Allergic rhinitis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
J30.1 Allergic rhinopathy due to pollen
J30.2 Other seasonal allergic rhinopathy
J30.3 Other allergic rhinopathy
J30.4 Allergic rhinopathy, unspecified
ICD-10 online (WHO version 2019)
Electron microscope image of pollen, the cause of hay fever (pollinosis)

The allergic rhinitis , including allergic rhinitis or allergic rhinitis , an allergic -related inflammation of the nasal mucosa ( rhinitis ).

The disease usually begins in early childhood and has impaired quality of life for decades. The health effects concern social life, school performance and work productivity. Depending on the source, the proportion of sick children and adolescents is between 15 and over 30 percent. Cross allergies also play a major role in adulthood .

Allergic rhinitis is often accompanied by other diseases of the respiratory tract such as inflammation of the paranasal sinuses ( sinusitis ) and asthma . A simultaneous inflammation of the conjunctiva of the eye ( conjunctivitis ) is called allergic rhinoconjunctivitis .

A subspecies of allergic rhinitis that is specifically triggered by pollen and only occurs seasonally is pollen-related allergic rhinitis , also known as hay fever , hay fever or, in medical terms, pollinosis or pollinosis (from the Latin pollen = fine flour).

Classification

Conventionally, the distinction between pollen-related allergic rhinitis (hay fever), which only occurs seasonally during the spring, summer and (depending on the region) autumn months, year-round (perennial) allergic rhinitis such as house dust allergy and allergic rhinitis due to genetic factors is often not precise enough Differentiated predisposition.

The World Health Organization (WHO) has proposed a new classification of allergic rhinitis, which distinguishes between interrupted (intermittent) and permanent (persistent) allergic rhinitis . Persistent is a duration of more than four days a week for at least four weeks.

How long the symptoms last depends on how sensitive you are to the allergen (triggering substance) and how long you have been in contact with the allergen. Flower and grass pollen ( see also: grass pollen allergy ) occur only at certain months or in certain areas, house mite dust is in the immediate vicinity (floor, bed linen) all year round.

Pollen calendar

Causes and origins

causes

The incidence ( prevalence ) of allergic rhinitis has increased steadily in recent years. Different causes of allergic rhinitis are listed. The allergy tendency ( allergic diathesis ) is inherited . The increasing number of diseases is explained, among other things, by the increase in hygiene and the increase in the aggressiveness of allergens due to pollutants and changes in lifestyle. The air pollution in urban areas enhanced by their additional pollutants the severity of the allergy.

In the human immune system , the original task of the antibody immunoglobulin E was to ward off parasites . In the industrialized nations , however, diseases caused by them have become a rarity. It is evident that allergic diseases are almost unknown in third world countries. The hygiene thesis states that the unemployed immune system creates new enemies, for example inhaled pollen. In Germany, rural children who grow up with animals and flowers suffer less from allergies.

It is expected that global warming will greatly increase both the number of people affected and the severity of symptoms. According to a study published in Environmental Health Perspectives in 2016, the number of people affected who are allergic to ragweed pollen has risen from 33 million at present to around 77 million, with the greatest increases occurring in countries such as Germany, Poland and France become. The pollen season also extends in large parts of Europe to September and October.

Emergence

Allergic rhinitis begins with a sensitization to an allergen (for example pollen or house dust mites ) for which no symptoms occur (first contact). A defense cell ( dendritic cells or macrophages ) picks up the allergen and presents it to a T lymphocyte , which then stimulates B lymphocytes to rebuild and multiply to fight the intruder. These produce said IgE antibodies, which are specifically directed against the allergen and are bound to mast cells . In a second contact, two antibodies are bridged by the allergen and the mast cell secretes potent mediators such as histamine , leukotrienes and platelet activating factor (PAF).

In simple terms, the defense system gets to know the supposed enemy on first contact in order to fight him on second contact. The body's typical reactions - redness, itching, sneezing and a runny nose - are triggered by histamine and the leukotrienes. The purpose is an improved blood circulation (this is how the rubor, that is the reddening, comes about), to make the way for defense cells to move easier, itching to bring attention to the said area, sneezing and mucus formation to clear foreign substances from the body .

The allergic disease now shows symptoms and without appropriate treatment it begins to become chronic with new sensitizations. In addition, pro-inflammatory (pro-inflammatory) TH2-associated chemokines and cytokines are released. The TH2 helper cells regulate the immune system towards a humoral response and are therefore of particular importance in the event of an allergy.

Allergic rhinitis is a type 1 allergy (according to Coombs and Gell ). A distinction is made between an immediate phase of allergic inflammation (less than two hours), in which histamine dominates as a mediator, and a late phase (2–48 hours after allergen exposure), in which leukotrienes are in the foreground.

Health effects

Allergic rhinitis and especially pollen-related rhinitis is characterized by sneezing, itching ( pruritus ), secretion ( runny nose) and obstruction (congestion) of the nose, as well as conjunctivitis (conjunctivitis of the eye), while mite-related rhinitis is mainly used for obstruction (narrowing) the airways. Another characteristic is nasal hypersensitivity (hyperreactivity) to unspecific stimuli such as cold air, tobacco smoke, scents or sporting activity. This hypersensitivity triggers symptoms just like the allergen contact. The impairment of the quality of life of those affected ranges from sleep disorders with accompanying daytime sleepiness to a reduction in the ability to concentrate and learn , especially in children.

Comorbidities

The comorbidities (simultaneously existing diseases) of allergic rhinitis are:

A connection between habitual snoring , obstructive sleep apnea syndrome and allergic rhinitis has been established in children .

Diagnosis

Taking the medical history ( anamnesis ) is an important tool for diagnosing allergic rhinitis. A conclusion about the relevant allergen or allergens can be drawn from the duration and the circumstances of the symptoms . The allergens can then be identified (recognized) using the prick test. In this procedure, various allergenic solutions are dripped onto the skin of the forearm. Then the skin is scratched with a needle. If there is hypersensitivity (sensitization) to one or more substances, reddening of the skin with wheals will appear within 20 minutes. A provocation test can also be carried out to verify the results. To do this, the patient is brought into contact with the allergens. This is usually done using a nasal spray (nasal provocation test) or eye drops (conjunctival provocation test).

A blood test is preferable to the prick test, especially in young children. Either the total IgE titer ( Radio-Immuno-Sorbent Test , RIST) or specific IgE antibodies ( Radio-Allergo-Sorbent Test , RAST) are determined. The RIS test gives an indication of an underlying allergic disease, but is also increased in other diseases, such as certain tumors. The RAS test, on the other hand, precisely detects sensitization to a specific allergen.

Differential diagnosis

In addition to allergic rhinitis, there are other diseases with similar symptoms, including the following:

Also, similar symptoms can occur during pregnancy or menopause .

therapy

The treatment of allergic rhinitis has three main aspects: the waiting (avoidance of the allergen), pharmacotherapy (treatment of symptoms associated with acute effective drugs) and specific immunotherapy (long-term elimination of allergic reaction). It seems to be advantageous to intervene in the disease process as early as possible, because this avoids re-sensitization and prevents the development of asthma. Although allergic rhinitis is a chronic disease, its course can be stopped and often even cured with adequate (adapted) therapy. However, only a fraction of those affected are under medical treatment, and there is often an astonishing ignorance on the part of doctors about the meaning and treatment of allergic rhinitis.

One study suggests a weak positive effect of placebos like acupuncture on allergic rhinitis. The symptoms and the need for medication are reduced, but the potency is classified as very low.

Parental leave

FFP3 respirator

Leave of allergens is to avoid the allergens. With some materials such as animal hair this is relatively easy, contact with cats or dogs can usually be avoided. In the case of a house dust mite allergy , renovating the bed (for example with suitable encasing covers) and more frequent cleaning and ventilation of the bedroom often leads to improvement. In the case of pollen allergies, it is advisable to change clothes and wash your hair before entering the bedroom after spending time outdoors. Leisure activities outdoors should, if possible, be scheduled after a heavy rain shower. It is also possible to keep pollen and house dust away from the respiratory tract with the help of a respiratory protection mask, also known colloquially as a dust mask, which is used in occupational safety. These are available in filter levels P 1–3. This makes it possible to do sports even during heavy pollen counts or to sleep without discomfort in a bed that is heavily contaminated with house dust. The most convenient are folding masks or masks with a sealing lip. A half mask with an inserted P3R filter is most effective.

Pharmacotherapy

  • As locally effective therapeutic agents , cromones such as cromoglicic acid are available, which are weaker than antihistamines and glucocorticoids ( cortisone ). These drugs stabilize the mast cells, but the onset of action is delayed, so that Cromone must be used a week before the first pollen flight in the event of a pollen allergy.
  • Antihistamines prevent the symptom-causing effects of histamine. They can be applied (introduced) locally as a nasal spray (such as levocabastine ) or systemically (for internal use) in tablet form such as levocetirizine , loratadine or fexofenadine . Modern antihistamines do not have a sedative (tiring) effect like antihistamines of the first generation, so that they are to be preferred to older substances, especially in children. The antihistamines block the peripheral histamine H 1 receptors ; thus they suppress the effects of histamine.
  • Topical glucocorticoids (cortisone) such as flunisolide , budesonide , mometasone and fluticasone are probably the most effective drugs for treating allergic rhinitis. They suppress all nasal symptoms, especially obstruction (constipation), which is hardly influenced by antihistamines. Unfortunately, conjunctivitis (inflammation of the conjunctiva of the eye) is not affected, which is why the simultaneous administration of a topical corticosteroid and an antihistamine can be useful. The topical (externally applied) glucocorticoids do not suppress the function of the adrenal cortex , so the side effects of (systemically acting) cortisone are not to be feared. Treatment can also be regular, with children receiving corticosteroids with low systemic bioavailability, such as fluticasone or mometasone. Systemic corticosteroids can be useful at the beginning of treatment, but should only be given for a limited time, as otherwise side effects such as diabetes mellitus can occur.
  • Nasal sympathomimetics (nasal spray / drops to decongest the nasal mucosa) remove the obstruction, but leave the other symptoms unaffected. They should only be used for a short period of time because they in turn can lead to rhinitis (inflammation of the nasal mucosa - rhinitis medicamentosa).
  • In herbal medicine and in homeopathy some find of medicinal plants derived drugs to treat the symptoms application. However, the effectiveness of homeopathic preparations could not be proven . They are used here, for example

Specific immunotherapy (SIT)

A specific immunotherapy (SIT), also called desensitization, aims at permanent insensitivity to the allergy trigger. It should be started as early as possible, as it is particularly effective in mono- or oligosensitized people (people with one or a few allergies). As a rule, children can be treated with SIT from the age of five. The SIT is usually carried out over a period of three years. In individual cases it can make sense to extend the treatment time. A basic distinction is made between subcutaneous specific immunotherapy (SCIT) and sublingual specific immunotherapy (SLIT). In SCIT, the preparations are injected into the back of the upper arm; in SLIT, they are dripped under the tongue or administered using a tablet.

Preparations to be applied sublingually are usually taken by the patient at home, while SCIT is carried out at the doctor's office. In SCIT, the allergens are either injected as intact, chemically unchanged allergens or as so-called allergoids (chemically modified allergens on a carrier substance) every 7–13 days in the increase phase. When the maintenance dose (maximum dose) has been reached, it is injected again about every four weeks, or up to eight weeks for individual preparations. A positive effect on the prevention of allergic asthma and a long-term effect beyond the end of therapy have been proven for individual preparations. The mechanism of action of specific immunotherapy is not fully understood. It is known that during therapy the TH1 lymphocytes increasingly take over the regulation of the immune system to the disadvantage of the TH2 helper cells.

Individual evidence

  1. ↑ Ingrid Moll: Dual Series - Dermatology . 2005, p. 166 .
  2. ↑ Hay fever: Cross-allergies play a major role in adulthood. In: Medical Observer. ( medicalobserver.com ).
  3. ↑ a b c d e f g h i Claus Bachert, U. Borchard, B. Wedi, Ludger Klimek , G. Rasp, H. Riechelmann, G. Schultze-Werninghaus, U. Wahn, Johannes Ring : Allergic Rhinoconjunctivitis. In: Allergo Journal . No. 12 , 2003, p. 182-94 .
  4. ↑ Allergologist Peter Schmid  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. ( University Hospital Zurich ) on SRF 1, April 15, 2013.@1@ 2Template: Dead Link / www.srf.ch  
  5. ↑ Barbara Nickolaus: Allergy prevention: the earlier, the better . In: Deutsches Ärzteblatt . No. 107 , 2010, p. 11 ( aerzteblatt.de ).
  6. ^ Iain R. Lake et al .: Climate Change and Future Pollen Allergy in Europe . In: Environmental Health Perspectives . 2016, doi : 10.1289 / EHP173 .
  7. ↑ a b c d Johannes Ring: Applied Allergology. 2nd Edition. MMV Medizin Verlag, Vieweg, ISBN 3-8208-1096-X .
  8. ↑ hay fever. Retrieved June 19, 2020 .
  9. ↑ Benno Brinkhaus, Miriam Ortiz, Claudia M. Witt, Stephanie Roll, Klaus Linde, Florian Pfab, Bodo Niggemann, Josef Hummelsberger, András Treszl, Johannes Ring, Torsten Zuberbier, Karl Wegscheider, Stefan N. Willich: Acupuncture in Patients With Seasonal Allergic Rhinitis A Randomized Trial. In: Annals of Internal Medicine. No. 158 (4) , February 2013, p. 225-234 .
  10. ↑ Specific immunotherapy (desensitization) for IgE-mediated allergic diseases. Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Medical Association of German Allergologists (ÄDA), the Society for Pediatric Allergology and Environmental Medicine (GPA), the Austrian Society for Allergology and Immunology (ÖGAI) and the Swiss Society for Allergology and Immunology (SGAI), Allergo J 2009; 18: 508-37.

See also

literature

  • Katharina Bastl, Uwe E. Berger: Pollen and allergy. Recognize and alleviate pollen allergy . Manz, Vienna 2015, ISBN 978-3-214-00983-0 .

Web links

Wiktionary: hay fever  - explanations of meanings, word origins, synonyms, translations