ALLERGIC RHINITIS

Question 1: Doctor, what is allergic rhinitis?

      - Currently, allergic rhinitis is the most common chronic disease, affecting 25-35% of the world's population.

      - In Vietnam, since 2008, the rate of allergic rhinitis has accounted for about 12% of the population and by 2010 it increased to 20%.

      - In Ho Chi Minh City, with a population of about 10 million, we have over 1.5 million people with allergic rhinitis.

      - Nowadays, due to increasingly harsh climate and increasing environmental pollution, the rate of allergic diseases is also increasing, most cases start from 10-15 years old.

      - Allergic rhinitis is an immune disease. Caused by foreign allergens and the main route of invasion is the nasal mucosa.

Question 2: What are the symptoms of Allergic Rhinitis?

Symptoms of allergic rhinitis often appear in episodes such as: itchy nose, sneezing, stuffy nose and runny nose. Including:

   - Itchy nose is often a warning symptom, patients often have itching on both sides of the nasal cavity, sometimes spreading down to the throat causing an itchy throat and spreading up to the eyes causing itchy eyes.

   - Sneezing occurs in series, can be continuous from 5-10 times and the patient cannot control himself, sometimes sneezing so much causes headache symptoms.

   - Nasal congestion: usually atypical, can be stuffy at a certain time of the day, one nostril is stuffy or both nostrils are completely stuffy.

   - Runny nose: is an important symptom. After an itchy nose and sneezing, the patient will start to have a runny nose. Usually the runny nose is thin, clear like water, sometimes in drops and the runny nose often increases when the weather changes, especially early morning and evening.

Question 3: What causes Allergic Rhinitis?

      As mentioned above, allergic rhinitis is an immune disease. Caused by foreign allergens and the main route of penetration is the nasal mucosa. And the irritants that cause allergic rhinitis are very rich and diverse, today the World Allergy Association has unified 3 types: airborne allergens, environmental pollutants, Aspirin and non-steroidal anti-inflammatory drugs.

      Allergic rhinitis is divided into 3 types: seasonal allergic rhinitis, perennial allergic rhinitis and occupational allergic rhinitis.

      1.Seasonal rhinitis:

        - Often found in young people, has a family factor and shows clear genetic inheritance.

        - Allergens are often outside the home, such as: Grass pollen, mold and fungal spores in the air, environmental pollutants...

        - Seasonal allergic rhinitis has typical symptoms: sneezing, runny nose, stuffy nose that only lasts 7-15 days, often accompanied by watery eyes, conjunctivitis, lower respiratory tract allergies causing difficulty breathing or bronchial asthma.

      2. Perennial rhinitis:

        - Allergic attacks often recur, occurring year-round, and often have a family component.

        - Allergens commonly found in the home are very diverse: house dust mites, cockroaches and molds, tiny pieces of skin and fur from cats and dogs, cigarette smoke... often the allergen cannot be identified.

        - Symptoms are often atypical like seasonal rhinitis, nasal congestion is the most common and uncomfortable symptom for patients, sometimes with postnasal drip, down the palate and throat.

      3.Occupational rhinitis:

        - Occupational rhinitis occurs with special allergens in the production work environment: chemicals, industrial dust...

        -Usually considered an occupational disease. Typical symptoms: sneezing, runny nose, in some people there may also be a mild fever, cough, chest tightness or asthma attacks.

Question 4: Doctor, why do some people get allergic rhinitis and others don't?

      - Allergic rhinitis is an immune disease, so allergic rhinitis occurs in people with allergic constitution or more specifically, genetic factors.

      - If both parents have allergic rhinitis, the chance of their children having allergic rhinitis is 75%.

      - If either the mother or father has allergic rhinitis, the child's chance of having allergic rhinitis is 50%. 

      There is also acquired allergic rhinitis, which is when the father and mother do not have allergies but the child lives in an environment with allergic factors, the result is also allergic rhinitis.

Question 5: So what should be done to diagnose Allergic Rhinitis, doctor?

    - Allergic rhinitis is a clinical diagnosis, meaning the doctor only needs to rely on medical history, medical history and clinical examination.

    - In which, taking a history of allergies is very important in diagnosing allergic rhinitis, helping the doctor to orient to a type or group of allergens as the cause of the disease.

        History includes:

         +  Family history: parents and siblings have allergies.

         +  Personal history: diseases such as hives, allergic bronchial asthma, food allergies, drug allergies, facial swelling when exposed to chemicals...

   -  Must ask carefully when the illness started, favorable conditions such as flu, change in weather, or living conditions.

   -  When do symptoms such as prolonged sneezing, runny nose, and stuffy nose usually occur? And which symptoms cause the patient the most discomfort?

   -  Clinicalexaminationthrough nasal endoscopy helps doctors evaluate:

        +  Nasal mucosa condition: in allergic rhinitis, the nasal mucosa is often pale and often edematous.

        +  Condition of the nasal turbinates: can be degenerative or hypertrophic. Thereby assessing the ability of the nasal turbinates to contract when vasoconstrictor drugs are applied.

        +  Nasal discharge is initially clear or gradually becomes cloudy when there is a secondary infection.

        +  Through nasal endoscopy, the doctor can observe whether there are nasal polyps or degenerated nasal turbinates like polyps.

   -  In addition, patients can also do paraclinical tests such as:

        +  Nasal fluid cell test.

        +  Test to detect IgE allergy antibodies.

        +  Skin tests & provocation tests with allergens performed by allergists.

Question 6: How to treat allergic rhinitis ?

   Because allergic rhinitis is a genetic disease, treatment goals include the following factors:

      1. Control and relieve symptoms: sneezing, runny nose, stuffy nose.

      2. Prevents recurrence of allergic attacks.

      3. Reduce the number of patient visits.

      4. Reduce the duration of illness.

      5. Reduce the use of drugs to treat symptoms.

      6. Help patients improve their quality of life.

  The principle of treating allergic rhinitis is the harmony of 4 factors between patient and doctor:

      1. Patients should avoid allergens when possible.

      2. Patients need to comply with oral medications and nasal sprays to reduce symptoms as prescribed by the doctor.

      3. Doctors educate patients on prevention and avoidance.

      4. Perform immunotherapy for special cases.

      Immunotherapy (also known as specific desensitization): After testing, the patient will know exactly which antigen he is allergic to. The patient will be injected with the antigen causing the disease in increasing doses, making the body gradually adapt to that substance and when exposed, the allergy will no longer occur. The success rate of this method is 80-90% (most effective in cases of allergies caused by pollen, house dust and cat and dog hair). The treatment period usually has to last 4-5 years to achieve the desired effect; symptoms such as sneezing, runny nose, and stuffy nose begin to improve clearly after 6-12 months.

Question 7: How to prevent allergic rhinitis?

      - Patient education on prevention and avoidance is very important in the treatment of allergic rhinitis.

      - For those allergic to dog or cat hair, pets should be removed from the bedroom, or even better, from the house. Vacuum carpets and mattresses regularly.

      - Ensure dry conditions in the house to avoid mold.

      - Eliminate cockroaches, remove moisture from cracks in floors or ceilings. Clean fabric surfaces to remove allergens.

      - For people with pollen allergies, they should stay indoors and close the doors during peak pollen periods. They can wear sunglasses to avoid eye allergies.

     - House dust mite allergen is the most mentioned allergen in allergic rhinitis. To prevent it, ventilate the house well to reduce humidity, wash pillows regularly at 60 degrees Celsius, use a vacuum cleaner, remove curtains, move pets and toys such as stuffed animals out of the bedroom...

     In addition, patients should minimize exposure to cigarette smoke, vehicle exhaust, perfumes, flavors, or other strong-smelling substances. For occupational allergies, if it is not possible to change jobs, patients should wear masks, respirators, or use alternative materials.

Question 8: Progression of allergic rhinitis if left untreated ?

      Allergy attacks usually last a few days and then go away without treatment. Attacks will recur over time, with age, and with exposure to allergens.

     Some  patients with nasal allergies go to the doctor and are given medication by an ENT specialist and treated for a few days, but they see a significant improvement, so they stop taking the medication and do not return for a follow-up visit for continued treatment. As a result, patients often have recurring nasal allergies and then complications occur.

     Although not life-threatening, allergic rhinitis causes patients to always feel headaches, sleepiness, discomfort, fatigue, affecting work and daily activities. If left untreated for a long time, patients may suffer from upper respiratory tract infections, otitis media, sinusitis, or nasal polyps... which leads to prolonged treatment time and costs.