高反應(yīng)性鼻炎

1精選ppt耳鼻咽喉頭頸外科學(xué)第二篇鼻科學(xué)及顱面疾病〔3〕精選ppt第十一章

鼻黏膜高反響性鼻病3精選ppt第一節(jié)

變態(tài)反響性鼻炎4精選pptRespiratorymucosainnoseThenasalmucosashowedbytransmi-ssionalelectromi-Croscope.5精選pptThepictureofnormalmucosashowedbynasalendoscope6精選pptNasalhyper-reactivityNasalcavity:FirstlineofairwaySensitivity:richnervedistributionMucosalcompound:respiratoryepithelialcellsGobletcellglands(serousormucous)richvessels7精選pptImmunecompound:Toll-likereceptorslymphocytes(T,B)serouscellsmastcellsepithelialcells

8精選pptResponseofnoseinducedbysomefactorsChallengefactors:enviromentalWeather、temperature、humidityinhalants:Dust、allergen、chemicalspollutionmostofabove9精選pptIntrinsic:nervous、stressordisappoint、depressoranxious

10精選pptNasalresponse——ProtectiveCongestion—reducepatencyoftheairwayandamountofharmfulgasandparticlestoenterairwayRhinorrhea—TodischargeforeignparticlesandinflammatorymediatorsSneeze—rapidlyruleoutharmfulgasandparticles

11精選ppthyper-reactivityofNasalmucosaThedifferenceofnasalmucosalreactionbetweenphysiologicandpathologiccondition

12精選ppt

physiologicpathologic

Inducernervousstressimmunologic(allergy)temperaturechangesuddenlypsychologicodordustendocrineduration<2days>4days(consecutively)<1h>1hpathologicnervereflexinflammationbase〔mainly)〔mainly)13精選ppt高反響性鼻病Definition：

HyperreactiveRhinopathyissymptomicdisorderandthereactionofnasalmucosainducedbystimuliexceednormallimit14精選pptMainincluding:AllergicRhinitisNon-allergicrhinitis——coldairinducingrhinitisendocrinerhinitisdruginducingrhinitisnonallergicallergicrhinitiswitheosinophiliavasomotorrhinitis(idiopathicrhinitis)

15精選pptAllergicrhinitis16精選pptAllergicrhinitisisasymptomaticdisorderofthenoseinducedafterallergenexposurebyanimmunoglobulinE(IgE)-mediatedinflammationofthemembranesliningthenoseDifinitionofAllergicrhinitis17精選pptKeypointofthedifinitionSusceptibleindividualInducedbyallergenexposureIgEmediatedmainlyNasalmucosainfalmmationMainsymptomsincludesneeze,rhinorrheaandobstruction18精選pptallergenPollen:tree,grass,cropplant19精選pptfugi20精選pptdustmite21精選pptpetdander22精選pptMechanismofallergicinflammation-Th2response23精選pptTh2BIL-4變應(yīng)原NaiveThIgEIL-4IL-5釋放炎癥介質(zhì)毒性蛋白細(xì)胞因子釋放炎癥介質(zhì)和細(xì)胞因子Eo變應(yīng)性鼻炎免疫學(xué)機(jī)制－以Th2反響為主的免疫性疾病嗜酸性粒細(xì)胞肥大細(xì)胞和嗜堿性粒細(xì)胞速發(fā)反響〔EarlyPhaseReaction〕遲發(fā)反響〔LatePhaseReaction〕抗原提呈細(xì)胞24精選pptSymptomsNasalobstructionSymptoms>1hrdaylyLasting>4dsweekly精選pptsneeze精選pptNoserunning精選ppt精選pptPale-edemamucosa精選pptNoseitch精選pptHowarethesymptomscaused?Irritationoffreenerveendings---- ItchingandsneezingIncreasedmucusproduction------ RhinorrhoeaVasodilation--------MucosacongestionIncreasedvascularpermeability----Mucosaoedema31精選pptRelationshipbetweenupandlowairwayMorbidityofasthmainPatientswithallergicrhinitisis3timesmorethanonewhonoallergicrhinitis20%ofchildrenwithallergicrhinitiswilloccurasthmainlifelate32精選pptRelationshipbetweenupandlowairway33精選pptMucosalinflammationispresentintheentireairwayofpatientswithallergicrhinitisand/orasthma.UpperairwayinflammationisassociatedwithbronchialhyperresponsivenessLowerairwayremodelingispresentinasthmatic,butalsoinallergicrhinitispatients.Relationshipbetweenupandlowairway精選pptAllergicrhinitisandasthmaarecharacterizedbyaninflammatoryprocessthatismarkedhistologicallybytissueeosinophils,mastcells,Tlymphocytes,macrophages,andepithelialcells.精選pptinflammation精選pptImportantConceptOneairway,OnediseaseGrowsman-199737精選pptWorldwideprevalence38精選pptPrevalenceofAllergicrhinitisinCHINA〔2007〕39精選pptIncreasingprevalenceofARThecausemaybeassociatedwithfactorsasfollows:Airpollution:exhaustparticle;ozone,NO2(nitrogendioxide),SO2(sulfurdioxide)Lifestyle:unsaturatedacidHyper-Hygiene40精選pptTheimpactofARonqualityofLiveQualityoflive(QOL):Sleepingworkstudyentertainmentsocialcommunicationsystemicfelling41精選ppt

AllergicrhinitisandItsimpactonasthma〔ＡＲＩＡ2021〕—theWHOGuideline:Allergicrhinitisisaglobalhealthproblemthatcausesmajorillnessanddisabilityworldwide.Itaffectssociallife,sleep,schoolandwork.

42精選pptBothallergicrhinitisandasthmaaresystemicinflammatoryconditionsandareoftenco-morbidities.Theeconomicimpactofallergicrhinitisissubstantial.

43精選pptIntermittent

<4daysperweekor<4weeksClassficationofAR44精選pptPersistent≥4daysperweekand≥4weeks45精選pptMildnormalsleepnoimpairmentofdailyactivities,sport,leisurenormalworkandschoolnotroublesomesymptoms46精選pptModerate-severeoneormoreitemsabnormalsleepimpairmentofdailyactivities,sport,leisureabnormalworkandschooltroublesomesymptomsARIA2021,CHINAGuideofAR202147精選pptDiagnosisofAR48精選pptDiagnosisofARHistorySpecificdiagnosis——IgEinvitro——specificIgEforaallergenTotalIgE(withastnma)invivo——allergenskintest49精選pptHistory—cornerstoneofdiagnosisDuringandseverityInducer:grasspollendampmatteroldclothingsandbeddingpadpet(cat,dog)Nasalhyper-reactivity：sneezingrhinorrheaResponsetoH1antihistaminetherapy50精選pptAllergyskinpricktesting(SPT)Skinpricktest/positiveresult51精選pptImmediatehypersensitivityskintestsareusedtodemonstrateanIgEmediatedreaction.Adropofallergensolutionisplacedontheskinandintroducedintotheepidermisbyasterileneedleorstylette,byalightpunctureoftheskin.52精選pptPositiveandnegativecomparatortestsusinghistamineandsalinecanbeperformedtoprovethattheskiniscapableofdemonstratingapositivereaction,andtopreventtheinterpretationoffalse-positiveresultsoccurringasaresultofdermatographism.53精選pptApositivewheal>3mmdiameterreactionindicatesthatthepatientisproducingIgEantibodiestoaspecificallergen,andtakeninconjunctionwithapositivehistory,isevidencethattheallergenisresponsibleforthepatient’ssymptoms.54精選pptExplanationofSPTresultPositiveNotable:mayseenearly25%innormalEmphasizing:correspondingwithhistoryinformation:Yes——makediagnosisNo——maypredictive

55精選pptNegativeexcludedrugeffectunknowallergenmaypresentnonallergic

56精選pptSerumSpecificIgE(sIgE)SpecificIgEimmunoassaysmaybeused:extensiveskindisease,skintestsuppressivetherapy(antihistamines)thatcannotbediscontinued,uncooperativepatients,orwhenthehistorysuggestsanunusuallyhighriskofanaphylaxisfromskintesting.57精選pptPositiveresultsoftestingspecificIgEmustbecorrelatedwithhistoryandphysicalfindingstoassesstheirclinicalSignificanceGenerally,sensitivetyandspecificityofSPTissuperiortotestingofserumspecificIgE58精選pptDifferentialdiagnosisByexclusiveprocess(SPT;serumsIgE)Non-allergicnasalhyperreaciverhinitisVasomotorrhinitis(idiopathic)Non-allergiceosinophilia

rhinitis(aspirinintolerance?)Hyper-reflectiverhinitis(Psubstance?)Endocrinerhinitis(estrogn)59精選pptManagementofARAllergenAvoidancePharmacotherapyImmunotherapy60精選pptPharmacotherapyMedicationsusedtotreatallergicrhinits:AntihistaminesDecongestantsCorticosteroidsMastCellstabilizersAnticholinergicsAntileukotrienes〔抗白三烯藥〕61精選pptAnti-HistaminesActbypreventinghistaminefrombindingtotheH1-receptorsPrimarilyhelpfulincontrollingSneezing,itching&rhinorrhoea;ineffectiveinreleivingnasalblockage62精選ppt1stgenerationanti-histamines -chlorpheniramine -diphenylhydramine2ndgenerationanti-histamines -cetrizine -azelastine -fexofenadine -loratadine63精選pptAnti-HistaminesIndications:mildintermittentorpersistentrhinitismoderate-severe——combinedwithintranasalcorticosteroids64精選pptGenerally,Secondgenerationantihistaminesisfirstchoiceadvantage:longtermeffectnosedativeRoutesofadministrationoralorintranasal65精選pptIntranasalcorticosteroidtherapyPotenttopicalactivityAdministrationoflowdosesdirectlyatsiteofactionConsiderableefficacyatlowdosesHightopical:systemicactivityratios66精選pptRapidfirst-passhepaticmetabolismofanysystemicallyabsorbeddrug,tocompoundswithnegligibleactivity67精選pptIntranasalcorticosteroidsIndications:Moderate-severeintermittentorpersistentorcomplicatedwithasthmaAdvantage:anti-inflammationeffectissignificantlysuperiortoantihistainessafe,nosystemicsideeffect68精選pptAnti-leukotrieneAnti-leukotrieneshouldbegivenforpatientswithbronchialsymptomsorseverenasalsymptoms69精選pptActionsofVariousNasalPreparationsintheTreatmentofRhinitisNasalPreparationSneezingItchingRhinorrhoeaCongestionAntihistamines++++++++++++0Anticholinergics00+++++0Corticosteroids++++++++++++++++70精選pptNasalPreparationSneezingItchingRhinorrhoeaCongestionDecongestants00++++++Mastcellstabiliser+++++++++0Antileukotrienes+++++0++++71精選pptSpecificImmunotherapy(SIT)SITisthepracticeofadministeri