[Dr. Lin Huangbin] A Brief Discussion on "Allergic Rhinitis"“
| Foreword:
Allergic rhinitis, commonly known as "nasal allergy," is a common disease worldwide, with a prevalence of approximately 15-30%. When both parents have allergic rhinitis, the child's chance of developing the condition can reach 47%, and the incidence of childhood allergic rhinitis has been increasing exponentially over the past decade. This disease is caused by inhaling allergens, triggering a series of immune responses in the nasal cavity, which in turn produce clinical symptoms.
| Clinical manifestations:
The four typical symptoms of allergic rhinitis are: runny nose, sneezing, nasal congestion, and itchy nose. Other symptoms include: itchy eyes, itching of the soft and hard palate, headache in the forehead and around the eyes, decreased sense of smell, and ear fullness, etc.
Treatment:
1. Avoid allergens:
Allergic rhinitis is a chronic disease that is difficult to cure. As allergens continue to stimulate the body, the condition and symptoms will become more and more serious. Therefore, it is very important to avoid allergens. According to statistics, the main allergens in Taiwan are dust mites, mold and cockroaches. Therefore, in daily life, you should use sheets and pillowcases to cover your mattress and pillows and wash and change them regularly. Curtains should also be washed and changed regularly. Avoid keeping pets and place potted plants outdoors.
II. Common drug treatments:
1. Oral antihistamines:
Histamine is the main mediator that causes allergic symptoms, so antihistamines can be used clinically to reduce nasal allergy reactions and control non-nasal symptoms caused by allergic rhinitis. However, these drugs are less effective in improving nasal congestion. Newer generation antihistamines have the advantages of rapid action and longer duration of action, and do not have the disadvantage of causing drowsiness that older antihistamines have. Therefore, second-generation antihistamines are now often used as first-line drugs for allergic rhinitis.
2. Local antihistamine:
Current topical antihistamines (nasal spray antihistamines), used twice a day, can relieve symptoms of nasal itching and sneezing; literature reports that they are as effective as oral medications and do not have the side effect of drowsiness, although a few people may experience transient taste abnormalities; this medication is effective for milder cases and is only effective when symptoms occur in a single organ.
3. Topical steroids:
Since the introduction of topical nasal sprays in 1973, steroid sprays have become the most effective medication for controlling allergic rhinitis, conveniently used once or twice a day. Their function is to suppress inflammation, thereby achieving therapeutic effects. Regular preventative use of topical steroids can effectively reduce all nasal symptoms, with better results than oral or topical antihistamines. Furthermore, long-term use of these medications does not currently cause adverse side effects such as nasal mucosal atrophy. Nasal steroid sprays are particularly effective in treating patients whose main symptom is nasal congestion. However, a drawback of these medications is their relatively slow onset of action (approximately 12 hours), requiring several days or even weeks to reach maximum efficacy. These medications can be used as first-line treatment for patients with moderate to severe symptoms.
III. Surgical treatment:
For patients with allergic rhinitis, persistent nasal congestion is caused by long-term rhinitis and inferior turbinate hypertrophy (commonly known as nasal flesh). If the symptoms are severe, surgery may be considered to relieve nasal congestion, but the effect of surgical treatment on improving other symptoms of allergic rhinitis is relatively limited.
1. Septoplasty:
Traditional surgery involves partially removing the hypertrophic inferior turbinate and correcting the deviated septum. However, it requires a 2-3 day hospital stay, involves significant bleeding, and necessitates nasal packing, which can be quite uncomfortable.
2. Nasal mucosal cauterization surgery:
Radiofrequency ablation and laser surgery are the least invasive and simplest procedures, making them suitable for those who fear surgery. However, their effectiveness is not as good as traditional surgical methods, and the high-temperature burning is more likely to damage the mucosal function. Modern constant-temperature radiofrequency ablation can avoid high-temperature burning and is also more comfortable, improving the shortcomings of previous laser and radiofrequency ablation surgeries.
3. Minimally invasive surgery on the inferior turbinate:
The "functional inferior turbinate reduction surgery," also known as "minimally invasive inferior turbinate surgery," which has become increasingly popular in recent years, not only combines the advantages of outpatient surgery but also reduces the chance of recurrence of inferior turbinate hypertrophy. This surgery uses minimally invasive surgical instruments, employing a minimally invasive powered rotating blade inserted deep into the submucosa of the inferior turbinate (as shown in the attached image) to break the hypertrophic tissue into small pieces, which are then immediately suctioned out, much like liposuction, completely preserving the surface mucosa. The surgery takes about twenty minutes to complete. Post-operatively, only slight packing with hemostatic sponge is required; hospitalization is not necessary, and the procedure can be performed in an outpatient operating room. Slight discomfort and minor bleeding may occur for about a day after surgery due to nasal packing, but these discomforts will subside after the packing is removed. As for wound scabbing, it is not noticeable due to the small size of the wound and usually heals within about two weeks after surgery.
Dr. Lin Huangbin, Department of Otolaryngology, Taichung Hospital