Recognising and managing allergic disease in the community

Allergic disease and its symptoms, whether seasonal or perennial, can have a significant impact on individuals' quality of life. Asthma, allergic rhinitis, eczema, urticaria and food allergy are among the common allergies that nurses may encounter in the community. This article discusses the causes of allergic disease, the importance of considering allergen avoidance, and the alternative treatment options available.     

变应性鼻炎与吸入性变应原及花粉致敏的关系

目的:回顾2004年及2005年3～12月吸入性变应原皮试检测结果,寻找吸入性变应原及花粉致敏诱发变应性鼻炎的发病规律。方法:对近两年以变应性鼻炎为首诊症状的病人进行临床检查及变应原皮肤实验。结果:960例病人中,检查阳性749例(78.0%),阴性211例(22.0%)。19种吸入性变应原中花粉变应原占七种,其皮试阳性503例,占皮试阳性率67.2%,其它变应原皮试阳性246例,占皮试阳性率32.8%。花粉皮试阳性率与季节密切相关。结论:吸入性变应性原皮内实验有助于诊断、预防、治疗、变应性疾病。变应性鼻炎、花粉症发病与季节密切相关,特别是花粉症与气传花粉播散季节及花粉种类、浓度相关性甚强。     

Allergic rhinitis and its pharmacology

The pathophysiology of allergic rhinitis and its drug treatment is reviewed. Special emphasis is placed upon potential new treatments. Allergic rhinitis is characterized by allergen(s), symptoms (sneezing, itching, rhinorrhea, nasal congestion and nasal hypersensitivity), and signs such as invasion of nasal mucosa by inflammatory cells. Such pathological changes are due to inflammatory responses mediated by way of allergen-immunoglobulin E (IgE)-cell complex formation. The complexity of the disease and the multiple pathways involved offer many targets for drug treatment, but to date no single drug is totally effective. This review summarizes the current knowledge of allergic rhinitis, its prevalence, pathophysiology and experimental and clinical treatments. In the search for new drugs, different experimental animal models of allergic rhinitis are required. As a result the models have also been reviewed. Furthermore, particular aspects of the pathophysiology of allergic rhinitis are discussed in greater detail including the immune cells involved in the mediation of the disease, chemical mediators, their actions, and the receptors on which they act. Therapy, particularly that with current drugs, targets many of the known mediators and some of the cellular processes with varying success. Other drugs, for example, vasoconstrictors given to reduce rhinorrhea, provide symptomatic relief by counteracting symptoms. Since the incidence of allergic rhinitis is prevalent and growing in many parts of the world and current treatments are not ideal, it is important to continue to study the pharmacology of this disease as part of a search for better drugs.     

Allergen-induced inflammation and the role of immunoglobulin E (IgE).

The prevalence of common allergic disorders such as asthma, allergic rhinitis, and atopic dermatitis has increased significantly in the past 30 years. The impact of these atopic diseases on the patient and the health care system is considerable: Allergic disorders are associated with a high degree of morbidity, which can profoundly impact patient quality of life and health care resource use. Existing strategies to treat allergic disorders beyond simple allergen avoidance focus on diminishing or eliminating the recurrent and/or persistent signs and symptoms that characterize the allergic response. A new strategy has been developed that uses antibodies directed against immunoglobulin E (IgE) to prevent it from binding to cells bearing its receptors and thus neutralizing the allergic response before it begins. These new agents reduce allergic responses in atopic individuals and improve their symptoms while reducing rescue medication and corticosteroid use in patients with allergic asthma or seasonal allergic rhinitis. Thus, anti-IgE antibodies represent proof that IgE plays a central role in allergic reactions and that anti-IgE therapy is a potentially effective treatment for allergic disease.     

儿童变应性鼻炎的相关因素及其治疗

儿童是变应性鼻炎的高发年龄。变应性鼻炎可给患儿的学习及生活带来很大影响，使整个家庭的生活质量降低。本文主要针对儿童变应性鼻炎发生的相关因素进行探讨，并依据儿童的特点提出相应的治疗措施。     

Use of intranasal cromolyn sodium for allergic rhinitis

Allergic rhinitis affects 10% to 20% of Americans. It frequently coexists with other conditions, such as allergic conjunctivitis, sinusitis, and asthma, and is associated with impaired occupational function and performance in school, decreased quality of life, and increased health care costs. An efficacious agent with minimal adverse effects and a lack of drug interactions is needed to help simplify treatment of allergic rhinitis, especially in patients with comorbidities. Controlled studies of intranasal cromolyn sodium therapy for patients with seasonal and perennial allergic rhinitis are reviewed, and appropriate candidates for treatment with this agent are discussed. Cromolyn inhibits the degranulation of sensitized mast cells, thereby blocking the release of inflammatory and allergic mediators. It reduces symptoms of allergic rhinitis, and, when used prophylactically, cromolyn can prevent symptoms from occurring. Controlled studies comparing cromolyn with placebo, intranasal corticosteroids, and antihistamines have shown the efficacy of cromolyn in relieving rhinitis symptoms. In addition, because cromolyn is poorly absorbed systemically, it is well tolerated and not associated with drug interactions. Intranasal cromolyn has an excellent safety record, is available as an over-the-counter medication, and has been proved to be efficacious in patients with allergic rhinitis.     

变应性鼻炎评分在变应性鼻炎诊断中的应用

目的比较变应性鼻炎评分系统（SFAR）与皮肤点刺试验（SPT）在变应性鼻炎诊断中的作用,评估SFAR在变应性鼻炎诊断中的作用,为变应性鼻炎的诊断提供一种新的筛选诊断工具。方法耳鼻咽喉科门诊进行就诊的变应性鼻炎疑似患者,按入选标准筛选后,共88例进入试验;采用SFAR评估患者的变应性病史,进行皮肤点刺试验检测患者的过敏原,进行统计学分析。结果与皮肤点刺试验相比较,变应性鼻炎评分与其具有相当高的一致性,其灵敏度为82．3％,特异度为60．1％;其准确度为75％。结论变应性鼻炎评分系统不仅为变应性鼻炎的诊断提供了简单经济的方法,也为临床病史的采集提供了有益的参考。     

Allergic rhinitis in family practice: the role of levocetirizine in clinical care

Allergic rhinitis is one of the most common presentations of allergic disorders in the United States, affecting more than 20% of the population. Chronic rhinitis affects patients' quality of life and exacerbates comorbid conditions. Its widespread burden affects society by substantially decreasing worker and scholastic productivity. Allergic rhinitis is typically managed with pharmacotherapy to alleviate symptoms and control comorbid conditions, yet many of these agents carry their own burden due to bothersome and sometimes severe side effects that can compromise patient safety. A new generation of non- or less-sedating antihistamines has recently emerged. These agents offer the promise of enhanced effi cacy and tolerability. Of these agents, levocetirizine is the latest antihistamine introduced in the United States. It appears to be safe and effective for the treatment of allergic rhinitis. In addition to covering the above topics, this article reviews the value of levocetirizine for the treatment of allergic rhinitis based on its pharmacologic and pharmacokinetic profile, its effi cacy compared with placebo and other new-generation antihistamines, and its safety and tolerability.     

Allergen immunotherapy decreases interleukin 4 production in CD4+ T cells from allergic individuals

Allergen specific CD4+ T cell clones generated from allergic individuals have been shown to produce increased levels of the cytokine interleukin 4 (IL-4), compared to allergen specific clones generated from nonallergic individuals. This difference between CD4+ T cells from allergic and nonallergic individuals with regard to cytokine production in response to allergen is thought to be responsible for the development of allergic disease with increased IgE synthesis in atopic individuals. We examined the production of IL-4 in subjects with allergic rhinitis and in allergic individuals treated with allergen immunotherapy, a treatment which involves the subcutaneous administration of increasing doses of allergen and which is highly effective and beneficial for individuals with severe allergic rhinitis. We demonstrated that the quantity of IL-4 produced by allergen specific memory CD4+ T cells from allergic individuals could be considerably reduced by in vivo treatment with allergen (allergen immunotherapy). Immunotherapy reduced IL-4 production by allergen specific CD4+ T cells to levels observed with T cells from nonallergic subjects, or to levels induced with nonallergic antigens such as tetanus toxoid. In most cases the levels of IL-4 produced were inversely related to the length of time on immunotherapy. These observations indicate that immunotherapy accomplishes its clinical effects by reducing IL-4 synthesis in allergen specific CD4+ T cells. In addition, these observations indicate that the cytokine profiles of memory CD4+ T cells can indeed be altered by in vivo therapies. Thus, the cytokine profiles of memory CD4+ T cells are mutable, and are not fixed as had been suggested by studies of murine CD4+ memory T cells. Finally, treatment of allergic diseases with allergen immunotherapy may be a model for other diseases which may require therapies that alter inappropriate cytokine profiles of memory CD4+ T cells.     

郴州地区支气管哮喘与其他过敏性疾病的相关性调查分析

目的 了解郴州地区支气管哮喘的相关过敏因素,及其他过敏性疾病的相关性.方法 对216例支气管哮喘进行过敏原的相关检测,及其他过敏性疾病的相关性进行临床调查.结果 有176例患者变应原检测阳性,其中吸入性过敏原以户尘螨、粉尘螨阳性率最高,为42.05%,食人性过敏原中以鱼蟹虾的阳性率最高,为28.98%,发现62.04%支气管哮喘患者有变应性鼻炎、湿疹、荨麻疹、过敏性结膜炎、药物过敏等过敏性疾病,51.38%支气管哮喘患者有哮喘疾病家族遗传史.结论 郴州地区的支气管哮喘过敏原检测以粉尘、尘螨最多见,哮喘和其他过敏性疾病及家族史有一定相关性.     

变应性鼻炎的研究进展

变应性鼻炎是鼻黏膜慢性炎症反应性疾病，近年来发病率呈上升趋势。本文重点介绍变应性鼻炎的病理生理学、分型、伴发疾病和治疗的最新进展。     

Allergy shots for hay fever

Although allergy shots have been used for many years, immunotherapy for symptoms of allergic rhinitis has only recently been clearly shown to be effective. Standardization of allergens will provide even better results in the diagnosis and treatment of allergic rhinitis in the future. Success in an individual patient depends on appropriate application. Immunotherapy should be reserved for patients who have allergy to airborne allergens, have significant symptoms after exposure to them, have sensitivity that has been proven by a skin or in vitro test, and cannot avoid the allergen or control symptoms with drugs. Thus, allergy shots are generally not used for allergy to pet dander or food. Immunotherapy is begun with a very dilute concentration of allergen, which is gradually increased to the maximum dose that is safely tolerated. The interval between shots is then increased gradually to once a month. Duration of treatment is usually 3 years in children and longer in adults. Treatment usually fails if the patient cannot free the environment of large amounts of known allergens, if the allergen was not correctly determined during initial evaluation, or if the allergen dose is inadequate. The patient must have realistic expectations: Allergy shots often do not totally eliminate symptoms, and improvement takes time.     

Allergic rhinitis: a growing primary care challenge

PURPOSE: To describe the growing problem of allergic rhinitis (AR) and the latest recommendations on its diagnosis and management for the nurse practitioner (NP) in primary care settings. DATA SOURCES: Recent clinical research, review articles and consensus guidelines, and the author's clinical experience. CONCLUSIONS: The prevalence of AR is increasing, possibly due to increased airborne pollutants, poor ventilation, and rising levels of indoor allergens. Allergic disease is systemic and rarely involves a single symptom. Treatments include reducing exposure to allergens as well as pharmacotherapy. IMPLICATIONS FOR PRACTICE: Patient education is crucial for successful management and includes understanding the allergic basis of symptoms, reducing allergen exposure, understanding proper use of medications, and reassessing the plan on a regular basis.     

变应性鼻炎患者血清总IgE和特异性IgE分析

目的分析深圳特区变应性鼻炎的吸入性过敏原分布特点,为该地区变应性鼻炎的预防、诊断和治疗提供依据。方法采用德国Mediwiss过敏原体外检测系统,对569例变应性鼻炎患者血清特异性IgE和总IgE检测结果进行回顾性分析。结果 569例变应性鼻炎患者中,吸入性过敏原中以户尘螨阳性率最高(62.6%),其次是蟑螂、狗毛和屋尘,阳性率分别为14.4%、14.1%和10.0%;男女性别间过敏原阳性率没有显著差异(P0.05),但儿童组吸入性过敏原阳性率为87.8%,成人组吸入性过敏原阳性率为65.4%,两者差异显著(P0.0001);血清总IgE阳性率为81.9%,吸入性过敏原特异性IgE阳性率为74.2%,总IgE阳性率明显高于特异性IgE阳性率,差异有统计学意义(P0.0001)。结论户尘螨是诱发深圳特区变应性鼻炎的主要过敏原;儿童AR患者过敏原阳性率高于成人AR患者,可能与其免疫系统发育尚不完善有关;联合检测血清总IgE和过敏原特异性IgE可提高变应性鼻炎诊断的准确性。     

标准化尘螨疫苗免疫治疗过敏性鼻炎的疗效

目的探讨过敏性鼻炎患者进行标准化尘螨变应原疫苗免疫治疗时,护理干预、强化心理护理和健康教育对免疫治疗进度及治疗效果的影响。 方法将86例过敏性鼻炎患者进行标准化尘螨变应原疫苗（安脱达）免疫治疗,治疗基础上实行护理干预、强化心理护理和健康教育,并对治疗疗效和症状改善评分, 全身不良事件分级。 结果86例患者全部完成2年的免疫治疗,无脱漏病例。治疗结束时显效38例（44.2%）、有效42例（48.8%）、无效6例（7%）,总有效率为93%。 结论安脱达免疫治疗过敏性鼻炎疗效是安全、有效、可靠的,高质量的护理干预是确保治疗效果的关键。       

变应性鼻炎与鼻中隔偏曲相关性分析

目的从临床的角度探讨鼻中隔偏曲与应变性鼻炎的相关性。方法通过问卷和前鼻镜检查,对3856例体检后诊断为鼻中隔偏曲的702例患者,同时在体检人员中随机选择702例非鼻中隔偏曲者作为对照组进行回顾性分析,比较变应性鼻炎的发生情况。结果鼻中隔偏曲合并常年性变应性鼻炎的有309例,占44．0％（309／702）,季节性鼻炎35例,占5．0％（35／702）;对照组常年性变应性鼻炎77例,占11％（77／702）,季节性变应性鼻炎28例,占4．0％（28／702）。两组常年性变应性鼻炎发生的差异性有明显的统计学意义（P〈0．01）。结论鼻中隔偏曲与常年性变应性鼻炎的发生有相关性。     

呼吸道变应性炎症

变应性鼻炎和哮喘等呼吸道变应性炎症存在共同的炎症反应机制。本文重点介绍变应性炎症的遗传学基础、免疫病理学、上下呼吸道炎症的相互作用以及治疗的相关性     

Nasal disorders in children. Allergic rhinitis, vasomotor rhinitis, and nasal polyps

Although the symptoms of allergic rhinitis, vasomotor rhinitis, and nasal polyps are similar, these conditions usually require different treatment. Allergic rhinitis responds best to environmental control, avoidance of allergens and irritants, and intermittent use of medication. Hyposensitization therapy is useful in some patients. Vasomotor rhinitis is usually helped by avoidance of environmental factors, but medical or surgical management is sometimes appropriate. Nasal polyps can be removed surgically.     

Nursing for allergic rhinitis in traditional Chinese medicine

Allergic rhinitis is one of Taiwan's most common and most serious health problems, and many sufferers of the condition seek remedies in traditional Chinese medicine. In order to fulfill their duties as practitioners of traditional Chinese medicine and meet the health needs of the people, nurses must engage in rigorous study of traditional Chinese medicine as it relates to allergic rhinitis. This paper describes traditional Chinese medicine's approach to allergic rhinitis, looking at the condition's symptoms, causes and remedies, including care in the home and nasal exercises.