Allergic Rhinitis变应性鼻炎
Lai he 赖荷
E.N.T department
The second affiliated hospital
Guangzhou medical college
广医二院耳鼻咽喉教研室
General information
1,Definition定义
Allergic rhinitis can be defined as a
disease giving rise to two or three of the
following symptoms,sneezing attacks
serous hypersecretion（ 高分泌） and
nasal blockage due to a swollen nasal
mucosa.
2.Morbidity （ 发病率） 10%-40%
General information
3.Classification 分类
Perennial allergic rhinits 常年性变应性鼻炎
Seasonal allergic rhinitis 季节性变应性鼻炎
( pollinosis)
4.Atopic type特应型个体
It is a individual who brings the genes which have
relation with allergic rhinitis (familial or hereditary
nature)
带有与变应性鼻炎发病有关的基因的个体
Pathophysiology病理生理
Ⅰ type allergy 一型变态反应
It is an inflammatory disorder characterized
by an immunoglobulin E(IgE) mediated
hypersensitivity to allergens
由 IgE介导的机体对变应原超敏反应而引
起的炎症性损害
Pathophysiology病理生理
1.Sensitization 致敏
contact
Antigens Respiratory mucosa 呼吸道粘膜
activate
CD4+ T Lymphocyte Th2 cell
secrete
Deliver signal IL-4,IL-5,IL-6,IL-10,IL-13 (Mediators炎症介质 )
activate
B cell Hemaendotheliocyte 血管内皮细胞
ICAM-1(intercellular adhesion molecule-1细胞间粘附分子 -1)
produce
attach Eosinophil嗜酸细胞
IgE Mast cell 肥大细胞 go to nasal mucosa
receptor on basophil嗜碱细胞
T lymphocyte淋巴细胞
Pathophysiology病理生理
2,Allergy
contact nasal
Antigen bridging of antigen molecule and IgE
mucosa again
mast cell derganulation 脱颗粒
release
Histamine 组织胺 and other mediators
contraction of high excitability increasing in hypersensitivity
resistant vessel parasympathetic vascular permeability of sensory nerve
& dilatation of nerve 副交 通透性 感觉神经
capacity vessel 感神经
阻力血管收缩和
容量血管扩张
increasing mucosal nasal itching
pale &purple glandulous secretion edema sneezing
Nasal Mucosa 粘膜水肿 鼻痒、打喷嚏
blockage watery discharge
Clinical Presentation 临床表现
1,nasal itching sometimes itching of eyes
鼻痒 conjunctival injection 结膜充血
2,Sneezing attacks 阵发性打喷嚏
3,Nasal discharge 流涕 watery
4,Nasal blockage 鼻塞
5,Hyposmia 嗅觉减退
Examination 检查
1.Nasal examination,light blue,congestive
鼻腔检查 or pale mucosa,mucosal
edema 水肿
especially inferior turbinate
下鼻甲
2.Nasal discharge exam,a lot of eosinophil
鼻分泌物 嗜酸细胞
3.Serum total IgE determination
血清总 IgE检查
Examination
2,Finding allergen 寻找抗原
commom allergen,page 58
Perennial,house dust 屋尘； mite 螨虫
fungus真菌； pollen 花粉
chemical material
Seasonal,pollen ( sun flower,corn,glass)
Examination检查
2,Finding allergen 寻找抗原
a,Special IgE examination 特异性 IgE检查
① Skin testing,prick test 点刺试验
intracutaneous test 皮内试验
② Serum special IgE determination 血清特异性 IgE检查
b,Nasal allergen challenge test 鼻激发实验
Diagnosis诊断
1.History 病史
2.Clinical manifestation临床表现
3.allergy diagnosis变应原诊断
Differential Diagnosis鉴别诊断
? 1.Nonallergic rhinitis with eosinophilia
嗜酸粒细胞增多性非变应性鼻炎
? 2.Vasomotor rhinitis
血管运动性鼻炎
Complication并发症
1,Allergic nasal sinusitis
变应性鼻窦炎
2,Asthma
支气管哮喘
3,Secretory otitis media
分泌性中耳炎
Treatment治疗
1.Pharmacotherapy 药物治疗
a,Steroid, topical— nasal spray 鼻喷雾剂
类固醇 general 全身用药
b.Antihistamines,H1-receptor antagonist H1受体拮抗剂
抗组胺药
First-generation第一代, toldrin 朴尔敏
second-generation:clarity (don’t cross the blood-
第二代 brain barrier 不能通过血脑屏障 )
c.Mast cell stabilizing drug:disodium cromoglycate
肥大细胞膜稳定剂 色甘酸钠
Treatment治疗
d,Decongestants 血管减充剂
typical,short term
e.Anticholinergic drug,抗胆碱药
f.Others,reduce sensitivity of nasal mucosa
inferior turbinate---lazar,crymotherapy 冷冻
microwave 微波
surgery,vidian neurectomy 翼管神经切断术
手术 anterior ethmoid neurectomy 筛前神经切断术
submucous resection of nasal septum 鼻中隔矫正术
Treatment治疗
2.Avoid to contact allergen 避免接触变应原
3.Immunotherapy 免疫治疗
Indication,IgE-mediated disease (Ⅰ type allergy) caused by
适应症 inhalant allergen
Method,increasing doses of allergen are injected until
方法 the maximum tolerable dose is reached
maintenance dose(maximum tolerable dose )
最大耐受剂量
Course,2 years or more
疗程
Immunotherapy免疫治疗
Mechanism 作用机理, unclear
blocking antibody 封闭抗体
balance between Th1and Th2
Rush immunotherapy,pollinosis 花粉症
快速免疫疗法 1-2weeks reach maximum
tolerable dose(maintenance dose)
references
1,Tian yong-quan et al,otolaryngology 5th edition,
textbook of series of new century,2001.
2,Niels mygind et al,nasal allergy 2nd edition,blackwell
scientific publications,1979
3,Hueston G.king,otolaryngologic allergy,symposia
specialists Inc.1981.
4,Allen M.seiden,otolaryngology:the essentials,thieme
medical publishers,Inc,2001
5,Ye shitai et al,allergology science press beijing 1998
Question
1.what’s the definition of allergic rhinitis?
2.The main symptoms of allergic rhinitis are:
3.please write three common allergens of perennial
allergic rhinitis,
4.The main complications of allergic rhinitis are:
5.The indication of the immunotherapy?
6,Pharmacotherapy of allergic rhinitis include,
Lai he 赖荷
E.N.T department
The second affiliated hospital
Guangzhou medical college
广医二院耳鼻咽喉教研室
General information
1,Definition定义
Allergic rhinitis can be defined as a
disease giving rise to two or three of the
following symptoms,sneezing attacks
serous hypersecretion（ 高分泌） and
nasal blockage due to a swollen nasal
mucosa.
2.Morbidity （ 发病率） 10%-40%
General information
3.Classification 分类
Perennial allergic rhinits 常年性变应性鼻炎
Seasonal allergic rhinitis 季节性变应性鼻炎
( pollinosis)
4.Atopic type特应型个体
It is a individual who brings the genes which have
relation with allergic rhinitis (familial or hereditary
nature)
带有与变应性鼻炎发病有关的基因的个体
Pathophysiology病理生理
Ⅰ type allergy 一型变态反应
It is an inflammatory disorder characterized
by an immunoglobulin E(IgE) mediated
hypersensitivity to allergens
由 IgE介导的机体对变应原超敏反应而引
起的炎症性损害
Pathophysiology病理生理
1.Sensitization 致敏
contact
Antigens Respiratory mucosa 呼吸道粘膜
activate
CD4+ T Lymphocyte Th2 cell
secrete
Deliver signal IL-4,IL-5,IL-6,IL-10,IL-13 (Mediators炎症介质 )
activate
B cell Hemaendotheliocyte 血管内皮细胞
ICAM-1(intercellular adhesion molecule-1细胞间粘附分子 -1)
produce
attach Eosinophil嗜酸细胞
IgE Mast cell 肥大细胞 go to nasal mucosa
receptor on basophil嗜碱细胞
T lymphocyte淋巴细胞
Pathophysiology病理生理
2,Allergy
contact nasal
Antigen bridging of antigen molecule and IgE
mucosa again
mast cell derganulation 脱颗粒
release
Histamine 组织胺 and other mediators
contraction of high excitability increasing in hypersensitivity
resistant vessel parasympathetic vascular permeability of sensory nerve
& dilatation of nerve 副交 通透性 感觉神经
capacity vessel 感神经
阻力血管收缩和
容量血管扩张
increasing mucosal nasal itching
pale &purple glandulous secretion edema sneezing
Nasal Mucosa 粘膜水肿 鼻痒、打喷嚏
blockage watery discharge
Clinical Presentation 临床表现
1,nasal itching sometimes itching of eyes
鼻痒 conjunctival injection 结膜充血
2,Sneezing attacks 阵发性打喷嚏
3,Nasal discharge 流涕 watery
4,Nasal blockage 鼻塞
5,Hyposmia 嗅觉减退
Examination 检查
1.Nasal examination,light blue,congestive
鼻腔检查 or pale mucosa,mucosal
edema 水肿
especially inferior turbinate
下鼻甲
2.Nasal discharge exam,a lot of eosinophil
鼻分泌物 嗜酸细胞
3.Serum total IgE determination
血清总 IgE检查
Examination
2,Finding allergen 寻找抗原
commom allergen,page 58
Perennial,house dust 屋尘； mite 螨虫
fungus真菌； pollen 花粉
chemical material
Seasonal,pollen ( sun flower,corn,glass)
Examination检查
2,Finding allergen 寻找抗原
a,Special IgE examination 特异性 IgE检查
① Skin testing,prick test 点刺试验
intracutaneous test 皮内试验
② Serum special IgE determination 血清特异性 IgE检查
b,Nasal allergen challenge test 鼻激发实验
Diagnosis诊断
1.History 病史
2.Clinical manifestation临床表现
3.allergy diagnosis变应原诊断
Differential Diagnosis鉴别诊断
? 1.Nonallergic rhinitis with eosinophilia
嗜酸粒细胞增多性非变应性鼻炎
? 2.Vasomotor rhinitis
血管运动性鼻炎
Complication并发症
1,Allergic nasal sinusitis
变应性鼻窦炎
2,Asthma
支气管哮喘
3,Secretory otitis media
分泌性中耳炎
Treatment治疗
1.Pharmacotherapy 药物治疗
a,Steroid, topical— nasal spray 鼻喷雾剂
类固醇 general 全身用药
b.Antihistamines,H1-receptor antagonist H1受体拮抗剂
抗组胺药
First-generation第一代, toldrin 朴尔敏
second-generation:clarity (don’t cross the blood-
第二代 brain barrier 不能通过血脑屏障 )
c.Mast cell stabilizing drug:disodium cromoglycate
肥大细胞膜稳定剂 色甘酸钠
Treatment治疗
d,Decongestants 血管减充剂
typical,short term
e.Anticholinergic drug,抗胆碱药
f.Others,reduce sensitivity of nasal mucosa
inferior turbinate---lazar,crymotherapy 冷冻
microwave 微波
surgery,vidian neurectomy 翼管神经切断术
手术 anterior ethmoid neurectomy 筛前神经切断术
submucous resection of nasal septum 鼻中隔矫正术
Treatment治疗
2.Avoid to contact allergen 避免接触变应原
3.Immunotherapy 免疫治疗
Indication,IgE-mediated disease (Ⅰ type allergy) caused by
适应症 inhalant allergen
Method,increasing doses of allergen are injected until
方法 the maximum tolerable dose is reached
maintenance dose(maximum tolerable dose )
最大耐受剂量
Course,2 years or more
疗程
Immunotherapy免疫治疗
Mechanism 作用机理, unclear
blocking antibody 封闭抗体
balance between Th1and Th2
Rush immunotherapy,pollinosis 花粉症
快速免疫疗法 1-2weeks reach maximum
tolerable dose(maintenance dose)
references
1,Tian yong-quan et al,otolaryngology 5th edition,
textbook of series of new century,2001.
2,Niels mygind et al,nasal allergy 2nd edition,blackwell
scientific publications,1979
3,Hueston G.king,otolaryngologic allergy,symposia
specialists Inc.1981.
4,Allen M.seiden,otolaryngology:the essentials,thieme
medical publishers,Inc,2001
5,Ye shitai et al,allergology science press beijing 1998
Question
1.what’s the definition of allergic rhinitis?
2.The main symptoms of allergic rhinitis are:
3.please write three common allergens of perennial
allergic rhinitis,
4.The main complications of allergic rhinitis are:
5.The indication of the immunotherapy?
6,Pharmacotherapy of allergic rhinitis include,
