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Not allergic eosinophilic rhinitis

Epidemiology

The epidemiology of not allergic eosinophilic rhinitis is studied badly.

Etiology and pathogeny

There are no accurate data. Perhaps, not allergic eosinophilic rhinitis is the first manifestation of intolerance of nonsteroid antiinflammatory medicines.

Clinical signs and symptoms

In a clinical picture of not allergic eosinophilic rhinitis the progressing difficulty of nasal breath and decrease in sense of smell, sneezing paroxysms, profuse watery allocations from a nose prevail. Not allergic eosinophilic rhinitis is characterized by a persistent current and often leads to development of a polypostural rinosinusit and bronchial asthma.

The diagnosis and the recommended clinical trials

When collecting the anamnesis it is not possible to reveal typical symptoms of an allergic disease, skin tests with allergens usually negative, specific IgE in blood serum are absent. At cytologic research of a nasal secret during clinical manifestations eosinophils make more than 10% of cell population.

Differential diagnosis

It is necessary to carry out differential diagnosis with other types of rhinitis.

General principles of treatment of not allergic eosinophilic rhinitis

Glucocorticoids for topical administration and inhibitors of leukotriene receptors belong to the main medicines applied in pharmacotherapy of not allergic eosinophilic rhinitis:
Beclomethasone on 50 mkg in each nostril 2 — 3 r / days or
Budesonid on 100 mkg in each nostril 2 r / days or
Zafirlukast inside on 20 mg 2 r / days or
Mometazon on 50 mkg in each nostril 1 r / days or
Montelukast inside po10 mg 1 r / days (before going to bed)
Flutikazon on 50 mkg in each nostril 1 r / days

Efficiency of inhibitors of leukotriene receptors in treatment of not allergic eosinophilic rhinitis is still insufficiently studied. These medicines are included into group of means of basic therapy at patients from aspirinovy bronchial asthma. Perhaps, they will find the place and in pharmacotherapy of not allergic eosinophilic rhinitis.

Also the method of desensitization of ASK is used.
The method of desensitization is based on a phenomenon of development of tolerance to repeated reception of nonsteroid antiinflammatory medicines. The most widespread scheme of peroral desensitization consists in the following. The patient accepts ASK each 3 hours in the increasing doses (the 1st day — 3 mg — 30 mg — 60 mg; the 2nd day — 100 mg — 300 mg — 600 mg), after each reception is spent monitoring of function of external respiration. At emergence of the phenomena of a bronchospasm carry out the corresponding treatment and the dose which caused reaction, do not increase until its disappearance. At reception sick daily 600 mg of aspirin tolerance to nonsteroid antiinflammatory medicines can remain vaguely long, however at drug withdrawal disappears during 2 — 14 days. For prevention of side effects from a digestive tract began to use the new simplified scheme in recent years: The 1st day — 50 mg in the morning — 50 mg in 8 hours; the 2nd day — 500 mg; the 3rd day — 100 mg and further the same dose within at least 9 months. Desensitization is carried out in the conditions of a hospital, before the first reception of aspirin establish an intravenous catheter on a case of need of the emergency actions. function of external respiration is investigated in an initiation of treatment and after reception of each subsequent dose of ASK, desensitization is continued only if indicators of function of external respiration decrease no more than by 25% of initial sizes.
For intranasal desensitization at not allergic eosinophilic rhinitis use the ASK soluble forms, and prepare solution for spraying in a nasal cavity just before each procedure. The course of treatment usually consists in introduction of 8 mg of ASK every other day within 6 months. Results of an acoustic rinometriya demonstrate reduction of the sizes of polyps, and also decrease in an expression of leukotriene receptors of a mucous membrane after a course of local desensitization.

Assessment of efficiency of treatment

Efficiency of treatment is estimated on dynamics of clinical manifestations.

Complications and side effects of treatment

Complications of glucocorticoids for topical administration — see "allergic rhinitis". Long reception of high doses of ASK causes by-effects from a gastrointestinal step in many patients. At daily reception of 500 mg of aspirin such phenomena developed at 20%, and at reception of 1300 mg — at 46% of patients.

Mistakes and unreasonable appointments

Unfairly long therapy by glucocorticoids for topical administration and ASK can
to lead to development of the complications described above (see. "Complications and side effects of treatment").

Forecast

Not allergic eosinophilic rhinitis often is complicated by development of a polypostural rinosinusit and bronchial asthma as enough effective methods of treatment of this disease do not exist.

 
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