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The pollen season is in full swing, which is a real torment for millions of Poles suffering from allergic rhinitis. Although the disease is not life-threatening, it can dramatically decrease the quality of life, leading to problems with sleep and attention, which makes it difficult to work and learn. It is also a risk factor for the development of bronchial asthma, and therefore this often underestimated problem requires effective treatment. And in this field, significant progress has been made in recent years.
Allergic rhinitis (AR) is a group of symptoms that includes a runny nose, often accompanied by a stuffy, itchy nose and sneezing. There may also be eye discomfort in the form of lacrimation, redness and itching of the conjunctiva. A fairly common accompanying symptom is a cough, which is a consequence of the increased flow of nasal secretions down the back of the throat.
AR is a widespread disease in the population. Statistical studies show that up to 40% of the population may be sick (in Poland this percentage is estimated at approx. 25%). Symptoms of the disease appear most often in childhood and adolescence, although it is known that the disease can occur at any age. In 80% of cases, however, the first symptoms appear before the age of 20. AR develops in people who are allergic to various types of allergens. Symptoms of the disease occur when exposed to a harmful allergen. And this is what the frequency of symptoms depends on.
In the past, two basic forms of ANN were distinguished: seasonal and all-year-round. Seasonal was to be associated with exposure to allergens occurring in the pollen season, while the year-round result from exposure to allergens with which we have contact all year round. However, this division is no longer valid. It is known that the symptoms do not depend on the mere presence of a given allergen, but on whether the exposure to the allergen is permanent or only periodic. Thus, a person allergic to dust mites, who is not exposed to dust in his home, will only have rhinitis symptoms when he finds himself in a dusty basement or warehouse. As soon as he returns to his apartment, the symptoms will pass. Therefore, nowadays there is talk of the periodic and chronic form of AR. The criterion for diagnosis of chronic disease is the persistence of symptoms for at least four days a week for at least four weeks.
A well-collected history from the patient is enough to diagnose the disease in a significant percentage of cases. Patients tell about the characteristic symptoms of the disease, often identifying the triggering allergen themselves. It is essential that symptoms recur when exposed to an allergen. Then, supplementary tests are usually not needed. In case of doubt, it is possible to confirm the sensitization to the suspected allergen by means of tests such as skin tests or testing the level of IgE antibodies against the sensitizing substance. The so-called provocation tests in which a suspected allergen is administered intranasally to see if it causes symptoms. The most common culprits are pollen (causing symptoms during the pollen season – the pollen calendar for Poland can be found at www.kichacze.pl), house dust mites, animal hair. In the presence of sinusitis (the lining of the paranasal sinuses is continuous with the nasal mucosa), which can sometimes be difficult to distinguish from chronic or infectious sinusitis, a Pap smear test may be helpful. The types of cells that dominate the inflammatory infiltrate help determine whether allergic or infectious mechanisms are responsible for the symptoms.
It is known that in AR, contact with an allergen activates cells and immune mechanisms, resulting in the development of allergic inflammation. These mechanisms are similar to those underlying the development of bronchial asthma and other allergic diseases. Some studies show that up to half of asthma patients may have symptoms of AR. And in this group of patients, proper and effective treatment of rhinitis is essential. It is known that untreated AR in these patients may impede proper asthma control and cause more frequent exacerbations. AR often coexists with atopic dermatitis. A very interesting phenomenon is the relationship between ANN and the so-called oral allergy syndrome (OAS). It may be a separate disorder, but it is most often associated with other allergic conditions, such as AR or bronchial asthma. As a result of mechanisms not fully understood so far, the so-called cross-sensitization to food allergens. This is due to the similar structure of inhaled allergens, such as birch pollen, and the ingredients of the consumed substances, such as apples. And so, in people who have symptoms of allergic rhinitis caused by an allergy to birch pollen, oral allergy symptoms may appear when consuming apples. On contact with the apple, the lips and tongue begin to itch, redness and swelling appear.
Symptoms of AR can vary in severity. Sometimes the only problem is increased sneezing and stuffy nose, which, however, are not too bothersome and do not significantly limit daily activities. However, when the symptoms of AR are very bothersome, cause sleep disturbances, make it difficult to perform daily duties, including work and / or school, or prevent the exercise of current physical activity – the disease requires intensive and systematic treatment.
As a mantra, medical textbooks reiterate the three basic strategies for treating allergic rhinitis. The first is to avoid contact with the allergen that causes your symptoms. However, this is probably a recommendation that is very difficult to implement in practice. Because how to avoid the now ubiquitous birch pollen, the concentration of which in the air will increase in the coming days? Children must go to school and adults must go to work. Eliminating dust mites from the house is also a huge problem, which often requires a real hygienic revolution. Sometimes it is also difficult to part with a beloved domestic animal. In patients with severe symptoms, it is necessary to make every effort to eliminate the presence of the allergen causing the disease.
The second and basic therapeutic method, however, is the use of drugs whose task is not only to remove the symptoms, but – in moderate and severe cases of AR – also to extinguish the inflammation in the nose. And here, in recent years, the real breakthrough is the new preparations of glucocorticosteroids intended for intranasal use. They are anti-inflammatory and help to permanently eliminate the symptoms of AR. A significant improvement in the safety of these drugs meant that they can be used chronically, also in children, without exposing the patient to the systemic effects of glucocorticosteroids. Since glucocorticosteroids develop their effect only after a few days of use, antihistamines are also used for the immediate relief of symptoms – both orally and intranasally. Sea salt solutions are also very helpful, as they allow you to thoroughly clean the nose and prepare its mucosa for the administration of anti-inflammatory drugs. Vasoconstrictors, which are commonly available over the counter, are definitely a thing of the past. Patients willingly use them due to the fact that they quickly bring relief to a stuffy nose. It is known, however, that the action of these drugs is short-lived, and overuse leads, paradoxically, to intensify catarrhal symptoms. They are not recommended for use in children or adults.
The last treatment option is called specific immunotherapy commonly referred to as “desensitization”. It involves giving an allergen to an allergic person that causes their symptoms in very small doses, which over time causes tolerance of the substance. Although this treatment is highly effective – even 80% – it is a long-term process. The first beneficial effects are observed after about 6-12 months, and the therapy itself can last up to 5 years. This treatment is initiated and supervised by allergists.
Text: lek. Paulina Jurek
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