儿童变应性鼻炎鼻窦炎

变态反应在美国人群中估计占１５～３０％。儿童变态反应则更多估计在６０％。有经验的临床医生早就认识到上呼吸、消化道复发性感染和变应性状态间的关系。近期的研究已进展到变态反应基础病理生理，已能解释临床上一些现象的机制。鼻、鼻窦炎最常见的病理途径是由各种原因包括变态反应引起的炎症造成粘膜水肿。水肿致鼻窦自然开口受阻，局部组织缺氧（纤毛运动降低），血管扩张和液体渗入细胞间隙，为细菌及病毒生长提供了理想基础环境。水肿使通过鼻腔气流量下降，对鼻及鼻窦正常功能产生有害作用。易感个体变态反应介质是由Ｔ辅助淋巴细…     

重视儿童变应性鼻炎研究

变应性鼻炎(AR)是影响儿童身心健康、学习成绩和生活质量的主要鼻部疾病,患病率高,具有较大的社会影响.10年来,国际儿童哮喘和变应性疾病研究项目(International Study of Asthma and Allergies in Childhood,ISAAC)报告了全球变应性鼻炎、哮喘和特应性湿疹的患病情况在近7年间呈总体上升趋势,其中不同国家和地区6～7岁儿童变应性鼻炎的患病率波动于2.2%～24.2%,13～14岁儿童的患病率波动于4.5%～45.1%[1].国际上有关中国儿童变应性鼻炎流行状况的报告近年增多,不同年龄、地区和生活方式的儿童,变应性鼻炎的患病率存在较大差别.     

儿童变应性鼻炎免疫治疗研究进展

变应性鼻炎发病率逐年升高,严重影响儿童的生长发育、身心健康及学习生活,儿童变应性鼻炎的有效治疗成为儿童健康成长的关键。免疫治疗可通过免疫调节机制改变疾病的自然发展进程,不仅减轻临床症状,同时可降低哮喘的发病率,主要包括皮下免疫治疗及舌下免疫治疗。本文就儿童变应性鼻炎的免疫治疗研究进展进行综述。     

儿童变应性与非变应性鼻炎的鉴别诊断

儿童变应性与非变应性鼻炎发病率高,鉴别诊断困难,近年所用鉴别诊断方法不能最后解决问题。目前文献报导生物基质结晶体检查法对各类疾病有高度敏感性,可作为儿童变应性与非变应性鼻炎的辅助鉴别诊断法。将长4～5cm 的消毒纱条放入总鼻道留置1小时,取出后置入盛2ml 生理盐水的试管内10～15分钟。取出纱条并挤出所含液体,边摇动试管边滴入10ml 2%氯化铜酒精液,在室温下放置15分钟形成混悬液,过滤后将滤液注入烧杯并置恒湿和37℃恒温器中,5～6小时后形成CaCl_2·6H_2 O 动态系统、出现结晶体;或将经上述处理的滤液涂片,置入相同恒湿恒温器中形成CaCl_2·     

儿童变应性鼻炎的特异性免疫治疗

自1911年英国医生Noon首次报道“枯草热”(花粉症)的脱敏疗法(desensitization),迄今已整整100年.所谓脱敏疗法,是指通过应用逐渐增加剂量的变应原提取物,减轻由于变应原暴露而引发的症状,使患者实现针对该变应原的临床耐受乃至免疫耐受,又称变应原特异性免疫治疗( allergen-specific immunotherapy,简称免疫治疗).     

儿童变应性鼻炎验案一则

变态反应性鼻炎简称变应性鼻炎,又称过敏性鼻炎,以阵发性发作的喷嚏,大量的清水鼻涕,鼻塞为典型症状,多数患者伴有嗅觉减退,局部检查多见两侧下鼻甲肥大水肿,鼻腔粘膜苍白。变应性鼻炎为IgE介导的鼻黏膜I型变态反应,属于中医中的"鼻鼽"的范畴,《素问玄机原病式·六气为病》中曰"鼽者,鼻出清涕也。""嚏,鼻中因痒而气喷作于声也。"     

儿童变应性鼻炎的诊断要点

儿童变应性鼻炎(AR)是指易感患儿接触变应原后主要由IgE介导的鼻黏膜非感染性炎性疾病.国际儿童哮喘和变应性疾病研究(international study of asthma and allergies in childhood,ISAAC)表明,儿童AR在全球大多数地区呈持续流行增加趋势工,在我国AR的患病率约为10%[1-2],且呈逐年增加趋势.儿童AR并不是一个孤立的疾病,其对下呼吸道炎性疾病(如支气管哮喘)的发生、发展、严重程度及临床转归均有重要影响.儿童AR的临床特点、检查及治疗与成人有一定区别,因此制订针对于儿童AR的诊断和治疗指南,对规范临床诊疗及防控AR引起的相关疾病具有重要意义.本文根据最新制订的<儿童变应性鼻炎诊断和治疗指南>[3],结合我们临床工作经验对儿童AR的诊断和鉴别谈以下几点看法.     

儿童非变应性鼻炎与变应性鼻炎患者生活质量的对比研究

目的：分析比较儿童非变应性鼻炎（NAR）患者与变应性鼻炎（AR）患者生活质量之间的差异,探讨NAR对患儿生活质量的影响。方法2011年6月～2012年6月在门诊首次确诊的52例NAR患儿和69例AR患儿（6～12岁）,指导患儿及家长采用视觉模拟量表（VAS）评价患儿的鼻、眼及胸部症状,并采用儿童鼻结膜炎生活质量调查表（RQLQ）评估并比较NAR与AR患儿的生活质量有无差异。统计结果采用SPSS13.0软件进行分析。结果 NAR组与AR相比,VAS评分无明显差异（P〉0.05）;RQLQ两组评分无明显差异（P〉0.05）。NAR组内,各项症状VAS评分比较差异有统计学意义（P〈0.01）,“鼻堵”为首要症状;RQLQ各项目以及各方面间比较差异均有统计学意义（P〈0.01）,各项鼻部症状相比差异有统计学意义（P〈0.05）,“鼻堵”和“流涕”为首要症状,各项非鼻眼部症状相比差异也有统计学意义（P〈0.01）,“注意力难以集中”为首要症状。结论 NAR对患儿的生活质量有着明显的影响,值得临床护理工作中重视。     

变应性鼻炎对儿童中耳的影响

目的探讨变应性鼻炎对中耳听功能的影响。方法对变应性鼻炎患儿100例和正常儿童50例行耳镜检查、声导抗和纯音听阈的测定。分别对正常儿童组．轻度与中重度变应性鼻炎组的鼓膜异常率、鼓室导抗图异常率、听力损失率、昕阈值进行对比分析,并进行病程与各项观察指标的分析。结果轻度变应性鼻炎组与中重度鼻炎组、中重度鼻炎组与正常儿童组中耳病变和功能异常的发生率相比。差异有统计学意义（P〈O．01）,而轻度变应性鼻炎组与正常儿童组相比,无统计学意义（P〉0．05）;轻度变应性鼻炎组和中重度变应性鼻炎组症状持续时间均与听力损失程度有相关性,病程越长听力损失越重,Spearman相关性检验,r值分别为0．86（P〈0．01）和0．79（P〈O．01）;三组纯音听阈均数经配对t检验,差异均有统计学意义户〈0．01）。结论儿童变应性鼻炎引起的中耳病变和听功能异常发生率较正常儿童显著提高,症状越重。病程越长,发生率越高。     

儿童变应性鼻炎与心理行为问题

<正>目前,变应性鼻炎(allergic rhinitis,AR)是影响儿童健康最常见的慢性疾病之一。鼻痒、喷嚏、鼻塞和流鼻涕是AR最典型的四大症状。绝大多数AR患者起病于儿童时期,后随着年龄增长患病率逐渐增高。国际儿童哮喘与变态反应研究系统评价了98个国家的哮喘、变应性鼻结膜炎及湿疹的发病情况后,发现6~7岁儿童的总患病率为8.5%,而13~14岁则为14.6%~[1]。Westman等~[2]在对2024名儿童的前     

加强变应性鼻炎研究促进临床规范治疗

国内外流行病学调查资料显示，变应性鼻炎患病率呈现逐渐上升趋势。世界卫生组织关于变应性鼻炎及其对哮喘的影响（allergic rhinitis and its impact on asthma,ARIA）的文件指出，世界范围内的患病率大约在15％～20％，我国目前缺乏全国性、多中心的流行病学观察数据，部分中心城市的初步观察结果显示其患病率大约在5％～10％，估计全国的患病人数超过五千万。众所周知，变应性鼻炎所引起的鼻部症状、眼部症状及相关器官症状给患者健康和生活质量带来严重影响，患者的睡眠、体力活动以及情绪等各项指标都有明显改变。研究表明，变应性鼻炎对体力活动的影响高于哮喘，对情绪的影响二者相似，对于体能和社会活动的影响不如哮喘，但同时也给患者及其家庭带来了巨大的经济负担。尽管如此，在当今日益发达的信息化社会，变应性鼻炎并未引起患者、家属以及专科医生对生活质量影响的足够重视，患者的生活和临床诊疗尚存有不少亟待解决的问题。     

Allergic rhinitis in children as a risk factor of bronchial asthma

This study was designed to measure hyperreactivity of bronchi in patients aged from 7-8 to 13-14 years presenting with allergic rhinitis. The efficiency of the bronchoprovocative test with physical exercises was shown to be higher than the study of external respiratory function at rest.     

Allergic rhinitis epidemiology in Japan

We epidemiologically surveyed allergic rhinitis nationwide, mailing questionnaires to 9,471 otorhinolaryngologists and their families nationwide in June 1998 responses by the end of September 1998: 42.8%, providing 17,301 subjects. Few differences were seen in the age composition between the subject population and the general Japanese population. Cedar pollinosis morbidity after adjustment for population distribution was 17.3%, higher overall on the Pacific Ocean side and in central districts of Japan compared to districts on the Sea of Japan and the Inland Sea and lower in high or low latitudes. By age, morbidity increased sharply among subjects in their teens and decreased among subjects in their 60s. Morbidity was high in districts of heavy cedar pollen dissemination. By housing, morbidity was high in the suburbs, followed by residential areas and cities. Pollinosis due to causes other than cedar pollen showed results similar to those for cedar pollinosis in morbidity by age and the relationship between the housing environment and morbidity, with morbidity after population distribution adjustment 11.7%. Morbidity of perennial allergic rhinitis after adjustment for population distribution was 19.8% was slightly higher than that of pollinosis. By age, morbidity increased sharply at 5 to 9 years of age, being highest in the young than in cedar pollinosis; no decrease in morbidity after age 60 was seen. Unlike cedar pollinosis, perennial allergic rhinitis showed no difference in morbidity by area or housing environment. The present survey using otorhinolaryngologists and their families nationwide as subjects enabled us to find areawise differences in morbidity for cedar pollinosis and perennial allergic rhinitis. Ours is useful epidemiologically in allergic rhinitis mainly for cedar pollinosis in Japan because it is superior to other questionnaires in response and because reply reliability is high.     

Allergic rhinitis and rhinosinusitis

A relationship between allergic rhinitis and acute and chronic rhinosinusitis has been postulated for many years. Epidemiologic evidence suggests that such a relationship is likely. In addition, evidence of a common pathophysiologic mechanism linking these diseases is compelling and continues to evolve. Although a clear and definitive causal relationship remains to be elucidated, an increasing number of studies support the plausibility of this link. The current paradigm of the "unified airway" and evidence to support this model further strengthen this link. This article reviews the literature relating allergic rhinitis and acute and chronic rhinosinusitis.