鼻炎分类和诊断及鼻腔用药方案的专家共识

目的本文基于临床经验和循证医学证据制定的鼻炎（萎缩性鼻炎除外）分类和诊疗的专家共识,其中在治疗方面重点关注了鼻腔局部用药的临床应用,旨在进一步规范鼻炎尤其是慢性鼻炎的诊疗,明确鼻腔局部用药如鼻用糖皮质激素、鼻用抗组胺药和鼻腔盐水盥洗等在鼻炎治疗中的临床地位及注意事项,以便指导临床医师进行合理用药,提高鼻炎的疗效和患者的满意度。     

鼻用减充血剂的临床应用暨药物性鼻炎的诊治专家共识(2022，北京)

鼻用减充血剂可以快速缓解鼻塞,但长期过量使用可导致药物性鼻炎。目前临床上对鼻用减充血剂的使用和药物性鼻炎的治疗还存在很多误区。鉴于此,中国鼻病研究协作组召集国内中青年鼻科专家,基于临床经验和循证医学证据制订了鼻用减充血剂的临床应用暨药物性鼻炎的诊治专家共识。本共识系统总结了临床应用鼻用减充血剂治疗鼻塞的注意事项及药物性鼻炎的治疗原则,旨在指导并规范临床应用鼻用减充血剂,并正确有效地治疗药物性鼻炎。     

鼻用糖皮质激素治疗变应性鼻炎的临床疗效:白介素-17A的影响

目的 探讨鼻用糖皮质激素治疗变应性鼻炎的临床疗效及鼻腔分泌物中白介素(interleukin,IL)-17A浓度对鼻用糖皮质激素疗效的影响.方法 总共纳入29例中-重度持续性变应性鼻炎患者,采用酶联免疫吸附试验(ELISA)检测鼻腔灌洗液中IL-17A的浓度,评估IL-17A浓度与鼻部症状总计分(total nasal symptom score,TNSS)之间的关联性；比较鼻用糖皮质激素(丙酸氟替卡松,每天1次,每次每鼻孔2喷)治疗2周前后TNSS的差异及与鼻腔不同IL-17A浓度之间的关系.结果 变应性鼻炎患者鼻腔灌洗液中IL-17A的浓度明显高于正常对照组.其中,21例患者鼻腔灌洗液中IL-17A检测阳性(均数为56.4pg/mL),8例患者IL-17A阴性(低于检测下限).IL-17A浓度与TNSS之间存在显著关联性(P＜0.05).IL-17A+和IL-17A-的两组患者经鼻用糖皮质激素治疗后TNSS相对基线值的改善幅度分别为-2.69和-4.52,差异有统计学意义(P＜0.05).结论 IL-17A能够加重变应性鼻炎患者的临床严重程度并且降低鼻用糖皮质激素治疗变应性鼻炎的临床疗效.     

鼻用糖皮质激素对小儿鼾症的疗效

鼻用糖皮质激素因具有强大的抑制变态反应、抗炎及抗水肿作用,临床上作为治疗变应性鼻炎(AR)、鼻窦炎和鼻息肉的一线用药,其疗效已经得到了普遍认同和证实。鼻用糖皮质激素喷鼻的给药方式不仅作用于鼻腔,亦使得整个上气道受益。腺样体肥大是小儿鼾症最主要的病因之一,并与     

儿童变应性鼻炎治疗中的药物选择和疗程依据

药物治疗是变应性鼻炎(AR)最重要的治疗手段之一.儿童AR的治疗原则与成人相同,但应特别注意各类药物的适用年龄、推荐剂量和不良反应.目前临床常用的AR治疗药物包括:口服或鼻用抗组胺药物(H1受体拮抗剂)、鼻用糖皮质激素、抗白三烯药(白三烯受体拮抗剂)、色酮类药物和鼻用减充血剂等.根据变应性鼻炎及其对哮喘的影响(allergic rhinitis and its impact on asthma,ARIA)指南(2008)[1],这些药物均适用于间歇性AR和轻度持续性AR的临床治疗,而对于中-重度持续性AR,则首选鼻用糖皮质激素.     

糖皮质激素受体与变应性呼吸道疾病

吸入性糖皮质激素是目前治疗哮喘、变应性鼻炎和慢性鼻及鼻窦炎与鼻息肉等变应性呼吸道疾病中最常用也是最有效的药物,而糖皮质激素主要是通过糖皮质激素受体来发挥其作用.本文就糖皮质激素本身及其与变应性呼吸道疾病的关系做一综述.     

糖皮质激素受体与变应性呼吸道疾病

吸入性糖皮质激素是目前治疗哮喘、变应性鼻炎和慢性鼻及鼻窦炎与鼻息肉等变应性呼吸道疾病中最常用也是最有效的药物,而糖皮质激素主要是通过糖皮质激素受体来发挥其作用.本文就糖皮质激素本身及其与变应性呼吸道疾病的关系做一综述.     

皮质类固醇在治疗变应性鼻炎和哮喘中的研究进展

在预防和治疗变应性炎症中,糖皮质激素目前被认为是最为有效的一线药物,随着对变应性鼻炎和哮喘发病机制研究的深入和糖皮质激素疗效的肯定,局部应用糖皮质激素在治疗变应性鼻炎和哮喘中的作用越来越受到广泛的关注,现就近几年关于耳鼻咽喉头颈外科和呼吸内科应用吸人皮质类固醇（inhaled corticosteroid,ICS）治疗变应性鼻炎和哮喘的安全性及ICS的合理应用等方面的研究进展作一综述。     

鼻舒宁治疗变应性鼻炎的疗效观察

目的观察鼻舒宁喷雾剂对变应性鼻炎的临床疗效。方法30例变应性鼻炎患者,用鼻舒宁喷雾剂喷鼻,观察治疗前后患者的临床症状、体征变化。结果治疗2周后症状、体征明显改善,P<0.01,均为显效,其中鼻痒、喷嚏疗效最佳。结论鼻舒宁喷雾剂对变应性鼻炎有良好的临床疗效。     

鼻腔盥洗及联合鼻用糖皮质激素治疗变应性鼻炎及血管运动性鼻炎效果观察

观察单用鼻腔盥洗及鼻腔盥洗联合鼻用糖皮质激素治疗变应性鼻炎（allergic rhinitis，AR）和血管运动性鼻炎（vasomotor rhinitis,VMR）的效果。     

Comparison of intranasal hypertonic dead sea saline spray and intranasal aqueous triamcinolone spray in seasonal allergic rhinitis

Intranasal corticosteroids are well known to be efficacious in the treatment of allergic rhinitis. Nasal irrigation with saline, including hypertonic saline, has long been recommended for the treatment of sinonasal disease, and it has been shown to have a positive effect on the physiology of the nasal mucosa. Until now, no study of the clinical efficacy of intranasal hypertonic Dead Sea saline as a monotherapy for seasonal allergic rhinitis has been reported. We conducted a prospective, randomized, single-blind, placebo-controlled comparison of intranasal hypertonic Dead Sea saline spray and intranasal aqueous triamcinolone spray in 15 patients with seasonal allergic rhinitis. Results were based on a 7-day regimen. Based on Rhinoconjunctivitis Quality of Life Questionnaire scores, clinically and statistically significant (p < 0.0001) improvements were seen in both active-treatment groups; as expected, the corticosteroid spray was the more effective of the two treatments. No significant improvement occurred in the control group. Our preliminary results not only confirm the efficacy of intranasal corticosteroid therapy in moderate-to-severe allergic rhinitis, they also suggest that the Dead Sea saline solution can be an effective alternative in mild-to-moderate allergic rhinitis, particularly with respect to nasal and eye symptoms. The hypertonicity of the Dead Sea solution may have a positive effect on the physiology of the nasal mucosa by improving mucociliary clearance. In addition, the dominant cation in the Dead Sea solution--magnesium--probably exerts anti-inflammatory effects on the nasal mucosa and on the systemic immune response.     

Efficacy of intranasal steroid spray (mometasone furoate) on treatment of patients with seasonal allergic rhinitis: Comparison with oral corticosteroids

Objective

Intranasal corticosteroids are effective for allergic rhinitis and broadly used in daily clinical practice. Systemic oral corticosteroids are also known to be effective for treatment of allergic rhinitis. These topical and systemic corticosteroids are both effective formulations for allergic rhinitis, and both drugs have some side effects. When treatment formulations for allergic rhinitis are selected based on side effects, topical corticosteroids are more commonly selected than systemic steroids. Systemic corticosteroids, on the other hand, have traditionally been believed to have higher and more instantaneous therapeutic effects than those of topical corticosteroids. However, there have been few reports of direct comparisons between topical corticosteroid and systemic corticosteroid efficacy. The purpose of this study was to evaluate the subjective outcomes of nasal symptom management using topical intranasal corticosteroid therapy or systemic oral corticosteroid therapy in patients with seasonal allergic rhinitis. We compared the efficacy of mometasone furoate nasal spray (MFNS) to betamethasone oral tablets (BOT) for the treatment of patients with seasonal allergic rhinitis.

Methods

In an open label study, patients with seasonal allergic rhinitis who had intermediate-to-severe symptoms and who visited the hospital without prior treatment were allocated to 1 of 3 treatment groups (noncorticosteroid group, topical corticosteroid group, and oral corticosteroid group). Evaluation was conducted using allergy diaries that consisted of patient questionnaires. The Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ) was used in this study.

Results

Compared to only loratazine nonsteroid therapy, both MFNS 200 μg once daily and BOT 0.25 mg twice daily significantly reduced the total and individual symptom scores for sneezing, nasal obstruction, watery nasal discharge, and nasal itching (P < 0.05). Scores for itching of the eyes were reduced slightly more in the MFNS group than in the noncorticosteriod treatment group, but the difference was not significant.

Conclusion

MFNS and BOT have virtually equivalent effects on nasal symptoms in patients with seasonal allergies. Our study was the first direct comparison between an intranasal corticosteroid spray and a systemic oral corticosteroid for seasonal allergic rhinitis. No significant differences were found in the therapeutic effects of the topical and systemic corticosteroids tested, suggesting that topical corticosteroids are expected to sufficiently improve nasal symptoms without administration of oral corticosteroids. Treatment with intranasal corticosteroid spray is more strongly recommended than treatment with systemic corticoid steroids, due to the side effects associated with each treatment.     

Effect of topical nasal steroid sprays on nasal mucosa and ciliary function

PURPOSE OF REVIEW: This review was conducted to examine current evidence focusing on the effect of nasal steroid sprays on nasal ciliary function. RECENT FINDINGS: Review of current literature suggests that long term effects of topical corticosteroid nasal sprays are safe and fail to cause damage to local nasal structure and function. SUMMARY: The use of corticosteroid nasal sprays for the treatment of allergic rhinitis is widely accepted. Popularity of this class of medications is based on a well-established combination of efficacy, tolerability, and safety. Although current literature suggests that the use of intranasal steroids is indeed safe, increasing indications for prolonged administration continue to fuel debate regarding the long-term effect on local nasal structure and function. The purpose of this article is to review current literature addressing the effects of the components of local intranasal steroid sprays on the structure and function of the nasal mucosa.     

白三烯受体拮抗剂和吸入性皮质激素在变应性鼻炎中的应用

目的:探讨吸入性皮质激素(ICS)与白三烯受体拮抗剂(LTRAs)联合应用对变应性鼻炎(AR)的影响。方法:将对ICS无反应的47例患者用LTRAs孟鲁斯特治疗2周,其中单独应用孟鲁斯特26例(B组),与糠酸莫米松合用21例(C组),用生理盐水滴鼻和口服维生素C的10例AR患者为对照组(A组),治疗前后对患者症状进行评分,对各组间症状进行评分。结果:在AR患者中有少部分患者对激素不敏感;且出现的比例在并发有哮喘症状的AR患者中较其他无并发症状的患者要高,差异有统计学意义(P<0.05);与A组患者相比,B组患者症状有明显改善,差异有统计学意义(P<0.05);C组患者的症状控制更为有效,差异有统计学意义(P<0.05)。结论:对ICS不敏感的AR患者可以选择LTRAs辅助治疗;并可同时用ICS和LTRAs控制AR的症状。     

Intranasal fungal (Alternaria) infection related to nasal steroid spray

During the past three decades intranasal corticosteroid sprays have been proven to be efficient and reasonably safe for the treatment of rhinitis, sinusitis and nasal polyposis. The adverse effects are generally localized and self-limited and rarely systemic or significant. We report an immunocompetent female treated with triamcinolone acetonide nasal spray for chronic rhinitis in whom an intranasal fungal infection with Alternaria species developed three months later. The infection was refractory to topical therapies alone, and was resolved with a combination of systemic and topical antifungal therapy. We also described the clinical manifestations of this rare infection and our therapeutic experience. In addition, we reviewed previous literature of fungal infections related to nasal corticosteroid sprays and compared them with our report.     

The approaches to diagnostics and therapy of allergic rhinitis

Allergic rhinitis is a common disease of great socio-economic significance. The treatment of this condition is carried out on an individual basis depending on the clinical course of the disease; it includes prevention of contacts with the allergen, medicamental and immunotherapy. The principal pharmaceuticals used to treat the patients include oral and intranasal H1 anti-histaminic preparations, intranasal corticosteroids, intranasal cromones, anti-leukotrien agents, and specific subcutaneous immunotherapy. Glencet (levocetirizine) is one of the modern antihistaminic preparations of the second generation having an advantage over other drugs for the treatment of allergic rhinitis in that it may be prescribed to the patients presenting with concomitant bronchial asthma and cardiac diseases.     

青岛地区豚草花粉症85例

目的 探讨青岛地区豚草花粉症的临床表现、变态反应特点及与新的变应性鼻炎分类方法的关系和防治措施。方法 在就诊的花粉症患者中,通过豚草花粉变应原皮内试验、鼻黏膜激发试验、血清特异性IgE测定等检测方法,按照“ARIA”关于变应性鼻炎新的分类标准进行了分类和阶梯式治疗及特异性免疫治疗。结果 在502例花粉症患者中, 85例为豚草花粉症,占16.93%,发病季节自8月下旬至10月初。69例并发过敏性眼结膜炎,占81.12%,18例合并哮喘,占21.21%,符合间歇性鼻炎者占63.53%,持续性鼻炎者占36.07%。特异性免疫治疗有效率为84.62%。结论 豚草花粉已成为青岛地区花粉症的主要病因之一,必须采取拨除豚草的有效预防措施。特异性免疫治疗是治疗花粉症和阻止其向哮喘方向发展的重要防治方法。     

Effect of topical corticosteroids on nasal patency after acute positive airway pressure exposure

IntroductionNasal congestion and obstruction are reported in the majority of continuous positive airway pressure users and are frequently cited as reasons for noncompliance. Baseline inflammation due to allergic rhinitis could increase or exacerbate the inflammatory effect of high airflow in the nasal cavity as the result of continuous positive airway pressure and lead to greater continuous positive airway pressure intolerance. In this setting, intranasal steroids would be expected to counteract the nasal inflammation caused by allergic rhinitis and/or continuous positive airway pressure.ObjectiveThe aim of the present study is to evaluate the effects of topical corticosteroid use on nasal patency after acute exposure to positive pressure.MethodsTen individuals with allergic rhinitis were exposed to 1 h of continuous airway pressure (15 cm H₂O) in the nasal cavity, delivered by a continuous positive airway pressure device. Visual analog scale, nasal obstruction symptom evaluation scale, acoustic rhinometry and peak nasal inspiratory flow were performed before and after the intervention. After 4 weeks topical nasal steroid (budesonide) application, positive pressure exposure was repeated as well as the first assessments.ResultsPatients reported a statistically significant improvement both on the visual analog (p = 0.013) and obstruction symptom evaluation scales (p < 0.01). Furthermore, objective measurements were improved as well, with increased nasal cavity volume on acoustic rhinometry (p = 0.02) and increased peak nasal inspiratory flow (p = 0.012), after corticosteroid treatment.ConclusionIn patients with allergic rhinitis, intranasal corticosteroid therapy improved objective and subjective parameters of nasal patency after acute exposure of the nasal cavity to positive pressure.     

Acute candidiasis of the oro- and hypopharynx as the result of topical intranasal steroids administration

Topical nasal steroids have become increasingly popular for the treatment of allergic and other types of rhinitis. However, undesirable local effects of intranasal steroids, such as nasal irritation and burning, crusting and epistaxis are quite common. Candidiasis of the pharyngeal mucosa is a complication, which has not been described so far after treatment of rhinitis with intranasal topical corticosteroids. Between March 1997 and September 1998, we managed to treat successfully three patients with acute erythematous candidiasis of the pharynx, which was the result of the use of intranasal topical steroids. Mechanism, clinical features of acute pharyngeal candidiasis, differential diagnosis and treatment are discussed.