术 anterior ethmoid neurectomy 筛前神经切断术 submucous resection of nasal septum 鼻中隔矫正术,Treatment治疗,2.Avoid to contact allergen 避免接触变应原3.Immunotherapy 免疫治疗 Indication: IgE-mediated disease (type allergy) caused by 适应症 inhalant allergen Method: increasing doses of allergen are injected until 方法 the maximum tolerable dose is reached maintenance dose(maximum tolerable dose ) 最大耐受剂量 Course: 2 years or more 疗程,Immunotherapy免疫治疗,Mechanism 作用机理 : unclear blocking antibody 封闭抗体 balance between Th1and Th2 Rush immunotherapy: pollinosis 花粉症 快速免疫疗法 1-2weeks reach maximum tolerable dose(maintenance dose),references,Tian yong-quan et al,otolaryngology 5th edition, textbook of series of new century, 2001.Niels mygind et al, nasal allergy 2nd edition, blackwell scientific publications, 1979Hueston G.king, otolaryngologic allergy,symposia specialists Inc.1981.Allen M.seiden,otolaryngology:the essentials,thieme medical publishers,Inc. 2001 Ye shitai et al, allergology science press beijing 1998,Question,1.whats the definition of allergic rhinitis?2.The main symptoms of