AllergicRhinitis變應性鼻炎Laihe賴荷E.N.TdepartmentThesecondaffiliatedhospitalGuangzhoumedicalcollegeGeneralinformationDefinition定義Allergicrhinitiscanbedefinedasadiseasegivingrisetotwoorthreeofthefollowingsymptoms:sneezingattacksseroushypersecretion（高分泌）andnasalblockageduetoaswollennasalmucosa.2.Morbidity（發病率）10%-40%Generalinformation3.Classification分類Perennialallergicrhinits常年性變應性鼻炎Seasonalallergicrhinitis季節性變應性鼻炎(pollinosis)4.Atopictype特應型個體Itisaindividualwhobringsthegeneswhichhaverelationwithallergicrhinitis(familialorhereditarynature)

帶有與變應性鼻炎發病有關的基因的個體Pathophysiology病理生理1.Sensitization致敏contactAntigensRespiratorymucosa呼吸道粘膜activateCD4+TLymphocyteTh2cellsecreteDeliversignalIL-4,IL-5,IL-6,IL-10,IL-13(Mediators炎癥介質)activateBcellHemaendotheliocyte血管內皮細胞

ICAM-1(intercellularadhesionmolecule-1細胞間粘附分子-1)produceattachEosinophil嗜酸細胞IgEMastcell肥大細胞gotonasalmucosareceptoronbasophil嗜堿細胞Tlymphocyte淋巴細胞

Pathophysiology病理生理2.Allergy

contactnasalAntigenbridgingofantigenmoleculeandIgEmucosaagainmastcellderganulation脫顆粒releaseHistamine組織胺andothermediators

contractionofhighexcitabilityincreasinginhypersensitivityresistantvesselparasympatheticvascularpermeabilityofsensorynerve&dilatationofnerve副交通透性感覺神經capacityvessel感神經阻力血管收縮和容量血管擴張increasingmucosalnasalitchingpale&purpleglanduloussecretionedemasneezingNasalMucosa粘膜水腫鼻癢、打噴嚏blockagewaterydischargeClinicalPresentation臨床表現nasalitchingsometimesitchingofeyes

鼻癢conjunctival

injection結膜充血2.Sneezingattacks陣發性打噴嚏3.Nasaldischarge流涕watery4.Nasalblockage鼻塞5.Hyposmia

嗅覺減退

Examination檢查1.Nasalexamination:lightblue,congestive

鼻腔檢查orpalemucosa,mucosaledema水腫especiallyinferiorturbinate

下鼻甲2.Nasaldischargeexam:alotofeosinophil

鼻分泌物嗜酸細胞3.SerumtotalIgEdetermination

血清總IgE檢查Examination檢查2.Findingallergen尋找抗原a.SpecialIgEexamination特異性IgE檢查

①Skintesting:pricktest點刺試驗intracutaneoustest皮內試驗②SerumspecialIgEdetermination血清特異性IgE檢查b.Nasalallergenchallengetest鼻激發實驗

DifferentialDiagnosis鑒別診斷1.Nonallergicrhinitiswitheosinophilia

嗜酸粒細胞增多性非變應性鼻炎2.Vasomotorrhinitis

血管運動性鼻炎Treatment治療1.Pharmacotherapy

藥物治療a.Steroid

:topical—nasalspray

鼻噴霧劑類固醇general

全身用藥b.Antihistamines:H1-receptorantagonistH1受體拮抗劑

抗組胺藥First-generation第一代:toldrin樸爾敏second-generation:clarity(don’tcrosstheblood-第二代brainbarrier

不能通過血腦屏障)c.Mastcellstabilizingdrug:disodiumcromoglycate

肥大細胞膜穩定劑色甘酸鈉Treatment治療d.Decongestants血管減充劑typical:shortterme.Anticholinergicdrug:抗膽堿藥f.Others:reducesensitivityofnasalmucosainferiorturbinate---lazar,crymotherapy冷凍microwave微波surgery:vidianneurectomy翼管神經切斷術

手術anteriorethmoidneurectomy篩前神經切斷術submucousresectionofnasalseptum

鼻中隔矯正術Treatment治療2.Avoidtocontactallergen避免接觸變應原3.Immunotherapy免疫治療

Indication:

IgE-mediateddisease(Ⅰtypeallergy)causedby

適應癥inhalantallergenMethod:increasingdosesofallergenareinjecteduntil

方法themaximumtolerabledoseisreachedmaintenancedose(maximumtolerabledose)

最大耐受劑量Course:2yearsormore

療程

Immunotherapy免疫治療

Mechanism作用機理

:unclearblockingantibody封閉抗體balancebetweenTh1andTh2

Rushimmunotherapy:pollinosis花粉癥

快速免疫療法

1-2weeksreachmaximumtolerabledose(maintenancedose)

referencesTian

yong-quanetal,otolaryngology5thedition,textbookofseriesofnewcentury,2001.Niels

mygindetal