Allergic rhinitis and sinusitis
In children allergic rhinitis and sinusitis often combined with vasomotor component. The selection of allergic rhinitis and sinusitis in the special section is to some extent an artificial one — any allergic reaction, including nasal cavity and paranasal sinuses, is only a local manifestation of a General hypersensitivity. According to modern concepts, the treatment of inflammatory diseases of the upper respiratory tract in children can not be complete without considering the allergic background of the organism.
There is an opinion that allergic rhinitis and sinusitis occurs in early childhood, facilitated by characteristics of the organism in this period, frequent acute respiratory diseases, heredity, hormonal and other factors. Ways of penetration of allergen in the child's body different: through the placenta, mouth, respiratory tract, skin. Allergic rhinitis and sinusitis in children are causeed by exogenous (household, food, pollen, medicinal, bacterial, viral) and endogenous (inflammation, etc.) allergens, bacterial and non-bacterial (immediate and delayed type reactions). Allergic rhinitis and sinusitis can cause medicines: antibiotics, sulfonamides, salicylates, bromides, etc.
Of particular importance in children has serum (vaccinal), fungal and helminth allergy. Food allergic rhinitis and sinusitis can be from excessive and repetitive food. In children more common polyallergy. In the first year of life allergic reactions occur mainly in the skin and the mucosa of the gastrointestinal tract, and at the age of 2-3 years in the upper respiratory tract.
By collecting allergological data, find out the family history: the presence of allergic disease in the father, the child's mother and their relatives; whether there were allergic reactions in contact with animals, dust, bedding; does the child have a globulin, a blood and plasma transfusion, which immunization and therapeutic serum applied before, if the reaction to their; specify previously available allergic diseases and reactions.
If necessary, skin-allergic tests performed with one or more bacterial allergens: Staphylococcal, Streptococcal (hemolytic), Streptococcus Viridans, Proteus, Enterococcus, Escherichia, Pseudomonas Aeruginosa. With the correct formulation, assessment and the range of allergens tested, this method deserves attention, but not in all cases reliable, as the skin does not always shock site.
Eosinophilia of nasal secretions and contents of the sinuses is also a symptom of allergies, although variable. Eosinophilia of tissue is being treated as one of the most reliable signs of allergies, it is considered pathognomonic symptom of allergic inflammation. However, this test seems to be valuable only in comprehensive diagnosis, not an individual. Besides, as and other specified tests, it is very variable.
Well-known and common symptom of allergies in children is peripheral blood eosinophilia (over 5-6%), however, because it often occurs when helminthiasis, psoriasis, pemphigus, chronic myelosis, conduct additional research (helminths eggs in feces etc.), in some cases, a more complete research (using the non-bacterial allergens, provocation tests, etc.).
To identify food allergies and its natural connections with any food product (except Allergy tests), keeping a food diary in which record daily what ate the baby and what the allergic reaction was. If after exclusion of the suspect food from the diet allergic reaction disappeared, and after re-introduction of this product in the diet emerged again, this confirms the hypothesis of allergen.
Diagnosis and symptoms of allergic rhinitis and sinusitis
The allergic form of the disease (allergic rhinitis and sinusitis) indicate the long duration of its course with frequent exacerbations in spring and subsequent remission in the winter, the distribution process, profuse watery or mucous discharge from the nose. With allergic rhinitis and sinusitis are observed pronounced swelling of the nasal cavity mucous membrane, white or bluish spots, or the sagging pallor and bluish color of the mucous membrane of the turbinates front or rear ends, nasal polyposis. Due to itching children with allergic rhinitis and sinusitis rubbing the tip of the nose, most often the hand that was dubbed the "allergic salute".
Allergic rhinitis and sinusitis are characterized by dynamic x-ray data (parietal thickening of the sinuses mucous membrane, prevalence of the process), the failure of conventional treatments and, conversely, the effectiveness of antiallergic therapy, as well as the frequent combination with allergic diseases of other organs and systems:
- bronchial asthma
- atopic dermatitis (eczema)
- pollinosis etc.
Only on the basis of comprehensive clinical, allergological and laryngological special studies can clarify or exclude the assumption about the allergic nature of the inflammatory process.
Morphological changes in allergic rhinitis and sinusitis are characterized by infiltration of tissues with eosinophils and mononuclear cells, thickening and hyperplasia of the mucosa with a tendency to polypoid degeneration, edema of the submucosal tissue, proliferation of connective tissue elements, the swelling and compression of the glands, changes in the vascular bed of intercellular substance, the structure of collagen fibers and ground substance, basal membrane thickening.
Allergic rhinitis and sinusitis treatment
Allergic rhinitis and sinusitis treatment is mainly in the detection and elimination of the allergen, to conduct specific desensitization, and the use of tools that contribute to the normalization of the autonomic nervous and endocrine systems, the introduction of hyposensitizing drugs and the fight against concomitant infection (infection foci sanitation). If the allergen in allergic rhinitis and sinusitis can not be identified, the appropriateness of action depends on the suspected cause of sensitization. In some cases it is necessary to change the place of residence or withdraw from use woolen items, fur, plush toys, flowers with an irritating odor, dust, and perhaps change diet or to prohibit contact with animals (epidermal allergy)
The most efficient specific desensitization, which is based on the gradual increase in the concentration of the introduced allergen to which there is sensitization. However, the body of the child is almost always not one sensitized to any allergen, and their complex (polyallergy), so to identify them is difficult and often virtually impossible. In addition, specific desensitization in allergic rhinitis and sinusitis itself may cause secondary sensitization of the newly introduced protein. In the case of bacterial allergy recommended vaccines and autovaccines, polyvalent bacteriophage.
The use of antihistamines (diphenhydramine, etc.) contributed to the widespread idea of the role of histamine in the pathogenesis of allergy. It is believed that this is neutralized by the action of histamine, is released during an allergic reaction, the antigen-antibody complex. If allocated another anaphylactoid poison, antihistamines do not give effect, in addition, they do not prevent relapses, and its prolonged use is impractical.
In recent years in the treatment of allergic rhinitis and sinusitis used synthetic antihistamines: promethazine, diazolin, suprastin, pipolfen, analergin, piriton, intergen and hormones of the adrenal cortex — corticosteroids. Decreasing tissue permeability, they suppress antigen-antibody reaction, inhibit the release of histamine and other substances liberated during the reaction, reduce swelling and transudation, delayed antibody synthesis, inhibiting sensitization of the organism and increase its resistance.
Opinions on the mechanism of action of corticosteroids are contradictory. They might not be able to neutralize the action of histamine, already infiltrated into the blood, so apply them in the presence of infection is impractical (in which case suppression of the active inflammatory reaction. Known cases of allergy to cortisone, prednisolone, triamcinolone, dexamethasone, etc. These drugs often mask the allergic reactions and their long-term use unsafe for a child, especially if it is a general corticosteroid therapy. Corticosteroids (topically hydrocortisone 2.5% suspension, or injections, etc.) do not give stable recovery, and cause only a temporary effect.
In the treatment of allergic rhinitis and sinusitis used stimulants of the sympathetic nervous system (adrenaline, etc.) or agents that inhibit its (atropine, etc.) and delay the production of acetylcholine.
In the treatment of allergic rhinitis deserve special attention reflexology and intranasal novocaine or lidocain injections. For the purpose of the normalization and protection reflexogenic receptor apparatus of the nasal cavity, novocain or lidocain solution is injected intramucosal and not submucosal.
With abundant hypersecretion prescribed atropine, with difficulty or absence of nasal breathing — vasoconstrictor (epinephrine, sanorin, naphazoline), which, however, may contribute to sensitization, so they are used no more than 6-7 days.
In the treatment of allergic rhinitis and sinusitis marked effect upon oral administration of a vasoconstrictor in combination with other allergen preparations. Thus, effective measures for the treatment of allergic rhinitis and sinusitis are correction of altered reactivity of the nervous system, the impact on the receptors of the nasal cavity (intranasal novocaine or lidocain injections, electrophoresis with novocaine, lidocain or calcium chloride), surgical intervention when indicated (coagulation, spikes removal, deviated nasal septum correction, etc.). At the same time, it is believed that surgical intervention (especially wide plan) may further sensitize the body, so the question decide in favor of gentle methods (endonasally surgery, cryotherapy, turbinoplasty and turbinates electroacoustic for nasal breathing improvemet).
Perfume (cosmetic) rhinitis
Aroma cosmetics, of course, very attractive, and more and more women use various cosmetics with aromatic additives. At the same time increases the number of complications due to the toxicity of cosmetics. The lipid content in the aromatic additives ranges from 20 to 80%, adversely affecting the opportunity of long storage of cosmetics and increases its toxicity. Such flavoring agents can cause a runny nose, skin inflammation (dermatitis), conjunctivitis.
In accordance with modern classification, there are allergic, neurovegetative and mixed forms of vasomotor rhinitis, as well as vasodilator, gipersecretornye and combined. Vasomotor rhinitis occurs in children with hyperreactivity. Often a combination of rhinitis and sinusitis, which occur during common autonomic disorders. Clinic of these diseases is largely similar to that in acute processes, but the inflammatory phenomena are less marked.
Vasomotor form of inflammation (rhinitis) - a consequence of dysfunction of the autonomic nervous and endocrine systems, it is characterized by paroxysmal and severity of symptoms:
- nasal congestion
- profuse watery secretions
In the inflammatory process in vasomotor rhinitis can involve one, several or all paranasal sinuses.
Vasomotor rhinitis treatment
General treatment vasomotor rhinitis focused on the impact on the autonomic nervous system and decrease of the nervous system hyper-reactivity, the improvement of nasal breathing. Applied intranasal novocaine or lidocain injections, nasal cavity cryosurgery, electrophoresis with calcium chloride, reflexology. In allergic form of vasomotor rhinitis primary importance attached to the allergic component.