pediatric allergic rhinitis
Introduction
Introduction to allergic rhinitis in children Allergicritis is an abbreviation for allergic rhinitis. It is also called allergic rhinitis. Rhinitis refers to inflammation of the nasal mucosa. It is characterized by congestion or edema. Patients often have nasal congestion, runny nose, itchy nose, and throat. Department of discomfort, cough and other symptoms, allergic rhinitis is a kind of rhinitis, rhinitis caused by the body's allergy to a substance called allergicritis, and can cause a series of allergic symptoms. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: sinusitis conjunctivitis nasal polyps
Cause
Causes of allergic rhinitis in children
Causes
Genetic factors (10%):
Allergic constitution is heritable, which means that many people are born with allergies. For example, if the parents are allergic, then the next generation is more likely to have allergic rhinitis than the average child. Of course, people with allergic constitutions also need to induce allergic rhinitis under the combined effect of external factors, so it cannot be said that there is an allergic constitution and must be infected with allergic rhinitis.
Dietary factors (20%):
Allergic foods can cause allergic rhinitis. One thing that deserves special mention is that even people who are allergic, each person's allergens are not the same. That is to say, some people may be allergic to seafood, while others are only allergic to eggs, so people with allergies need to do allergic tests so that they can be determined to be taboo.
Pets (15%):
For people who are prone to allergic rhinitis, keeping a pet is also a big taboo. Cats, dog hair, and dust mites on the body are potential pathogenic factors for allergic rhinitis.
Living environment (20%):
Prevention of allergic rhinitis has stricter requirements on the cleanliness of the environment. Bedding must be kept clean. Curtains, sofa cushions, etc. also need to be cleaned in time to prevent dust mites from breeding. Aphids are also a major cause of allergic rhinitis. In addition, the cockroaches in the corner, and their bodies and feces can also be a predisposing factor for allergic rhinitis, so the ground inside the house also needs regular cleaning.
Disease infection (20%):
Nasal diseases, especially inflammation of the nasal passages, do not occur alone most of the time. For example, sinusitis, hypertrophic rhinitis, and many times allergic rhinitis and cause cross-infection.
Pathogenesis
It is known that allergic rhinitis is caused by IgE-mediated type I hypersensitivity reaction after inhalation of allergens (such as dust mites, fungi, pollen, etc.) in atopic children, and finally leads to nasal mucosal blood vessels. Expansion, nasal congestion, tissue edema, increased clogging and secretion.
Prevention
Pediatric allergic rhinitis prevention
Finding the cause, avoiding allergens, and controlling symptoms are the general principles of treatment for allergic diseases.
1. Avoid allergens
From the pathogenesis of allergic reactions, avoiding allergens is the most fundamental and effective way to prevent allergic diseases. It has the nature of etiological treatment. Some scholars have proposed four-word therapy, namely, avoid, avoid, replace, move. Avoid contact with specific allergens.
2. Adrenal cortex hormone
Inhaled by adrenocortical hormone aerosol, adrenal corticosteroids have anti-allergic effects in allergic diseases:
(1) Reduce the formation and release of histamine, serotonin and other active substances, thereby alleviating hyperemia, edema, exudation and cell damage caused by allergic reactions.
(2) Inhibition of capillary exudation.
(3) inhibition of mucosal, skin antigen-antibody reaction.
(4) inhibiting the transformation or formation of eosinophils.
(5) Reduce lymphocyte transformation or formation.
(6) Inhibition of antibody formation.
3. Specific desensitization therapy
The allergens that have an allergic reaction to the patient are prepared into various concentrations of the extract, starting from the diluent, gradually increasing the dose and concentration, and repeatedly injecting the patient; or repeatedly contacting the patient through other means to cultivate the patient The tolerance of the allergen is such that it no longer causes an allergic reaction or an allergic reaction when it is exposed to the allergen.
Complication
Pediatric allergic rhinitis complications Complications Sinusitis Conjunctivitis Nasal polyps
Common comorbidities:
Conjunctivitis
Mainly in the ball and sacral conjunctiva, there are itchy eyes, tears, or conjunctival congestion, edema, occasionally affecting the cornea, combined with eye symptoms including itchy eyes, more common in animals and seasonal pollen.
2. Sinusitis
Previously, the development of sinus was thought to be late, so infants and young children with sinusitis were less. According to current data, sinusitis may occur in children over 1 year old. Recent studies have confirmed that children with sinusitis are often associated with allergic rhinitis. Therefore, the treatment must be directed to the basic allergic aspect.
3. Nasal polyps are rare before the age of 10.
4. The relationship between allergic rhinitis and asthma
Airway dysfunction often coexists, and both often have the same cause. Allergic rhinitis is a risk factor for asthma, so timely diagnosis, prevention and treatment of allergic rhinitis can help prevent or prevent asthma. Become serious.
Symptom
Allergic rhinitis symptoms in children Common symptoms Allergic rhinitis, nasal itching, nasal congestion, secondary infection, lying on the lower side of the side of the infection...
The disease can occur at any age, including infants. Most patients have symptoms before the age of 20, and about 75% of children with asthma also have this disease. The main symptoms are nasal itching, continuous sneezing, lots of watery nose, etc., front nose Examination showed pale edema of the nasal mucosa, a large amount of water-like secretions, if nasal polyps or polypoid degeneration occurred due to persistent edema, because nasal congestion patients had to breathe through the mouth, so the total amount of allergens directly inhaled from the oral cavity, thus making asthma Exacerbation, the more atopic children are exposed to a particular allergen, the greater the chance of allergies to it.
Sneezing, nasal itching, runny nose and nasal congestion are the four major symptoms of allergic rhinitis. Sneezing is more than just waking up. Nasal congestion often changes with body position. Itchy nose is a characteristic manifestation of allergies, making children continue to use. Rubbing the front of the nose with your fingers or palms, many children often lick their noses, screaming and other strange movements. The larger children complain of loss of their sense of smell. The nose is clear water, and it can also change due to nasal congestion or secondary infection. Thick, children can also see gray-blue ring shadows and wrinkles called allergic shiners under the eyelids, which is caused by hypertrophy of the sphenoid venous plexus, causing congestion of the iliac veins and venous veins in the eyes. It is also a characteristic manifestation of atopic and nasal allergic reactions in children with atypical symptoms. The infants in this disease are mostly atypical, often with nasal congestion. In addition, children often have high nasal reactivity and thus are susceptible to various non-specific stimuli. Children often have a family history of allergic reactions. The internal examination of the nasal cavity usually shows turbinate edema, often pale or purple, with a thin layer of watery mucus on the upper cover.
Examine
Pediatric allergic rhinitis examination
1. Nasal secretion smear examination: During the onset of allergic reactions, eosinophils may be seen in nasal secretions, and more eosinophils or mast cells may be found.
2. Allergic challenge test: In vivo test generally uses skin test (scratch, intradermal and contact method, etc.). The principle is that there are various hypothetical allergic substances, so that after contact with the body, depending on whether there is any reaction, To assist in the diagnosis, the allergen can be used for desensitization after the allergen diagnosis is clear.
(1) Direct skin test: including scratches, pricking and intradermal tests.
(2) Provocative test of allergic rhinitis: For patients with unclear medical history or negative skin test and further exclusion, the criteria for nasal mucosa are:
1A few minutes after the allergen challenge, symptoms such as sneezing, nasal itching, increased nasal congestion and increased secretions (at least two symptoms) occurred.
2 nasal mucosa pale, swollen.
3 nasal cavity resistance increased (> 25%).
4 nasal secretions increased eosinophils.
Any one of the above criteria 1 and 2 to 4 above may be considered to be positive for the challenge test.
3. In vitro test
(1) Determination of total serum IgE.
(2) Determination of specific IgE in nasal secretions.
(3) The antigen induces leukocyte histamine release and the like.
Select X-ray chest and other examinations as needed.
Diagnosis
Diagnosis and diagnosis of allergic rhinitis in children
diagnosis
1. Carefully ask the medical history: to distinguish the disease from other chronic nasal diseases.
2. Examine EOS: stain with nasal mucosal swab smear, and then carefully examine EOS, such as EOS 5% to help diagnose the allergic rhinitis, but not for the diagnosis of infants below 3 months.
3. Serum IgE test: In children, especially children under 1 year of age, a slight increase in total IgE suggests that it is likely to have allergic or parasitic infections, while detection of specific IgE is beneficial for a clear cause.
4. Skin test: It is a safe and simple method to determine the cause of the disease, and the results are fast and very practical, but the results of the skin test should be explained in combination with medical history, physical examination and other examinations.
After the above examination, the diagnosis can not be confirmed, and the conjunctival and nasal mucosa stimulation test can be performed, which is helpful for the diagnosis and etiology diagnosis of the disease. Because of the obvious symptoms and mild pain, the former is particularly suitable for young children.
5. New diagnostic method for allergic rhinitis
(1) Take nasal secretions and smears to check for eosinophils.
(2) Take a biopsy of nasal mucosa and examine the contaminated cells, including basophils and mast cells, under electron microscope.
(3) Determination of the frequency of sneezing or the weight (or capacity) of nasal secretions can reflect the nature of nasal mucosal lesions.
(4) nasal rinse or aspirate, can directly check the content of histamine, kinins and leukotrienes.
(5) Determination of nasal mucosal blood flow, temperature, etc.
Differential diagnosis
Different from other chronic nasal diseases, careful examination of the medical history plus the necessary laboratory tests can distinguish this disease from other chronic nasal diseases.
