Pediatria pre prax 2/2006

ALLERGIC RHINITIS

The prevalence of allergic rhinitis has been increasing in the last decade, particularly in the paediatric population. The current classification is based on assessment of the severity and duration of the complaints and their influence on the patient‘s quality of life. Nasal symptoms in allergic rhinitis are due to the action of a wide range of mediators on various receptors. Itching and sneezing are caused by irritation of the sensory nerve endings, hypersecretion is induced reflexly by activation of the parasympathetic cholinergic fibres. Mucosal swelling is due to increased vascular permeability and mainly due to increased filling of the capillaries and capacity vessels in the nasal mucosa following H1 or, less frequently, H2 receptor interference. Having passed through the protective surface barriers, the antigen/ allergen binds to specific IgE antibodies which are bound to the cell surface Fc receptors and triggers an allergic type I reaction. Collaboration of various specialists is required for diagnosis and management. The majority of patients with chronic rhinitis require longterm pharmacotherapy. Currently, several drug groups can be chosen from with varying mechanisms of action, whether local-intranasal or systemic (administered orally): decongestants, antihistamines, cromones, anticholinergics, corticosteroids, and leucotrienes. Specific immunotherapy is the only therapeutic procedure to reduce the patient‘s atopic reactivity by restoring the balance between Th1-Th2 responsiveness of the T-lymphocyte subsystem in the organism. Bronchial asthma is the most serious complication of chronic rhinitis. All patients with allergic rhinitis should therefore be thoroughly examined in order to rule out bronchial asthma and, conversely, in asthmatics it is necessary to identify manifestations of allergic rhinitis.

Keywords: allergic rhinitis, aetiopathogenesis, diagnosis, treatment, bronchial asthma.