变应性鼻炎的长期抗炎治疗

Long-term anti-inflammatory treatment of allergic rhinitis

已经证实许多没有症状的变应性鼻炎(AR)患者存在亚临床的炎症状态,接触阈值以下的变应原剂量能够引起鼻黏膜炎性细胞的浸润,包括细胞黏附分子、鼻腔和结膜嗜酸性粒细胞以及其他炎性标记物的表达显著增加,这些都不会导致明显的过敏症状。虽然治疗AR通常以缓解症状为主,减轻无症状时期的炎性反应可能会对AR发病、进展以及严重程度有积极的影响。因此制定治疗方案时应该充分考虑到对于症状缓解后仍存在的潜在炎性反应。目前主要有三类治疗AR的药物,包括抗组胺药、抗白三烯药和鼻内糖皮质激素,鼻内糖皮质激素对AR患者持续炎症的长期抑制可能是最合理的治疗选择。

In Symptom-free patients with allergies,a subclinical inflammatory state has been described,in which subthreshold doses of an allergen have been found to cause inflammatory cell infiltration into the nasal mucosa. This includes increases in the levels of cellular adhesion molecules,nasal and conjunctival eosinophilia,and other markers of inflammation,which do not result in overt allergic symptoms. While allergic rhinitis（ AR） treatment is typically guided by the need to reduce symptoms,the treatment strategies that reduce inflammation during asymptomatic periods may have positive effects on the onset,progression,and severity of AR. Therefore,treatment options that target underlying inflammation along with symptom relief should be considered. There are three major classes of commonly used AR medications,namely,intranasal corticosteroids,antihistamines,and antileukotrienes. Among these,intranasal corticosteroids appear to be the most reasonable therapeutic option in patients who would benefit from continuous inhibition of persistent inflammation.