Teaching
Managing Allergic Rhinitis: From Antihistamines to Allergen Immunotherapy
One distinctive symptom of allergic rhinitis is persistent sneezing, ranging from a few to numerous sneezes. Allergic rhinitis, also referred to as allergic nasal inflammation, is a non-infectious inflammatory condition affecting the nasal mucosa. It involves various immune cells and cytokines, primarily mediated by IgE (immunoglobulin E), especially histamine. This histamine is released when a hypersensitive individual comes into contact with allergens. Allergic rhinitis is a global health concern that can lead to various diseases and a decrease in productivity.
Epidemiological and basic research has established a clear link between IgE and the pathogenesis and development of symptoms associated with allergic diseases. The incidence of asthma is correlated with elevated serum IgE levels, and in children, persistent wheezing is associated with serum IgE levels. Anti-IgE antibodies have proven effective in treating allergic respiratory diseases, mainly by reducing serum IgE and FceRI receptor levels. This leads to improved asthma outcomes in adults, adolescents, and children, subsequently reducing the need for steroid dosage. The safety and tolerability of anti-IgE antibodies in these studies have resulted in their approval for treating moderate to severe allergic asthma in adults and adolescents.
However, further research is necessary before recommending the use of these drugs for asthma patients with IgE-mediated diseases such as allergic rhinitis and food allergies. The ongoing anti-IgE-based therapy development requires continuous refinement and improvement.
For individuals already experiencing allergic rhinitis, in addition to preventive measures, symptoms can be alleviated through various interventions. Common approaches include using antihistamines such as loratadine and desloratadine, or nasal corticosteroid sprays, which help alleviate symptoms like nasal congestion and a runny nose. Incorporating saline nasal sprays or drops into daily life can cleanse the nasal passages, reducing congestion and inflammation.
In clinical treatment, managing allergic diseases involves allergen immunotherapy (AIT), an innovative treatment that gradually induces tolerance to allergens. This assists patients in alleviating allergic reactions and relieving symptoms. The basic idea of this therapy is to administer small amounts of allergens regularly, gradually adjusting the patient's immune system to produce a more normal response to allergens.
The treatment principle of AIT for allergic diseases aims to induce immune tolerance, which is related to the levels of specific IgE and IgA antibodies. In healthy individuals, allergen-specific IgA molecules are found, rather than IgE, and their T cells do not respond to allergens, possibly due to the development of regulatory processes actively suppressing the body's response to allergens. Because IgA is inversely related to allergy occurrence, there is promise in developing new therapies using IgA for allergic diseases, including allergic rhinitis and asthma.
Currently, numerous allergens can induce rhinitis, and individualized measures should be taken to reduce the occurrence of allergic symptoms.
* Dust mite allergens: Maintain indoor humidity below 50%, use dust mite-proof bed covers and pillowcases, regularly wash bedding and innerwear with hot water above 55°C, avoid using carpets throughout the house, and regularly vacuum and replace carpets, curtains, and home decor fabrics.
* Pollen allergens: Close windows during pollen seasons, use air purifiers with pollen-filtering effects in homes or vehicles, start taking antiallergic medications before the pollen season begins, and wear sunglasses, hats, and masks when outdoors.
* Fungal allergens: Reduce outdoor activities when mold levels are high, maintain humidity below 45%, preferably below 35%, promptly clean damp areas such as bathrooms, basements, laundry areas, or kitchens.
* Animal dander allergens: Prevent pets from entering bedrooms, keep bedroom doors closed, regularly clean bedrooms, remove or regularly clean furniture and items that pets like, and change clothes promptly after prolonged contact with animals.
* Food allergens: Avoid consuming foods that cause allergies, maintain a non-greasy diet, and reduce the consumption of carbonated beverages.