Guide
Hopefully, we can sneeze a few less times in the spring when the pollen is flying.
Source: Yimaitong Author: Daju This article is authorized by the author to be published by Yimaitong, please do not reprint without authorization.
"If the catkins rise because of the wind" has achieved the reputation of Xie Daoyun of the Eastern Jin Dynasty, when I learned this poem, I have been imagining how pleasant the ancients should be around the stove to make tea and enjoy the snow gossip.
And now, the spring is just right, and the flying catkins all over the city may reproduce the scene of "catkins rising because of the wind" in the mouth of talented women at that time. But the eyes are indeed enjoyed, but the nose is an old sin. Along the way, the sneezes one after another, almost flashed to the waist, and even more exaggerated was the itching and redness of my cheeks, and my colleague asked me with concern if I had lupus erythematosus, so scared that I quickly used loratadine to "help".
Recently, the allergy drug loratadine has rushed to the hot search, which shows that there are not a few people who have the same disease as me. I always thought that everyone was suffering from work and immunity, so in recent years, there have been many allergic diseases, and I, an internist, have also been fortunate to see all kinds of urticaria, atopic dermatitis, allergic rhinitis, asthma, etc., and have seen patients of all ages with big watery eyes, dragging two tubes of snot to look at me, hoarse voice asked me for loratadine. It seems that it is superficial to attribute allergies to the decline of immunity due to work pressure, after all, the allergy base of children and students is too large.
Nature: COVID infection can lead to a significantly increased risk of allergies
A recent multi-cohort study paper published in the journal Nature answered my questions.
The article, titled "Allergic Diseases After Novel Coronavirus Infection: A Multi-Country Cohort Study from South Korea, Japan, and the United Kingdom," showed that people infected with SARS-CoV-2 had a 20% increased risk of developing allergic disease overall after recovery (hazard ratio 1.20 compared to uninfected controls), and in particular allergic asthma increased by 125% (hazard ratio 2.25) and allergic rhinitis increased by 23% (hazard ratio 1.23) and moderate to severe COVID is at higher risk of overall allergic sequelae, regardless of whether the original or Delta strain is infected. And the study also conveys good news that vaccination against COVID is associated with a reduced risk of allergic diseases. The study found that the risk of overall allergic disease and its subtypes (including asthma, atopic dermatitis, allergic rhinitis, and food allergy) was no longer significantly higher with at least two vaccinations than with an uninfected control group (risk ratio of allergic disease with two doses was 0.89).
As for the mechanism of the increase in the overall risk of allergy after the new crown infection, the researchers analyzed that it is related to immune regulation and immune system destruction. First, post-COVID may lead to disruption of T cell homeostasis, and viral infections are known to often stimulate morphological changes, including tissue remodeling, and trigger an immune response that can trigger allergic diseases. In addition, conditionally driven regulatory T cell perturbations in the late stages of COVID-19 infection induce the uninhibited effects of effector cells and enable the underlying SARS-CoV-2 to exert its effects, which may lead to post-acute allergic sequelae. In addition, the "cytokine storm" associated with severe COVID-19 can lead to high inflammation and allergic sensitization, which may be related to severe respiratory sequelae. As for the improved effect of COVID-19 vaccination, it may be due to the adaptive immunity formed by additional doses of vaccines, which may lead to an increase in the clearance rate of the virus reservoir.
Therefore, while battling the ongoing pandemic, governments should be prepared to deal with the long-term allergic consequences of COVID in the post-COVID era. Allergic diseases are common chronic diseases that require early detection unless they evolve into severe, life-threatening forms. Vaccination reduces the risk of post-COVID-19 allergic disease, and the article advocates vaccination as a mechanism for preventing post-COVID-19 disease.
The pain of 250 million people
I never expected that people who have been infected with the new crown will have a significantly increased risk of allergies after recovery, which is really worse news for rhinitis patients.
In our world of rhinitis, it is never the sun or the alarm clock that wakes us up in the morning, but a continuous stream of sneezes. I had time to think, if people could do without noses, it would be great. However, I know I'm not alone.
A large number of epidemiological surveys at home and abroad have shown that the prevalence of allergic rhinitis has increased significantly in recent years, and it has become a major chronic inflammatory disease of the respiratory tract, which has a serious impact on the quality of life and social economy of patients. According to relevant reports, the incidence of allergic rhinitis in various regions of the world is between 5% and 50%, and this data is increasing year by year. In the United States, 1 in 7 people are diagnosed with allergic rhinitis, and the economic loss due to allergic rhinitis in EU countries is 30 billion to 50 billion euros. In 2011, the mainland conducted a telephone questionnaire survey in 18 central cities across the country, and the results showed that the self-reported prevalence of allergic rhinitis among adults in China has increased from 11.1% in 2005 to 17.6%. In recent years, these data have been further rising, according to the news data of "CCTV Finance" in 2023, there are nearly 250 million patients with allergic rhinitis in the mainland!
Allergic rhinitis/allergic rhinitis (AR) is a non-infectious chronic inflammatory disease of the nasal mucosa mediated mainly by immunoglobulin E (IgE) after exposure to allergens (allergens) in atopic individuals, and asthma can be present in 40% of patients with AR.
The pathogenesis of AR is mainly allergen-specific IgE-mediated chronic non-infectious inflammation of the nasal mucosa, and non-IgE-mediated mechanisms and neuroimmune dysregulation are also involved. Inhalation of allergens can induce local production of specific IgE in the circulating lymph nodes and nasal cavity in atopic individuals, and the specific IgE binds to high-affinity IgE receptors on the surface of mast cells and basophils that accumulate in the nasal mucosa to form a sensitized state.
When the body is exposed to the same allergen again, the allergen binds to IgE anchored on the surface of mast cells and basophils, activates large cells and basophils, and leads to the release of inflammatory mediators such as histamine and leukotrienes, which can stimulate the sensory nerve endings and blood vessels of the nasal mucosa, excite the parasympathetic nerves, and then cause nasal mucosal vasodilation and increased gland secretion, resulting in symptoms such as nasal itching, sneezing, and watery discharge.
Regarding the diagnosis of allergic rhinitis, the typical symptoms are paroxysmal sneezing, watery discharge, nasal itching, and nasal congestion, which may be accompanied by ocular symptoms, including itching, watery eyes, redness, and burning sensation.
Signs include pallor and swelling of the nasal mucosa on both sides at the time of attack, inferior turbinate edema, excessive watery discharge from the nasal cavity, and ocular signs are mainly conjunctival injection, edema, and sometimes papillary reactions.
Allergen testing includes skin tests, blood tests, and nasal provocation tests, with the nasal provocation test being the gold standard for diagnosing AR.
How to deal with it?
Regarding the treatment of AR, the principle is "prevention and treatment combined, four in one", including environmental control, drug therapy, immunotherapy and health education.
Environmental control mainly refers to avoiding or reducing exposure to allergens and various irritants, which is an important part of AR prevention and control strategies. The treatment methods of AR include anti-causal therapy, the former mainly using allergen-specific immunotherapy (referred to as immunotherapy), and the latter including drug therapy and surgical treatment. The first-line drugs for drug therapy are nasal glucocorticoids (nasal corticosteroids), second-generation oral and nasal antihistamines, and oral leukotriene receptor antagonists, while second-line drugs include oral glucocorticoids, oral and nasal mast cell membrane stabilizers, nasal decongestants, and nasal anticholinergics. Among them, nasal corticosteroids were superior to antihistamines in controlling nasal symptoms (including nasal congestion), and there was no significant difference between the two in relieving ocular symptoms, while second-generation antihistamines had limited effect on improving nasal congestion.
For us personally, avoiding allergens, avoiding colds, preventing colds, quitting smoking and drinking, eating lightly, exercising, and strengthening resistance can also be effectively coped.
In fact, for rhinitis patients, healing is a luxury, but if we can reduce the flare-ups and reduce the symptoms, it is also a victory for us.
Finally, I hope we can sneeze a few less times in the spring when the pollen is flying.
Bibliography:
[1] Oh J, Lee M, Kim M, et al. Incident allergic diseases in post-COVID-19 condition: multinational cohort studies from South Korea, Japan and the UK. Nat Commun. 2024; 15(1):2830. Published 2024 Apr 2. doi:10.1038/s41467-024-47176-w.
[2] Wise SK, Damask C, Greenhawt M, et al. A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023. J Allergy Clin Immunol Pract. 2023; 11(3):773-796. doi:10.1016/j.jaip.2023.01.007.
[3] Bousquet J, Anto JM, Bachert C, et al. Allergic rhinitis[J]. Nat Rev Dis Primers, 2020, 6(1): 95. DOI: 10.1038/s41572‐020‐00227‐0.
[4] Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self‐reported allergic rhinitis in major Chinese cities from 2005 to 2011[J]. Allergy, 2016, 71(8): 1170‐1180.DOI: 10.1111/all.12874.
[5] Chen Jianjun, Cheng Lei, Kong Weijia, Li Huabin, Li Lan, Liu Zheng, Tao Zezhang, Wang Dehui, Wang Hongtian, Wei Yongxiang, Xu Geng, Yang Qintai, Zhang-Hua, Zhang Luo, Zhao Changqing, Zhou Bing, Zhu Dongdong.Chinese guidelines for the diagnosis and treatment of allergic rhinitis (2022, revised edition)[J].Chinese Journal of Otolaryngology-Head and Neck Surgery,2022,57(2):106-129.
Editor-in-charge|Yiyi Mizi
Cover image source: Visual China
Yimaitong is a professional online doctor platform, and the mission of the platform is to "sense the pulse of the world's medicine and help China's clinical decision-making". Yimaitong has a series of products such as "Clinical Guidelines", "Medication Reference", "Medical Literature King", "Yizhiyuan", "eYantong" and "ePulse", which fully meet the needs of medical workers in clinical decision-making, obtaining new knowledge and improving scientific research efficiency.