变应性鼻炎药物治疗新观点——解读(荐举)ARIA指南2010年修订版

自2001年变应性鼻炎及其对哮喘的影响(allergic rhinitis and its impact on asthma,ARIA)指南颁布以来,变应性鼻炎(allergic rhinitis,AR)的临床诊治越来越受到耳鼻咽喉科、变态反应科、呼吸科和儿科等相关学科的共同关注。ARIA指南也成为各国制订诊疗指南时的基本参     

重视变应性鼻炎药物的合理应用

变应性鼻炎及其对哮喘的影响（allergic rhinitis and its impact on asthma．ARIA）自2001年在临床应用以来，对认识上、下呼吸道的相关性以及提高变应性鼻炎（AR）的诊治水平起到积极的推动作用。在此基础上，2008年4月发表的ARIA2008修订版（ARIA 2008 update）在介绍了近年有关AR发病机制研究进展的基础上进一步阐述了AR的治疗策略，主要包括患者教育、药物疗法和特异性免疫疗法。     

老年变应性鼻炎的诊治现状

变应性鼻炎(allergic rhinitis,AR)虽好发于儿童和青少年,但在老年人群中却呈流行增加趋势,其患病率为3%～12%〔1-2〕。老年AR的诊治比较复杂,原因在于患者大多伴有其他系统疾病,有些疾病可     

儿童变应性鼻炎的诊断与治疗

变应性疾病如变应性鼻炎(allergic rhinitis,AR)、哮喘和湿疹等的发病率逐年上升。根据世界变态反应组织公布来自30个国家的流行病学调查显示,变应性疾病的患病率高达21%,而世界卫生组织估计全球大约有6亿人罹患AR〔1〕;这与工业化进程导致空气污染、人类生活方式的改变以及心理压力增大有着密切的关系〔2〕。研究显示AR在发达国家18岁以下青少年儿童中的患病率高达40%〔3-4〕;国内不同地区、不同年龄段儿童和青少年的调查结果差异较大,AR的患病率波动在3.3%~43.0%〔5〕。儿童AR的发病具有以下特点:同年龄段男性儿童发病率高于女性;6~18岁儿童青少年中,年幼儿童发病率高于年长儿童;城镇儿童比农村儿童更易罹患AR〔5〕。当前AR呈现     

变应性鼻炎治疗的进展

变应性鼻炎(allergic rhinitis，AR)是由变应原激发的、由IgE介导的鼻部炎性疾病。近年来，全球变应性疾病的发病率呈上升趋势，引起社会越来越多的重视。2001年，世界：EL组织参与，由37位学者起草的包含2776篇参考文献的“变应性鼻炎及其对哮喘的影响”(allergic rhinitis and its impact on asthma，ARIA)发表，系统地介绍了AR相关基础和临床研究现状。有关AR与支气管哮喘以及与慢性鼻窦炎、中耳炎和睡眠疾病等关系的研究方兴未艾。     

过敏原集群和冲击免疫治疗的临床应用

<正>过敏性鼻炎(allergic rhinitis,AR)也称变应性鼻炎,是特应性个体接触过敏原后由IgE介导的鼻黏膜炎症反应性疾病,其主要症状是反复喷嚏、清涕、鼻塞和鼻痒,患者常伴眼痒、结膜充血和/或流泪[1]。根据2008年版"过敏性鼻炎及其对哮喘的影响"(allergic rhinitis and its impact on asthma,ARIA)数据显示,全球约有6亿人患有AR且呈流行增加的趋     

丙酸氟替卡松鼻用激素有效改善持续性变应性鼻炎患者的临床症状

尽管世界卫生组织《变应性鼻炎及其对哮喘的影响》（allergic rhinitis and its impact on asthma，ARIA）指南依照患者症状持续时间的长短及是否对生活质量产生的影响，将变应性鼻炎（AR）分为轻度间歇性、中重度间歇性、轻度持续性、中重度持续性4种临床类型[1]，但临床诊治的对象明显以持续性AR患者居多。     

变应性鼻炎及其对哮喘的影响(ARIA)2010年修订版解读

变应性鼻炎(AR)是一个全球性健康问题,其患病率高达10%～20%,且呈流行增加趋势,给患者、家庭乃至整个社会造成沉重负担.近年来,国内外AR临床指南的制订对提高疾病的诊治水平起到了积极的推动作用.其中最具代表性的指南是以循证医学为基础的"变应性鼻炎及其对哮喘的影响(allergic rhinitis and its impact on asthma,ARIA)".     

CCR3受体与气道变态反应关系的研究进展

变应性鼻炎(allergic rhinitis,AR)是严重影响人们日常生活的全球性健康问题之一,其发病率占世界人口的10%～20%〔1〕。它是上呼吸道鼻黏膜的慢性炎症反应,当特应性个体接触变应原后可出现大量水样鼻涕、阵发性喷嚏、鼻痒和鼻塞等症状。变应性哮喘和AR同属气道变态反应性疾病,具有     

非变应性鼻炎及其对哮喘的影响

在世界卫生组织发布"变应性鼻炎及其对哮喘的影响(allergic rhinitis and its impact on asthma,ARIA)"指南文件的引领下[1],医学界对于上、下气道炎性反应发病机制和诊疗的关联性已经有了越来越深入的认识:变态反应被认为是一种系统性疾病,变应性鼻炎(AR)的存在能够增加哮喘发生的危险性,二者之间存在明确的关联性.     

武汉市气传花粉调查及与花粉症关系的研究

目的:调查武汉市气传花粉的种类及飘散规律,探讨其与花粉症的关系.方法:2003年11月～2004年10月在武汉市3个城区选点4处.同时进行气传花粉的调查,并对1 200例花粉症患者进行花粉变应原皮肤试验及发病季节分析,对其中352例蒿属花粉过敏患者进行气道反应性测定,并分析其与花粉浓度间的相关性.结果:全年观察到花粉种类47种,收集花粉75 525粒.气传花粉飘散高峰集中在春季的3～4月和秋季的8～10月.花粉症患者的发病季节与气传花粉高峰期相吻合,反映气道反应性的PD20值(使1 s用力呼气容积降低20%所需乙酰甲胆碱的累计量)与气传花粉浓度呈负相关.结论:本调查为武汉市气传花粉的流行病学研究提供了参考资料,对本地区与花粉相关的变应性疾病的防治具有一定的临床指导意义.     

武汉城区花粉症患者主要致敏花粉的研究

为探明武汉城区花粉症患者主要致敏花粉的种类及播季节播散的规律，采用国内统一标准及方法，在进行气传花粉调查的同时，将主要致敏花粉对２００例花粉症患者进行了皮肤敏感试验和发病季节的调查。     

Einfluss von Umweltfaktoren auf die Allergieentstehung

The increase in allergic diseases is inter alia explained by the adjuvant effect of environmental pollutants: (1) The interaction between traffic-related airborne particles and pollen grains in the atmosphere may lead to agglomeration of particles on the surface of allergen carriers inducing their activation and to modulation of allergen release, generation of allergenic aerosols and adsorption of pollen proteins to airborne particles. (2) Anthropogenic air pollutants enhance the release of pollen-associated lipid mediators (PALMs) from pollen grains, substances with proinflammatory and immune modulating effects, which can lead to enhancement of allergic symptoms and maintenance of disease. (3) Air pollutants, such as NO(2), ozone, secondhand tobacco smoke, fine and ultrafine particles play an important role as adjuvants and trigger factors for allergic disease development as well as for elicitation and aggravation of allergic symptoms. (4) Polymorphisms in phase II drug-metabolizing enzymes can modulate susceptibility to the adjuvant effects of anthropogenic air pollutants on the IgE-mediated immune response. This highlights gene-environment interactions, which play an important role in the manifestation of allergic diseases.     

北京城区春季花粉与过敏性疾病就诊比例分析

目的 监测北京城区春季优势花粉,初步推测其与过敏性疾病关系.方法 应用重力法监测2019年春季每日花粉种类及浓度,计算每月优势花粉.通过杜恩综合医生工作站系统统计同期本院变态反应科诊断为过敏性鼻炎(AR)、过敏性结膜炎(allergic conjunctivits,AC)和过敏性哮喘(allergic asthma,A...     

北京市气传蒿属花粉浓度调查

目的：了解北京市秋季主要气传花粉的浓度,并对蒿属花粉浓度进行分级。方法：应用Burkard采样器于2007-08-01-2007-10-20对北京市气传花粉浓度进行监测,对单一蒿属花粉过敏的患者进行随访,对患者的病情及蒿属花粉浓度进行统计学分析。结果：①2007年北京市秋季气传花粉主要包括大麻葎草属和蒿属花粉,其构成比分别为51%和31%;②2007年北京地区蒿属花粉季节始于8月8日,止于10月8日;③蒿属花粉日最高浓度为267 g/m^3,平均每日71 g/m^3;大麻葎草属花粉日最高浓度为672 g/m^3,平均每日124 g/m^3;④门诊夏秋季变应性鼻炎和（或）哮喘患者中蒿属花粉阳性占88.5%,葎草属花粉阳性占28.2%;⑤气传蒿属花粉浓度分级：0～14 g/m^3为0级,15～40 g/m^3为Ⅰ级,41～116 g/m^3为Ⅱ级,≥117 g/m^3为Ⅲ级。结论：本文首次应用Burkard采样器对北京市夏秋季气传花粉浓度进行了监测,在蒿属花粉临床季节内,日平均浓度在100 g/m^3以上,花粉浓度在Ⅲ级以上时间分布在8月下旬至9月初。     

Relationship between airborne pollen count and treatment outcome in Japanese cedar pollinosis patients

In Japan, information on daily Japanese cedar pollen counts is made public during pollen season. If symptom severity and treatment outcome are predictable according to these pollen counts, management of seasonal allergic rhinitis may become more precise. The aims of the study were to evaluate the relationship between airborne pollen counts, symptom severity and treatment outcome in Japanese cedar pollinosis patients. In the randomized study, patients with moderate to most severe Japanese pollinosis were treated with fexofenadine (60 mg BD) or fexofenadine and nasal corticosteroids for 2 weeks. During the same period daily airborne pollen counts were measured. A total of 105 adult patients were enrolled. No difference of treatment efficacy was seen among groups. Detailed results of efficacy and safety were previously described elsewhere. In univariate analysis, the mean cumulative amount of airborne pollen exposure for 4 days prior to the study tended to affect symptom severity (P = 0.053) and the mean cumulative amount of airborne pollen during the treatment period tended to show difference among five treatment outcome categories (P = 0.066). In multivariate analysis, the mean cumulative amount of airborne pollen exposure for 4 days prior to the study was identified as the only significant factor of symptom severity (P = 0.0327) and cumulative amount of airborne pollen during the treatment period (P = 0.027) and allergic history (P = 0.027) were significant factors of treatment outcomes. No serious adverse effect was reported during the study. The amount of airborne pollen may be predictive of both symptom severity and treatment outcome.     

Laser surgery of the inferior turbinate for allergic rhinitis with seasonal exacerbation: an acoustic rhinometry study

Laser surgery has been used to successfully treat patients with perennial allergic rhinitis. We examined whether the numbers and types of sensitized allergens influence the effects of surgery. Two different groups (those allergic to house dust mites only, and those allergic to house dust mites and Japanese cedar pollen) prospectively underwent the same course of laser turbinectomy during the pollen dispersion season. The symptom scores for nasal obstruction significantly decreased in both groups, but the improvement of sneezing and rhinorrhea was less pronounced in the pollen group. We used acoustic rhinometry to measure postoperative changes in the nasal dimensions. Four months after treatment, the minimum cross-sectional area and nasal cavity volume had increased, respectively, by 61.7% and 30.7% in the house dust group, and by 30.7% and 16.2% in the pollen group. We conclude that laser surgery can be successfully applied to patients whose allergies show seasonal exacerbation by airborne pollen.     

重庆地区气传致敏花粉调查

目的 :调查重庆地区空气中气传花粉的种属及飘散规律。方法 :在重庆市区及近郊设两个暴片点进行空气中的花粉取样 ;按国内统一标准进行花粉变应原浸液皮肤敏感试验及结果判定 ;收集该地区气象资料及绿化树种类。结果 :重庆地区一年中空气中花粉高峰期在 3月 ,该月各种气传花粉的数量占全年总数的 6 5 .8% ,其主要气传花粉为松属、构属和柏属 ,此 3种花粉占全年总数的 6 9.4% ;该地区花粉抗原阳性率最高是秋季花粉 ,而春季花粉阳性率较低。结论 :重庆地区空气中致敏花粉以春季花粉为主 ,此特点与该季节的气温、降雨量及风力有关。     

夏秋花粉症与气传花粉相关性调查

目的 调查青岛地区夏秋气传花粉与花粉症的关系,以期为花粉症防治提供依据.方法 2010年7月1日至10月31日,采用重力沉降法进行空气曝片花粉调查,并通过花粉变应原皮内试验、鼻黏膜特异性激发试验和血清特异性IgE测定,确诊213例夏秋季花粉症患者.结果 2010年7～10月花粉为2971粒,主要气传花粉为蒿属、葎草属和豚草,空气中花粉含量与夏秋花粉症患者的发病有明显的相关性.213例中有118例合并哮喘,占55.40％.夏秋花粉症皮内试验结果得出蒿属花粉的阳性率最高,为83.53％.在60例疑诊患者的鼻黏膜激发试验中,阳性率为63.33％,其中激发后PEF≥10％者5例,占11.90％.在这些患者中采用免疫印记法行血清特异性IgE测定,阳性率为56.67％～61.67％.结论 夏秋季节中气传致敏花粉容易诱发气道(鼻腔和支气管)高反应性,特异性鼻黏膜激发试验可影响支气管的反应性.空气中蒿属、葎草和豚草花粉是引起青岛地区变应性鼻炎和支气管哮喘的重要病因.     

Dynamics of airborne pollen particles from inhalation to allergic reaction in the nose

BACKGROUND: Pollinosis is common worldwide, and has been frequently studied. However, the intranasal dynamics of pollen grains have not yet been documented. The purpose of this study is to elucidate for the first time the dynamics of Japanese cedar pollen (JCP) in the human nose at consecutive steps from inhalation to allergic reaction together with release of Cry j 1 (a major allergenic component of JCP) in the nose. METHODS: A personal sampler collected airborne pollens at head height outdoor on the street, while intranasal pollens after natural or experimental inhalation were collected by irrigation with 200ml saline. Cry j 1 in the supernatant after in vitro incubation with phosphate buffered saline or lavage was determined by enzyme-linked immunoassay. RESULTS: Head-height pollen was 183.0 +/- 43.1/300L/h, with 99% of the inhaled pollens deposited on the nasal surface. Eighty eight% of the inhaled pollen was transported to the out-side of the nose by ciliary function within 3 hours. During this process, considerable amounts of Cry j 1 were released in the nose reaching its plateau within 30 min. When the number of pollen deposited exceeded more than approximately 65 particles, symptoms may occur, leading presumably up to a 74% reduction of the intra-nasal pollen. CONCLUSION: The majority of inhaled airborne pollens was deposited on the nasal mucosal surface and moved out from the nose by mucociliary transportation. During this process, when allergenic substances are released up to a critical concentration, allergic reactions occur leading to expelling of pollen from the nose followed by subsiding of the symptoms.