How to effectively prevent and treat allergic rhinitis?
According to the analysis of the pollen allergy warning map, the pollen concentration in the Xinding Basin in Shanxi has continued to rise recently, and it is expected that this Wednesday to Friday is a time period with a high pollen dispersion concentration. Please pay attention to the general public, especially the sensitive crowd to travel to do a good job of protection..." On the TV, the female anchor does "pollen broadcasting" for the public, and the subtitles scrolling under the screen and Braille are also emphasizing relevant precautions.
The above is the picture that Zhao Changqing imagined. As the vice president of the Second Hospital of Shanxi Medical University and the director of the Department of Otolaryngology, Head and Neck Surgery, he bluntly said that he has a dream: he hopes to one day integrate "pollen broadcasting" into the weather forecast program of the Central Radio Station, starting from prevention and providing protective reminders for sensitive people.
China is a big country of allergic diseases, in recent years the incidence of a continuous upward trend, to allergic rhinitis as an example, China's prevalence of up to 17.6%, Professor Zhang Luo's team found that in the past 6 years alone In the past 6 years, China's allergic rhinitis patients have increased by 100 million.
The nightmare begins, devoured, saved
Taiyuan, where Zhao Changqing is stationed, has entered the middle of summer, with the cool light rain, the allergy season has quietly struck, and the Yimin crowd has also reached a period when they need to be fully armed. For people with allergic rhinitis, the fluttering pollen of artemisia grass, although invisible and untouchable, is the primary source of pain and fear.
Zhao Changqing's clinic welcomed a large wave of allergic rhinitis patients. The patients he received were mainly from the northwest and north China, and there were more patients with moderate and severe allergic rhinitis in these two regions, which were closely related to the type of local allergens, medical conditions and educational and cultural standards.
The onset season in the north is divided into two peak periods, one is july, August and September, which is now starting, the allergen is mainly artemisia grass, and the other is In March and April, the allergen is dominated by early spring pollen. Due to the high coverage rate of artemisia grass in northwest and north China, and the dry and dusty climate, there are relatively many floating particles in the air, many people are allergic to artemisia grass, and the age of onset is mostly seen in adolescents, and in recent years, infants and middle-aged and elderly people have also increased significantly.
Zhao Changqing has long been committed to rhinal science research, and more than half of the patients in each outpatient clinic suffer from rhinitis. Over the years, he has witnessed the distress and embarrassment of too many people with allergic rhinitis attacks.
People who are entangled in allergic diseases will face a protracted battle: high incidence, easy to recur, and the course of the disease can be infinitely extended. At the onset of the disease, some patients can sneeze more than 20 times at a time, and the clear water in the nasal cavity is like running water, and the paper towel does not leave the hand every day. In severe patients, falling asleep on their backs at night can also aggravate the condition, with breath holding, dyspnea, and even apnea.
Comorbidities are the culprit in eroding the quality of life of patients with allergic rhinitis. Zhao Changqing pointed out that some patients are also accompanied by allergic conjunctivitis, with symptoms such as itchy eyes, tears, and red eyes, especially the probability of seasonal allergic conjunctivitis can be as high as 85%. Severe allergic rhinitis can even be combined with otitis media, sinusitis, nasal polyps, asthma and other diseases, and is an independent risk factor for asthma attacks, and 40% of patients with allergic rhinitis will develop asthma.
"A lot of people treat it (allergic rhinitis) as a cold, but if the disease is allowed to develop, it will produce irreversible problems, such as asthma. Once you have asthma, the energy source of the oxygen supply throughout the body is affected, first and foremost the heart function. Zhao Changqing said.
Studies have shown that the peak age of allergic rhinitis is adolescents and middle-aged people. What worries Zhao Changqing is that moderate to severe allergic rhinitis has "targeted" children.
Zhao Changqing recalled his first consultation with an 8-year-old boy, Xiao Nian (pseudonym), who learned that Xiao Nian had eczema shortly after birth and later caused allergic rhinitis. At first, it was just nasal congestion and runny nose, but as the disease worsened, it eventually developed into asthma. "Children with eczema have a much higher rate of allergic rhinitis and asthma than other children." Zhao Changqing said.
Considering Xiao Nian's young age, serious illness and other factors, according to years of clinical experience, Zhao Changqing used pterodacty to intervene with pterygitis nerve amputation while drug desensitization treatment. For Xiao Nian, Zhao Changqing's diagnosis and treatment is undoubtedly a "rescue". After the operation, he followed the doctor's advice, took the right medication, improved the sleep quality of Xiao Nian, breathed smoothly, and returned to the classroom before long.
In fact, the small thoughts that have suffered from diseases are just the epitome of many people with allergic rhinitis. According to statistics, at present, the number of allergic rhinitis patients in China has exceeded 300 million, which is equivalent to 1 in every 4-5 people with rhinitis, the incidence of rhinitis is as high as 37%, and it is increasing at a rate of 3% (20 million to 30 million people) every year. Among them, adolescents and children with rhinitis account for 2/3 of the rhinitis population.
Zhao Changqing believes that patients can basically improve their symptoms through standardized drug treatment in the early stage, such as the use of nasal glucocorticoids and budesonide nasal sprays, and do not affect daily life. Especially when nasal symptoms appear for the first time, you should immediately go to the formal channels to ask for medicine, do not believe in the "miracle drug" and false propaganda and advertising on the Internet, blindly cooperate with the treatment not only delays the disease, but also brings other complications and increases the difficulty of treatment.
Elusive allergens
When receiving treatment, Zhao Changqing is often asked by patients: "I have checked the allergens, and the report shows that there is no, but why are I still allergic?" ”
For many years, the mainstream view in the medical community has been that antigens refer to substances that can stimulate the body to produce an immune response, and can bind to the surface of immune cells such as mast cells and produce immune effects with antibodies that can be produced as immune response products. Common allergens in life include pollen, willow wool, animal hair, dust mites, and so on.
There was a patient who went to Ordos to seek medical treatment but could not get rid of allergy symptoms, saying that he had seen many doctors and could not find out the allergen, but his ears had been red, accompanied by pus flowing out, and his nose was itchy. Zhao Changqing carefully examined the patient's dress, learned during the consultation that the patient had recently dyed his hair and put it on without washing new clothes, and deduced that it was hair dye, dye on new clothes, solid dosage and other chemicals accumulated, causing irritation to patients.
In clinical diagnosis and treatment, there are many allergens that make doctors elusive. For example, some people are allergic to cold air or hot and cold stimuli, some people are allergic to cosmetics, and some environmental changes are also very easy to cause allergic rhinitis.
In order to expand the scope of rhinitis research and improve the basic theory, after the efforts of several generations of medical workers, Zhao Changqing applied for the establishment of neuroimmune research (provincial key cultivation laboratory for airway inflammatory diseases), which is something he has long paid attention to and insisted on research.
At present, the Department of Otorhinolaryngology has combined with the backbone of respiratory and dermatology, and will regularly carry out linkage activities between disciplines, and set up an academic committee to continue to promote the research of the neuroimmune mechanism of inflammatory diseases of the airway mucosa and skin, and further study and overcome the difficulties in the treatment of allergic rhinitis.
Regarding the intervention of allergic rhinitis, Zhao Changqing emphasized "three-point treatment, seven-point nutrition". This nourishment is actually patient education. He has long been committed to patient education and the standardized diagnosis and treatment of grass-roots doctors to promote the development of the discipline.
"As an old doctor in the department of otolaryngology, I feel that there is a long way to go." Zhao Changqing called on people in the health community to do more extensive health education together, and public science popularization actions such as the China Allergy Care Action are very good, improving disease awareness and correctly treating allergic rhinitis.
"Reminder Mechanism"
Pharmacies are also an important part of the daily protection of patients with allergic rhinitis.
Walking into the Yixintang Pharmacy at No. 15 HaozhuangZheng Street, Yingze District, Taiyuan City, you can see the "Rhinitis Center" at a glance. On the shelves are all kinds of drugs to alleviate the symptoms of allergic rhinitis and auxiliary treatment, next to the popular science posters of allergic rhinitis symptoms, patients can quickly and accurately find symptomatic drugs through the control of symptoms. Before the "reminder mechanism" of the rhinitis center, many people directly mistook allergic rhinitis for a cold to treat.
Song Xiumei, a practicing pharmacist in Shanxi Hongxiang Yixintang Pharmaceutical, has encountered many patients who "eat medicine indiscriminately". In her view, a responsible practicing pharmacist must not only have the professional quality to provide patients with symptomatic drugs, but also pull patients out of the misunderstanding of diagnosis and treatment through patient inquiry. She has been working in pharmacy since 2006 and is now friends with many patients, including Lao Zhang (not her real name).
Lao Zhang is an easy to sensitive physique, has been plagued by allergy symptoms for many years, it is Song Xiumei's professional guidance, to help Lao Zhang realize that every season, he mistakenly thought of cold symptoms, such as sneezing in the morning, red and swollen eyes, nostrils, itching, etc., in fact, allergic rhinitis induced.
"We found that 50%-60% of patients have treated rhinitis as a cold, which over time can lead to serious complications." Song Xiumei pointed out. She formulated a "protection plan" for Lao Zhang: in the season of high allergies, especially in the season of pollen flying, pay attention to wearing a mask, which can not only protect the respiratory tract, but also isolate external allergens. In addition, it is necessary to take symptomatic medication and insist on medication for 2-4 weeks. Through some specific daily guidance of Song Xiumei, Lao Zhang can feel that allergic rhinitis is "subsiding" little by little - his breathing is getting smoother and smoother, the effective sleep time is getting longer and longer, and the spirit is getting better and better.
In order to allow more patients to get professional pharmacist guidance, in 2020 Yixintang set up a rhinitis center, under the professional service of pharmacists, most patients can receive guidance stably and achieve symptomatic treatment. At the same time, the preventive rhinitis measures provided by the pharmacist also significantly alleviate the patient's symptoms and improve their quality of life.
"We generally recommend that patients use budesonide nasal spray, levocatastatine hydrochloride and other nasal sprays, spray the nose 1-2 times a day, the course of treatment is not less than 2 weeks, the symptoms are serious and cause itchy eyes and nose, oral loratadine." However, oral anti-allergic drugs can not be taken for too long, generally 4 weeks is enough, coupled with auxiliary physiological seawater, and self-protection such as wearing masks, patients can safely survive the high season. Song Xiumei introduced.
In the past two years, Song Xiumei has rarely seen Lao Zhang in the pharmacy, and perhaps his condition has eased. Zhao Changqing also learned that Xiao Nian insisted on taking medicine and doing a good job of protection after the operation, breathing freely every day, full of energy, and enjoying the excitement that he should have at this age.
Source: Guangming Network
Source: Guangming Network