带你认识鼻炎大家族之过敏性鼻炎

人体内部有一套免疫系统,它们会进攻进入体内的过敏物质,在这一过程中就会发生一系列过激反应,进而出现炎症,发生在鼻子中的就被称之为是过敏性鼻炎,这些能够引发过敏的物质被称为是过敏原,打喷嚏、流清鼻涕、鼻塞和鼻痒都是一些主要症状。过敏性鼻炎本身又被称之为是变应性鼻炎,这种鼻炎主要是在过敏体质患者身上出现的。

过敏性哮喘和鼻炎患儿的临床免疫治疗研究

目的探讨过敏性哮喘和鼻炎患儿的特异性免疫治疗的临床应用。方法采用体外特异性过敏原检测系统对儿童医院门诊患儿进行血清过敏原特异性lgE(SlgE)抗体和总lgE进行检测,对尘螨过敏患儿进行分组治疗,免疫治疗组采用粉尘螨滴剂舌下脱敏治疗,对照组按普通药物抗过敏治疗,治疗6个月、12个月给予临床控制指标评分,同时观察患儿血清中SIgE的改变。结果 218例过敏患儿吸入性过敏114例(52.4%),食入性过敏101例(46.3%)。98例尘螨过敏患儿占总过敏者和吸入性过敏者的44.95%和85.96%。免疫治疗组与对照组比较差异有统计学意义(P<0.05);脱敏治疗患儿SIgE阳性率有所下降,但差异无统计学意义(P>0.05)。结论 218例过敏患儿的特异性过敏原检测中尘螨过敏者最多;舌下特异性免疫治疗过敏性哮喘和鼻炎效果显著。

Specific probiotics alleviate allergic rhinitis during the birch pollen season

AIM： To investigate whether birch pollen allergy symptoms are linked with gut microbiota changes and whether probiotics have an effect on these. METHODS： Forty seven children with confirmed birch pollen allergy were randomized to receive either a probiotic combination of Lactobacillus acidophilus （L. acidophilus） NCFM^TM （ATCC 700396） and Bifidobacterium lactis （B. lactis） BI-04 （ATCC SD5219） or placebo in a double-blind manner for 4 mo, starting prior to onset of the birch pollen season. Symptoms were recorded in a diary. Blood samples were taken for analysis of cytokines and eosinophils. Fecal samples were analysed for microbiota components, calprotectin and IgA. Nasal swabs were taken for analysis of eosinophils.RESULTS： The pollen season induced a reduction in Bifldobacterium , Clostridium and Bacteroides which could not be prevented by the probiotic intervention. During the intervention, significantly higher numbers ofB. lactis 11.2 × 10^7 ± 4.2 ×10^7 vs 0.1 × 10^7 ± 0.1 × 10^7 bacteria/g feces （P 〈 0.0001） and L. acidophilus NCFMTM 3.5 × 10^6 ± 1.3 × 10^6 vs 0.2 × 10^6 ±0.1 × 10^6 bacteria/g feces （P 〈 0.0001） were observed in the probiotic group compared to the placebo group.During May, there was a tendency for fewer subjects, （76.2% vs 95.2%, P = 0.078） to report runny nose, while during June, fewer subjects, 11.1% vs 33.3%, reported nasal blocking in the probiotics group （P = 0.101）. Concomitantly, fewer subjects in the probiotic group had infiltration of eosinophils in the nasal mucosa compared to the placebo group, 57.1% vs 95% （P = 0.013）. Eye symptoms tended to be slightly more frequent in the probiotic group, 12.5 d [interquartile range （IQR） 6-18] vs 7.5 d （IQR 0-11.5） （P = 0.066） during May. Fecal IgA was increased in the placebo group during the pollen season; this increase was prevented by the probiotics （P = 0.028）. CONCLUSION： Birch pollen allergy was shown to be associated with changes in fecal microbiota composition. The specific combination of probiotics used was shown to prevent the pollen-induced infiltration of eosinophils into the nasal mucosa, and indicated a trend for reduced nasal symptoms.

Clinical Research into Ke Min Yin for Treatment of Persistent Allergic Rhinitis in Patients with Qi Deficiency and Blood Stasis

Persistent allergic rhinitis (PAR) is one of the common diseases at ear-nose-throat department. From August 1998 to May 2001, we randomly selected 60 cases of PAR with qi deficiency and blood stasis for a clinical observation. 30 patients in the treatment group were treated with Ke Min Yin (克敏饮), a herbal medicine, to supplement qi, expel wind, nourish blood and promote blood circulation; and the other 30 cases in the control group were treated with cetrine. Through systematic observation and statistical processing, the clinical research is summarized and reported in the following.

Study on Cytokines IL-2,IL-6,IL-10 in Patients of Chronic Allergic Rhinitis Treated with Acupuncture

OBJECTIVES: To observe the plasmatic concentration of IL-6, IL-10 and IL-2 in the patient of chronic allergic rhinitis before and after acupuncture therapy. METHODS: Cytokine levels were determined before and after treatment in 30 healthy volunteers (Group A) and 90 patients of chronic allergic rhinitis (Group B) with an increased plasma IL-10 level. Group B was then divided into 3 subgroups: 30 patients treated with real acupuncture (Group B1); 30 patients treated with sham acupuncture (Group B2); 30 non-treated patients (Group B3). RESULTS: The allergic subjects of group B1, compared with controls, showed a significant reduction of IL-10 after a specific treatment with acupuncture (P

Acute cholestasis related to desloratidine

TO THE EDITORDesloratidine (Clarinex, Neoclarytin, Aerius, Azomyr, Opulis,Allex), the principal active metabolite of loratadine is itself a new oral antihistamine drug Its main indications are for the treatment of seasonal allergic rhinitis (SAR) and chronic idiopathic urticaria (CIU). The pharmacologic profile of desloratidine offers particular benefits, in terms of histamine H1-receptor binding potency and H1 selectivity. It has a half-life of 21-27 h, permitting a once-daily dose. No specific precautions are required with respect to its administration in renal or hepatic failure. No clinically relevant racial or gender variations in the disposition of desloratidine have been noted.We present here a clinical case of acute reversible idiosyncratic liver toxicity, related to its administration.

Treatment of Allergic Fungal Sinusitis：a Report of 31 Cases

Objective: To evaluate the effects of different surgical procedures on allergic fungal sinusitis. Methods: Thirty-one patients with allergic fungal sinusitis under endoscopic sinus surgery(24 cases) and Caldwell-Luc operation(7 cases) after medical treatment were investigated. Results: No complication was observed during one year's follow-up. No patient who conducted endoscopic sinus surgery reacurred and 3 patients who received traditional surgery required a second operation. Conclusion: This confirmed endoscopic sinus surgery provided a mini-traumatic and effective treatment. Combined treatment of surgical and medical ways was useful to the development of allergic fungal sinusitis.

A CLINICAL OBSERVATION ON THERAPEUTIC EFFECTS OF ACUPUNCTURE FOR ALLERGIC RHINITIS

The author applied acupuncture to treat52 cases of allergic rhinitis with certaintherapeutic effectiveness confirmed by afollowing-up for one year and more.The resultis reported as follows.

World Federation of Acupuncture-Moxibustion Societies(WFAS)Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis recommendation summaries

Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023.This is the first clinical practice guideline(CPG)on acupuncture and moxibustion for allergic rhinitis approved by an international academic organization,which provides evidence-based recommendations and the practical therapeutic protocols for acupuncture practitioners globally.This CPG was developed by following Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,and the principles of the World Health Organization Handbook for Guideline Development.The members in the guideline development group(GDG)were from different countries,with different professions,and they played a critical role in the development of clinical questions,recommendations,and therapeutic protocols.Recommendations are the core of a CPG and the direct answers to clinical questions,due to which this article focuses on the recommendations of this CPG.The recommendations were developed by using the modified Delphi method and the GRADE grid rules,based on the updated systematic reviews of clinical evidence.A total of 15 recommendations for 15 clinical questions were developed in this CPG,including one strong recommendation for intervention based on high-quality evidence,three conditional recommendations for either the intervention or the comparison based on very low quality of evidence,and 11 conditional recommendations for the intervention based on very low quality of evidence.

Full process of recommendation formulation for clinical practice guidelines:Taking World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis as an example

The formulation of recommendations is a crucial step in the development of clinical practice guidelines,which requires tools provided by the GRADE methodology.These tools include the evidence quality assessment tool,the evidence summary tool,and the evidence-to-decision(EtD)framework.Although there is a methodologically guided standard pathway for formulating recommendations in clinical practice guidelines,it remains unclear how to translate this theoretical pathway into the practical process for formulating recommendations and what the specific steps in this process entail.Therefore,this paper takes the World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guidelines on Acupuncture and Moxibustion:Allergic Rhinitis as an example to detail the full process of formulating recommendations and summaries it into a three-step method.Step one:Collect original materials from different sources to create EtD table.Step two:Distribute and collect EtD table,and preliminarily gather the recommendation voting results.Step three:Organize"salami-slicing pattern"guideline development group consensus meeting to formulate recommendations.The three-step method for formulating recommendations in clinical practice guidelines fully utilizes the GRADE EtD table to provide guideline development group with decision-making foundation and reference from multiple dimensions,including the importance of clinical questions,balance of benefits and harms,quality of evidence,resource required,values and preferences,health equity,acceptability,and feasibility.This approach enhances the scientific and practical nature of guideline recommendations.This paper provides a standard operating procedure to formulate recommendations for the incoming clinical practice guidelines,which aims to establish a standard pathway for the formulation of acupuncture clinical practice guideline recommendations.

Treatment on 28 cases of pediatric allergic rhinitis by combining Tuina and Chinese herbal medicine

Objective To discuss the clinical efficacy of treating pediatric allergic rhinitis by combiningTuina with Chinese herbal medicines. Methods Twentyeight cases of pediatric allergic rhinitis were treated by combining pediatric Tuine and oral administration of Yupingfeng powder （玉屏风散） combined with Guizhi decoction （桂枝汤）. The clinical efficacy was observed after 6 treatments. Results The treatment of pediatric allergic rhinitis by combining Tuina and Chinese herbal medicines had an overall effectivness rate of 85.71%. Conclusion Combined treatment using pediatric Tuina and an herbal mixture of Yupingfeng powder （玉屏风散） and Guizhi decoction （桂枝汤） has positive therapeutic efficacy for treatment of pediatric allergic rhinitis, and should be considered as a treatment for this condition.

Comparison of clinical effectiveness of acupuncture and a Western drug on allergic rhinitis:study protocol for a randomized controlled trial

OBJECTIVE： To compare the efficacy of an acu- puncture regimen for persistent allergic rhinitis （PER）, aimed at improving a patient＇s mind or Shen in Traditional Chinese Medicine, to that of a sec- ond-generation H-receptor antagonist, cetirizine hydrochloride. METHODS： This multicenter, randomized, con- trolled clinical trial on PER will be conducted at three institutions in China. The total study period will be 9 weeks. After a 1-week preparatory screen- ing period, 240 eligible participants with PER willbe randomized to receive acupuncture or pharma- cotherapy （1： 1） for 4 weeks with a 4-week fol- low-up. The primary outcome will be changes in 7-day average total nasal symptom score. Second- ary outcome measures include rhinoconjunctivitis quality of life questionnaire score and total non-na- sal symptom score. RESULTS： The presence and seriousness of psycho- logical and emotional impairments should be con- sidered in therapeutic programs for allergic rhinitis. No clinical trial for treating allergic rhinitis via acu- puncture regulation of psychological and emotion- al activities has been reported. CONCLUSION： The findings of the trial will allow us to determine the effects of the mind （Shen）-regula- tion treatment approach. We will also be able to confirm if the effects of acupuncture are equivalent to those of the conventional drug cetirizine hydro- chloride.

Influencing factors on efficacy of summer acupoint application treatment for allergic rhinitis:a retrospective study

OBJECTIVE:Allergic rhinitis(AR) is a common health problem.Summer acupoint application treatment(SAAT) is reported to effectively treat and prevent AR from seasonal onset.In the present study,we aimed to evaluate its effects,especially on the course of AR,through a retrospective study.METHOD:A cross-sectional multicenter study was performed based on patients treated between 2008 and 2009 in 13 clinical centers in China.A total of 1058 outpatients aged ≥2 years with documented AR and ≥1 year SAAT were eligible for enrollment.A case report form(CRF) was completed by both patient and doctor.The CRF was designed to collect data on the patient's history of SAAT,AR condition,and self-reported health condition.The outcomes(dependent variables) were incidence and intensity of AR and concomitant medications used.Data were analyzed with ordinal logistic regression(OLR).RESULTS:Treatment course and seasonal pattern of AR were related to all dependent variables positively.After controlling for sample bias and confounding factors,the findings suggested that a 3-year treatment course had better efficacy(OR/incidence of AR:2.57,95%CI:1.76-3.76;OR/intensity of AR:2.17,95%CI:1.50-3.17;OR/concomitant medications:2.20,95% CI:1.50-3.23) compared with a 2-year or less treatment course.CONCLUSION:The results showed that:1)the length of treatment course was positively associated with the efficacy of SAAT(the longer the treatment course,the better the efficacy);and 2)SAAT was more efficacious in treating seasonal AR than non-seasonal AR.

Acupuncture-moxibustion therapy of "banking up original qi and consolidating the foundation" for prevention and treatment of seasonal allergic rhinitis:A randomized controlled trial

Objective： To observe the clinical efficacy of acupuncture-moxibustion therapy of ＂banking up original qi and consolidating the foundation＂ for prevention and treatment of seasonal allergic rhinitis.Methods： Sixty included patients were divided into two groups according to the random number table method with 30 patients in each group. In acupuncture group, warming-needle moxibustion was carried out at Zúsānlǐ（足三里ST 36）, and cone moxibustion on Fùzǐ（附子Radix Aconiti Lateralis Praeparata） cake was conducted at Guānyuán（关元CV 4）, Qìhǎi（气海CV 6） and Dàzhuī（大椎GV 14）. The treatment was conducted in May or June（2 months before the onset of rhinitis in this area）. The treatment was carried out for once every other day and three times per week. Treatment for 24 times was considered as 1 course of treatment. No intervention treatment was conducted in control group. The score of rhinitis symptom, the visual analogue scale（VAS） score changes of total nasal symptom score（TNSS） and total non-nasal symptom score（TNNSS） of patients in 2015 and in 2016 were observed, and the clinical efficacy of the two groups was compared.Results：（1） The score of rhinitis symptom, the VAS score changes of TNSS and TNNSS in acupuncture group in 2016 declined when compared with the results in 2015, which were 4.57 ±0.82 vs 9.40 ± 1.89,13.37 ± 4.01 vs 30.80 ±4.77 and 15.93 ±6.30 vs 46.13 ± 9.79（P〈 0.001）, the results in acupuncture group after treatment were lower than that in control group at same time, which were 4.57 ±0.82 vs 7.53 ±2.06,13.37±4.01 vs 27.17±6.84,15.93±6.30 vs 35.53±11.69（all P〈0.001）. According to comparison, there was no obvious difference in the results in control group at the two time points, which were 8.60 ±2.39 vs7.53 ± 2.06, 29.63 ± 6.30 vs 27.17 ± 6.84 and 40.90 ±12.31 vs 35.53± 11.69（all P〉 0.05）.（2） The total effective rate was 96.7%（29/30） in acupuncture group and 10%（3/30） in control group, and the difference was statistically significant（P〈 0.001）.Conclusion： Acupuncture-moxibustion therapy of ＂banking up original qi and consolidating the foundation＂ was effective on prevention and treatment of seasonal allergic rhinitis.

Treatment of “itching symptom” of allergic rhinitis from the perspective of “wind”

Objective To observe the clinical efficacy of ＂itching symptom＂ of allergic rhinitis treated from the perspective of ＂wind＂. Methods Forty patients were given acupuncture therapy, Fengchf （风池 GB 20, bilaterally）, Dazhui （大椎 GV 14）, Fengmen （风门 BL 12, bilaterally）, Feishu （肺俞 BL 13, bilaterally） and Shangyingxiang （上迎香 EX-HN8, bilaterally） were selected. After needle withdrawal, a fire cup was applied between GV 14 and BL 13, and the cup was retained for 10 min. Treatment for 15 times was considered as 1 course of treatment. Three days were free from treatment between 2 courses, and 3 courses were needed. The curative effect was evaluated after treatment ends, and follow-up visit was performed one year after treatment. Results The scores of nasal symptom and itching symptom after treatment ends and one year after treatment significantly reduced when compared with that before treatment （all P〈0.05）, the difference was not statistically significant when compared the scores of nasal symptom and itching symptom one year after treatment with that after treatment ends （both P〉O.O5）.According to the follow-up visit performed one year after treatment, the markedly effective and effective cases reduced, ineffective cases increased, and the total effective rate declined slightly. The serum IgE levels, after treatment ends I-（164.79±44.29） IU/mL and one year after treatment [（180.71±52.81）IU/ mL] , both significantly reduced when compared with that before treatment [（380.12±61.45） IU/mL, both P〈0.05] , the serum igE level one year after treatment increased when compared with that after treatment ends, but the difference was not statistically significant （P〉O.05）. Conclusion （1） Significant short-term and long-term curative effects have been obtained during the treatment of ＂itching symptom＂ of allergic rhinitis from the perspective of ＂wind＂, （2） the mechanism of action may be related with the decrease of serum IgE level, （3） it is indicated that there are correlations between allergic rhinitis and atopic diseases such as atopic dermatitis and allergic conjunctivitis, etc.

Auricular Point Sticking Plus Cupping to Treat 30 Teenage Allergic Rhinitis

Seeds of Vaccarin Segetalis （王不留行） taped to the desensitization plaster are sticked tightly to the points of Lung（MA-IC1）, Internal Nose （MA-T）, External Nose（MA-T1）, Er Shenmen （MA-TF 1 ）, Endocrine （MA-IC 3）, External Ear （MA -T）, Fengxi （MA-SF） and Adrenal Gland （MA-T） plus Feishu （BL 13） in both sides sucked with the middle-sized cupping and Shenque （CV 8） with the large-sized cupping. Thirty cases of allergic rhinitis are treated. Of the 30 cases, 11 have the symptoms basically or totally disappeared. 17 have the symptoms of nasal blockage, itching, sneezing and watery discharge relieved or the frequency of attacks decreased. 2 have the symptoms not significantly improved before or after treatment.

Allergic rhinitis treated with warming-needle moxibustion

A case of allergic rhinitis treated with warming-needle moxibustion was introduced. A 57-year old patient w years was treated. Yingxiang （迎香 th allergic rhinitis for more than 10 LI 20）, Shangyingxiang （上迎香 EX- HN8）, Shangxing （上星GV 23）, Yintang （印堂 EX-HN3）, Cuanzhu （攒竹 BL 2）, Fengchi （风池 GB 20）, Tiantu （天突 CV 22）, Waiguan （外关 TE 5）, Hegu （合谷 LI 4）, Zusanli （足三里 ST 36）, Shensha （肾俞 BL 23） and Taixi （太溪 KI 3） were punctured. After deqi, warming-needle moxibustion was performed at LI 20 and ST 36. After treatment for 2 courses, all the symptoms disappeared without relapse of urticaria or asthma during treatment. Another 2 course of treatment was conducted additionally for consolidating the curative effect. No relapse was found during the follow-up visit half a year after treatment.