鼻内窥镜下微波治疗变应性鼻炎

目的探讨鼻内窥镜下微波治疗变应性鼻炎的疗效。方法 190例变应性鼻炎在鼻内窥镜下利用微波凝固筛前神经分布的鼻丘、下鼻甲和鼻中隔黏膜治疗;随访1年以上,采用治疗前后的症状分级记分和体征分级记分对远期疗效进行对比。结果总有效率为91.7%,症状分级记分和体征分级记分明显低于治疗前症状及体征分级记分,其差异均有显著性(P<0.01)。结论鼻内镜下微波热凝治疗变应性鼻炎可在直视下准确定位,视野清楚,操作简单,疗效满意。     

低温等离子下鼻甲射频消融术治疗慢性鼻炎与变应性鼻炎的疗效评价

目的观察鼻内镜下低温等离子下鼻甲射频消融术治疗慢性鼻炎及变应性鼻炎的疗效。方法对92例下鼻甲肥大的慢性鼻炎及变应性鼻炎患者施行鼻内镜下低温等离子下鼻甲射频消融术,术后1周、2周、1个月、2个月复诊,最后一次复诊时评价疗效。结果 76例慢性鼻炎患者中,术后2个月复诊示显效46例,占60.53%;有效26例,占34.21%,总有效率为94.74%。16例变应性鼻炎患者中,术后2个月复诊示显效8例,占50.00%;有效6例,占37.50%,总有效率为87.50%。92例慢性鼻炎及变应性鼻炎患者经低温等离子下鼻甲射频消融术治疗后,总有效率为93.48%,仅2例患者发生鼻腔粘连,并发症发生率为2.17%。慢性鼻炎与变应性鼻炎术后疗效比较,差异无统计学意义(P>0.05)。结论鼻内镜下低温等离子下鼻甲射频消融术治疗慢性鼻炎及变应性鼻炎效果良好,术后并发症发生率低。     

曲安奈德喷雾剂对变应性鼻炎的作用

目的研究曲安奈德鼻腔局部给药对实验性变应性鼻炎动物模型的治疗作用及对组胺致大鼠鼻气道阻力增加的缓解作用。方法以实验性变应性鼻炎模型豚鼠和组胺致鼻气道阻力增加模型大鼠为试验对象 ,以豚鼠鼻腔分泌物量、喷嚏次数、搔鼻次数、鼻组织学及大鼠鼻气道阻力为指标 ,全面考察曲安奈德喷雾剂对变应性鼻炎的作用。结果曲安奈德鼻喷雾剂 (5 0、10 0、2 0 0 μg·kg-1,对卵蛋白致敏实验性变态反应性鼻炎豚鼠模型的各种变应性鼻炎的症状和体症均有明显改善作用 ;与模型对照组比较 ,各给药组动物鼻腔分泌物量、喷嚏次数、抓鼻次数明显减少 ,并可对抗组胺所致大鼠鼻气道阻力的增加。结论曲安奈德鼻喷雾剂鼻腔局部给药对实验性变应性鼻炎有显著改善作用     

Pharmacotherapy of allergic rhinitis

The pathophysiology, clinical manifestations and diagnosis, and pharmacotherapy of allergic rhinitis are reviewed. Allergic rhinitis is an immunologically mediated disease initiated by an antigen-antibody reaction in sensitized persons. Clinical manifestations include nasal obstruction, rhinorrhea, itching of the nose and eyes, coughing, and sneezing and may be perennial or seasonal. Diagnosis is confirmed by challenging the patient with suspected allergens in skin-prick tests. Avoidance of offending allergens is the cornerstone of therapy. Antihistamines and decongestants provides only minimal relief when used alone and are more effective when combined with other agents. Two newer antihistamines, astemizole and terfenadine, lack the sedative and anticholinergic properties of older antihistamines. Intranasal corticosteroids are particularly effective in relieving symptoms; beclomethasone diproprionate and flunisolide do so without producing systemic adverse effects. Cromolyn sodium is effective in relieving nasal symptoms and is the prototype of a new noncorticosteroidal class of compounds termed antiallergy drugs. Drugs under investigation for the treatment of allergic rhinitis include histamine H2-receptor antagonists, nonsteroidal anti-inflammatory agents, anticholinergic agents, and beta-adrenergic receptor agonists. Immunotherapy is a helpful adjunctive treatment. Treatment with drugs may be necessary for those patients with allergic rhinitis who find it difficult or impossible to avoid the offending allergen. The severity of symptoms and the adverse effects of agents should be considered when individual therapeutic plans are being established.     

Effect of oral immunotherapy on nasal blockage in experimental allergic rhinitis

We previously reported that when Japanese cedar pollen was prophylactically p.o. administered before a sensitization stage in a guinea-pig model of allergic rhinitis, pollen-induced nasal blockage was suppressed. In this study, we evaluated whether the oral immunotherapy is also effective when the pollen extract was administered starting from the day when the nasal blockage was clearly induced and whether the effectiveness continued after cessation of the immunotherapy. Sensitized animals were repeatedly challenged by pollen inhalation once every week. After the 7th challenge, the extract was orally administered twice a week until the 30th challenge. At the 11th challenge, the oral immunotherapy showed inhibition of the biphasic nasal blockage. The effectiveness was consistently observed during the immunotherapy until the 30th challenge. Furthermore, the increased nasal responsiveness to intranasal application of leukotriene D4 was markedly suppressed by the immunotherapy. Interestingly, even after cessation of the therapy, inhibition of the nasal blockage was sustained for more than 2 months. Nevertheless, neither sneezing nor antigen-specific IgE antibody production was substantially influenced by the immunotherapy. In conclusion, Oral immunotherapy may be clinically useful for allergic nasal blockage. Mechanisms underlying the effectiveness may be associated with the hyporesponsiveness of the nasal mucosa to released mediators.     

小青龙汤对过敏性鼻炎豚鼠模型的干预作用

目的:探讨小青龙汤对过敏性鼻炎动物模型的干预作用.方法:以卵清白蛋白(OVA)滴鼻制备豚鼠过敏性鼻炎模型,随机分为6组,即正常组(A组)、模型组(B组)、氯雷他定组(C组)、小青龙汤高、中、低剂量组(D、E、F组),连续灌胃给药14天,于给药第7天及第14天动态观察并比较各组豚鼠擦鼻次数、打喷嚏次数及流涕程度.结果:用...     

变应性鼻炎及合并哮喘患者吸入性变应原检测结果

目的:明确主要变应原,为变应性鼻炎及合并哮喘患者提供防治指导和帮助。方法:分析吸入性变应原皮肤点刺试验阳性的231例变应性鼻炎患者结果,按是否合并哮喘分为两组,变应性鼻炎组199例,合并哮喘组32例。结果:两组患者的吸入性变应原阳性反应率及总体分布无明显差异,且均以粉尘螨、艾蒿、屋尘螨、热带螨、豚草为主。结论:皮肤点刺试验可作为变应性鼻炎及合并哮喘患者变应原检测的首选方法,但不是预测变应性鼻炎发展的手段。     

Animal models of allergic rhinitis

Actively sensitized Brown Norway rats and guinea pig are useful species for studying drug effects on symptoms of experimental rhinitis. Even if not all symptoms of human rhinitis can be induced and detected in the same animal species, the predictablity of methods generally used is well acceptable. In the present review, advantages and disadvantages of experimental methods of rhinitis will be discussed.     

Budesonide once-daily in seasonal allergic rhinitis

Summary

A randomized, parallel group, double-blind multi-centre study was carried out in 342 patients with symptomatic seasonal allergic rhinitis to assess the efficacy and tolerability of intranasal budesonide administered either as a single morning dose of 400 μg or as a 200 μpg twice-daily dose, morning and evening, for 4 weeks. Both treatments improved the symptoms of seasonal allergic rhinitis; specific nasal symptom scores recorded daily by the patient being reduced. The proportions of patients symptom free after 4-weeks'treatment were 46% in the 400 μg once-daily group and 54% in the 200 μg twice-daily group, with total daily symptom scores recorded by diary cards reduced by 79% and 80%, respectively. The differences between the groups were not statistically significant. Subgroup analysis of patients allergic to grass pollen (n = 166) showed similar total symptom scores at each level of grass pollen exposure (no significant difference between treatment groups). Patients assessed both treatments to be effective (no significant dgference between groups), with 65% of patients questioned stating a preference for a once-daily treatment given equal symptom control. Both treatments were equally well tolerated and few side-effects were reported.     

糠酸莫米松鼻喷雾剂对变应性鼻炎患儿血清嗜酸性粒细胞趋化因子水平的影响

目的 观察糠酸莫米松鼻喷雾剂对变应性鼻炎(AR)患儿血清嗜酸性粒细胞趋化因子( eotaxin)水平的影响.方法 30例AR患儿作为观察组,给予糠酸莫米松鼻喷雾剂治疗,使用ELISA法分别测定治疗前后血清eotaxin含量,同时与健康儿童(对照组)进行比较.结果 观察组治疗前症状和体征分数为(9.4±2.3)分,治疗后为(3.1±1.8)分,治疗前后差异有统计学意义(t =2.148,P＜0.05);治疗效果:显效19例(63.3％),有效9例(30.0％),无效2例(6.7％).观察组治疗前eotaxin水平(221.41±137.96)ng/L,显著高于对照组的(128.71±60.73)ng/L(t =-2.721,P＜0.05);观察组治疗后血清eotaxin水平(115.50±52.71)ng/L,显著低于治疗前(t =-3.661,P＜0.05).观察组未发生严重不良反应.结论 糠酸莫米松鼻喷剂治疗AR可以抑制变应性炎症,降低趋化因子eotaxin的水平.     

Bronchial lability in allergic rhinitis.

The aim of this study was to assess the relationship between exercise bronchial lability and the changes in pulmonary function over a one year period in allergic rhinitis. Eighty four nonsmoking male medical students of whom twenty two were allergic rhinitics were studied. Pulmonary function status was significantly lower and exercise bronchial lability significantly higher in the allergics. Over a one year period the mean decline in the forced expiratory volume in one second (FEV1) was three times greater and in the forced expiratory flow rate in the middle half of the vital capacity (FEF 25-75%) 50% greater among the allergics. The change in FEV1 was positively related to the bronchial lability, indicating that greater bronchial lability was associated with less decline in pulmonary function in these subjects.     

Effect of histamine H4 receptor antagonist on allergic rhinitis in mice

The aim of this study was to clarify the effect of histamine H₄ receptor antagonist, JNJ7777120 (1-[(5-Chloro-1H-indol-2-yl)carbonyl]-4-methyl-piperazine) on allergic rhinitis in mice. We measured allergic symptoms (sneezing and nasal rubbing), serum total IgE and the levels of cytokines in nasal lavage fluid. Histamine H₄ receptor antagonist, JNJ7777120, caused the dose-dependent inhibition of nasal symptoms by single and repeated intranasal administrations; however, JNJ7777120 caused no inhibition of serum total IgE by single and repeated intranasal administrations. Therefore, we investigated the effect of JNJ7777120 by oral administration. JNJ7777120 also caused a significant inhibition of nasal symptoms by both single and repeated oral administrations. In addition, repeated oral administration of JNJ7777120 caused significant inhibition of serum total IgE. Furthermore, JNJ7777120 caused a significant decrease in the levels of IL-4 and a significant increase in the levels of IFN-γ in nasal lavage fluid. These results indicated that histamine H₄ receptor is closely related with allergic rhinitis and is important in the pathogenesis of allergic rhinitis. From these results, it can be concluded that histamine H₄ receptor antagonist might be a new strategy to treat allergic rhinitis with immunomodulatory function.     

鼻内窥镜下海极翼治疗变应性鼻炎疗效观察

目的采用鼻内窥镜下海极翼治疗变应性鼻炎,探索治疗变应性鼻炎的新途径。方法 400例患者随机分为治疗组202例和对照组198例,治疗组采用鼻内窥镜引导下海极翼CZB型超声波鼻炎治疗仪治疗,对照组采用传统微波治疗仪治疗。2组均随访1年,观察2组临床疗效。结果治疗组总有效率为86.1%高于对照组的63.2%,差异有统计学意义（P〈0.05）。结论海极翼治疗变应性鼻炎具有定位准确、操作方便、无出血、并发症少、疗效好、恢复快等优点,值得临床推广应用。     

Investigational drugs for allergic rhinitis

Allergic rhinitis (AR) is a high-prevalence disease, triggered by an IgE-mediated reaction, and sustained by a complex inflammatory network of cells, mediators, and cytokines. When the exposure to allergens persists, the inflammatory process becomes chronic. The current therapeutic strategy is based on allergen avoidance when possible, drugs and allergen immunotherapy. The main drugs are oral and topical antihistamines and nasal steroids. They are overall effective in controlling symptoms, but do not modify the immune background that leads to allergic inflammation. In addition, safety concerns may be present, especially for prolonged treatments. Thus, efforts are currently made to improve the existing molecules and to develop new drugs, in order to achieve greater clinical efficacy with a better tolerability. Also, attempts are made to selectively block relevant signal pathways of the allergic reaction by means of specific anti-mediators. Specific immunotherapy, in addition to the clinical effect, is capable of modifying the Th2-biased immune response. Thus, an intense research activity is presently ongoing with the aim of improving the characteristics and modes of action of this treatment.     

变应性鼻炎的特异性免疫治疗

变应性鼻炎的患病率近年呈明显增加趋势.特异性免疫治疗不仅可以预防新的致敏且远期疗效较好,是目前惟一有可能通过免疫调节机制改变变应性疾病自然进程的治疗方法.本文综述变应性鼻炎的特异性免疫治疗疗效及安全性研究进展.     

Emerging treatments for allergic rhinitis

Allergic rhinitis has increased in prevalence and afflicts almost a fourth of the younger population in westernised countries. Recent discoveries concerning the pathophysiology of the allergic reaction have led to an increase in research for new and improved remedies for allergic rhinitis. Pharmacological research in the field of allergic rhinitis concentrates on selective agents that may block or inhibit the release or actions of certain mediators or cytokines. The complexity of the allergic inflammatory process, however, may question the benefit of this research, unless the drug interferes early in allergic processes. Current treatments such as antihistamines and intranasal steroids can also be improved, displaying better clinical potency with fewer side effects. All novel treatments, however, must measure up with the present ones, in terms of both clinical and cost effectiveness.     

Treatment of allergic rhinitis: H1-antihistamines and intranasal steroids

Allergic rhinitis is charterized as an inflammatory disease of the nasal mucosa. In clinical practice, H(1)-antihistamines and topical corticosteroids are most commonly used pharmacological agents for the treatment of allergic rhinitis. The beneficial effects of steroids depend upon their long-term anti-inflammatory effect rather than upon direct receptor antagonism. This is different to H(1)-antihistamines, which block both neural and vascular H(1) receptors and have a clinical effect on symptoms such as nasal itching, sneezing, and rhinorrhea. H(1)-antihistamines are rapidly absorbed and most of them are metabolized by the hepatic cytochrome P system and begin to reduce nasal symptoms (itching and sneezing) within one hour. Understanding of both the efficacy and the pharmacological properties of these commonly used drugs in the treatment of nasal allergic inflammation and its related nasal symptoms is very important. From a clinical viewpoint, it will provide a useful guideline for an appropriate use of these drugs.     

Intranasal corticosteroids for allergic rhinitis

Intranasal corticosteroids are accepted as safe and effective first-line therapy for allergic rhinitis. Several intranasal corticosteroids are available: beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide. All are efficacious in treating seasonal allergic rhinitis and as prophylaxis for perennial allergic rhinitis. In general, they relieve nasal congestion and itching, rhinorrhea, and sneezing that occur in the early and late phases of allergic response, with studies showing almost complete prevention of late-phase symptoms. The rationale for topical intranasal corticosteroids in the treatment of allergic rhinitis is that adequate drug concentrations can be achieved at receptor sites in the nasal mucosa. This leads to symptom control and reduces the risk of systemic adverse effects. Adverse reactions usually are limited to the nasal mucosa, such as dryness, burning and stinging, and sneezing, together with headache and epistaxis in 5-10% of patients regardless of formulation or compound. Differences among agents are limited to potency, patient preference, dosing regimens, and delivery, device and vehicle.     

黄芪对儿童变应性鼻炎血清Th1/Th2的影响

目的通过观察黄芪对变应性鼻炎患儿的Th1/Th2细胞因子的影响,探讨黄芪对变应性鼻炎的作用机制。方法60例变应性鼻炎患儿随机分黄芪治疗组和常规治疗对照组。两组均采用常规治疗,治疗组加用黄芪颗粒1/2包(7.5g),3次/d,疗程2￣6个月。观察患儿2个月内总有效率及用药前和用药2个月后血清Th1和Th2基因表达和蛋白产生水平的变化。结果2个月后黄芪治疗组总有效率显著高于常规治疗组,差异有统计学意义(χ2=0.666,P<0.05),用药后黄芪治疗组、常规治疗组血清Th1比例上升显著,高于健康对照组;用药后黄芪治疗组、常规治疗组Th2比例下降显著(P<0.05),而黄芪治疗组显著高于常规治疗组(P<0.05)。结论黄芪能纠正变应性鼻炎患儿体内Th1/Th2细胞因子的失衡状态,提高缓解率。