Concordia Shanghai



Changes In Weather, Cold or Allergy? - United Family Healthcare

HEALTH TIPS FROM UNITED FAMILY HEALTHCARE 

Meet The Expert

Geoffrey Chen陈东野 MD, PhD

Shanghai United Family Pudong Hospital Chief of ENT

上海和睦家新城医院 耳鼻喉科主任 副主任医师

Dr. Chen has 20 years of clinical, research and teaching experience in E.N.T. He is experienced in endoscopic sinus surgery, oto-neurosurgery, minimally invasive pharyngeal surgery, laryngeal microsurgery, and surgical treatments for sleep apnea syndrome. He has extensive research and clinical experience in obstructive sleep apnea (OSA) in adults and children (including adenoidal hypertrophy and hypertrophy of the tonsils), rhinitis, rhino sinusitis, nasal polyps, voice disorders, vertigo, otolithiasis, otitis media, hearing loss, and hereditary hearing impairment.

Changes In Weather, Cold or Allergy?

What is allergic rhinitis?

Allergic rhinitis (AR), refers to a chronic inflammatory disease of the nasal mucosa with paroxysmal sneezing, runny nose and nasal blockage as the main symptoms after exposure to allergens in susceptible individuals.

The standardized prevalence rate among adults in China reached 17.6% in2011 and continues to rise. [1]

What is the danger of allergic rhinitis?

Many people think that allergic rhinitis is just a little uncomfortable, without realizing its true harm:

1. Frequent attacks of symptoms affect work, life and rest, resulting in problems like decreased work and study efficiency, lack of sleep and hypoxia

2. There is a risk that it will develop into asthma. Due to the consistency of the upper and lower airway mucosa, when the upper airway mucosa has an allergic reaction, the lower airway mucosa will also have edema and increased exudation. According to statistics, about 40% of patients with allergic rhinitis will potentially develop into asthma [2]

3. If it worsens further, it can cause nasal polyps and sinusitis. Repeated episodes of allergic rhinitis can easily cause mucosal edema at the opening of the sinuses, blocking the ventilation and drainage of the sinuses, and part of the edema of the mucosa will eventually develop into polyps

How is allergic rhinitis diagnosed?

Symptoms: paroxysmal sneezing, watery mucus, nasal itching and nasal congestion, may be accompanied by eye symptoms: itchy eyes, tearing, burning sensation

Signs: pale and swollen nasal mucosa on both sides, inferior turbinate edema, watery nasal discharge

Inspection: Skin prick test, specific immunoglobulin E (IgE) test, nasal provocation test, etc.

 

How do doctors at Shanghai United Family Pudong Hospital diagnose and treat allergic rhinitis?

Step 1: Consultation

When a patient visits a doctor because of symptoms related to allergic rhinitis, the doctor will guide them through a detailed consultation, using an anterior rhinoscope or nasal endoscopy to check the nasal cavity to determine whether there is a possibility of allergic rhinitis.

Step 2: Detection

Shanghai United Family Pudong Hospital has advanced inhalation specific IgE detection equipment, which can identify allergens through blood sampling for further targeted treatment. There is also a nasal function tester that can detect the resistance and ventilation of the nasal cavity.

Step 3: Treatment Plan

Treatment for allergic rhinitis is designed according to each patient's age, needs, physical condition, and the type of allergen. It requires the doctor and the patient to discuss together to determine a suitable plan and firmly implement the following steps:

1. Getting rid of allergens: Suitable for all people, the focus of this program is to reduce contact with allergens. Methods include removing mites, removing mildew, keeping away from pets, and nasal washing/using mucosal barriers. The purpose is to prevent allergens from contacting the mucous membranes and isolate the source of allergic reactions.

Nasal irrigation with saline is a safe, convenient and inexpensive auxiliary treatment method. Using normal saline or hypertonic saline to flush the nasal cavity can remove irritants, allergens and inflammatory secretions in the nose, reduce nasal mucosal edema, and improve mucociliary clearance. You will need to ①master the correct flushing posture ②control the concentration of salt water between 1-3%, too high or too low will damage the nasal mucosa ③control the temperature of the salt water so that it is slightly higher than body temperature, ideally about 40℃.

Nasal cavity flushing: At present, there are many molded products on the market, and the more commonly used types are divided into: ① Spray type sprays salt water into the nasal cavity in a mist. Its advantages are that it is softer and less irritating, but the water temperature cannot be controlled and it may not be powerful enough for some patients. ② The lavage (also called irrigation)type generally involves dissolving a prepared salt packet into the container with water to rinse the nasal cavity. This type has a higher flow rate, and allows you to control the salinity and temperature of the water. The disadvantage is that you need to control the amount and intensity of flushing yourself, and the higher flow rate can be uncomfortable for some patients. It is usually recommended that patients use the spray type during maintenance periods and the lavage type during periods of acute attack.

2. Standardized drug treatment: Many people feel that allergic rhinitis is an “incurable disease" that can be relieved by medication for a period of time, but it will relapse immediately after stopping medication. In fact, this is the result of no standardized treatment. At present, there are many types of anti-allergic medication. These medications are divided into different doses and forms, covering almost all age groups. Even pregnant women have relatively suitable medication choices. The comprehensive use of first-line and second-line drugs can control the symptoms of most patients with allergic rhinitis. Standardized use and scientific collocation are the core of anti-allergic treatment.

At the beginning of treatment, doctors generally choose drugs based on the severity of the condition, usually starting from a nasal spray steroid+ an oral antihistamine. If this is insufficient for controlling symptoms. other drugs will be used in combination, and the drugs will be administered in different levels.

After the onset of allergic rhinitis. timely medication use according to the doctor's advice can often relieve nasal symptoms quickly, but the medication cannot be stopped immediately when the symptoms disappear. Generally speaking, nasal spray steroids need to be used continuously for at least 2weeks, and it is recommended that they be used for more than 4 weeks. Oral antihistamines need to be used for more than 2 weeks. Stopping the medication prematurely is likely to cause unstable efficacy. and increase the chance of recurrence.

Many patients are resistant to using nasal spray steroids, fearing that it will weaken their immune system, hinder growth, or cause weight gain or acne. In fact, nasal spray steroids are quite safe, and listed as first-line drugs in both domestic and foreign guidelines. They can be purchased in pharmacies and used by patient themselves. The concentration of steroid is very low, and it mainly acts on the local nasal mucosa and hardly absorbs into the blood. Even with long-term use, there are few adverse reactions. What requires greater attention is how you administer the spray:

1)Clean your hands first.

2)Clean the nasal cavity; before using the nasal spray, clean the nasal cavity and blow out the nasal mucus. You can use saline nasal spray to clean the nasal cavity, so that the drug can fully act on the nasal mucosa.

3) Shake the medicine well and remove the cap.

4)Hold the nasal spray: hold the bottom of the bottle with the thumb of your right hand, place the index finger and middle finger on either side of the spray head, and clamp the spray head down. Shake the vial thoroughly before administering the first dose and after the medication has been sitting for more than a week, then spray it into the air 1 to 2 times.

5)Spray the medicine slightly towards the outer wall of the nasal cavity, being sure to spray the amount and number of times prescribed by the doctor; after spraying. keep a natural head position and do not lie on your back.

3. Sublingual desensitization treatment: desensitization treatment has now become the first-line treatment for allergic rhinitis. For some specific allergens such as dust mites, desensitization treatment can be used, and the drug can be taken daily under the tongue. The principle of this treatment method is to allow the patient to be exposed to the corresponding allergen over a long period, gradually increasing the dose, and finally reaching a higher maintenance dose, allowing the patient to adapt to the allergen. After 3 years of treatment, the patient will be able to enjoy long term relief, with high safety and low side effects, which is of great significance for children. Sublingual desensitization can effectively lower the risk of allergic rhinitis complicated by asthma, and can also prevent the emergence of new allergens.

Sublingual desensitization is highly effective. A study shows that the effective rate can reach 89.7% after 2 years of treatment. It has been used in China for more than ten years, accumulating a large number of cases. In early 2020. the Allergy Branch of the Chinese Medical Association released the "Guidelines for Sublingual Immunotherapy for Allergic Rhinitis and Allergic Asthma", indicating that sublingual desensitization has become a mature treatment for allergic rhinitis and allergic asthma.

The advantages of sublingual desensitization therapy are

① Higher safety and mild side effects. There are no reports of severe adverse reactions of sublingual desensitization in China.

② Long-term curative effect. After 2 years of treatment, a long-term curative effect of 7 years can be obtained on average, and 3 years of treatment can have even longer-term benefits.

③ Easy to operate, you can administer the treatment at home, and patients only require follow up and evaluation once every 3 months.

The disadvantages are:

① The treatment period is very long, lasting at least two years, and a recommended period of three years or more

② The first month is more complicated, and you need to switch to a different dosage every day, which tests patience and care

4. Surgical treatment: For some patients who are unwilling to receive long-term medication or desensitization, for whom those other treatments have been ineffective, or who have combined diseases that require endoscopic surgery, surgical treatment can be considered. The relaxation and contraction of the nasal mucosa originate from local vascular expansion and changes in vascular permeability, and the local blood vessels are innervated by the parasympathetic nerves in the nose. This nerve fiber originates from the vidian nerve, and after passing through the sphenopalatine ganglion located in the pterygopalatine fossa, it sends out the posterior nasal nerve innervating the nasal mucosa, and enters the nasal cavity through the sphenopalatine foramen. During the operation, the doctor will use a plasma radio frequency knife to cut the parasympathetic nerve fibers inside the nasal cavity, which can significantly improve the nasal congestion and other allergic symptoms post operation. The efficacy rate of surgical treatment is close to 90%[3][4].

Shanghai United Family Pudong Hospital ENT Department has fully carried out the surgical treatment of allergic rhinitis. If you have any needs in this regard, please consult your doctor.

Step 4: Review and Evaluation

The treatment of allergic rhinitis is not a one-shot deal, and you cannot let yourself go as soon as the symptoms get better. Regular follow-up visits are required to evaluate the effectiveness of treatment, improve your treatment plan or even create a new treatment plan.

 

[1] Zhang Y, Zhang L. Increasing Prevalence of Allergic Rhinitis in China. Allergy Asthma lmmunol Res 2019; 11: 156-69.

[2] Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. JAS 2019;11:156-69.2001;108(Suppl.5):S147-S334.

[3]赵娜,石磊,翼管神经切断术的研究,1007-1520(2016)01-0081-04.

[4] 冀永进 张艳延 赵长青 吕声悦 王媛 关芳员 祁营萍,鼻内镜下经媒贸置管神经切断术的手术探讨,1007-1520(2014)06-0483-04