Pollen allergy should be treated every year, and how to treat it has become the voice of many patients with pollen allergy!
The following is the most complete collection of pollen allergy treatment.
Part I: Etiological treatment
Special therapy
The special treatment of pollinosis is the etiological treatment of allergic pollen. Because of its strong pertinence, definite clinical effect and few side effects, it is usually the main method for allergy doctors to treat hay fever.
First, avoid contact with pollen.
Because preventive measures have the nature of etiological treatment, they should be the most effective way to prevent hay fever, and avoiding contact with pollen can usually prevent asthma attacks. But it is precisely this that many allergic patients can't do.
When patients with bronchial asthma are diagnosed as allergic to pollen, they should first try to find out what kind of pollen they are allergic to, so as to avoid or reduce contact with this pollen at the corresponding time according to the drifting situation of this pollen in the local atmosphere. The methods to avoid it include long-term migration or temporary migration to areas with no or few allergic pollen during the pollen drift season, or living in a room with a filter during the pollen drift season. Usually, the filter is used in conjunction with the air conditioner to filter out pollen particles entering the room. Feinberg et al. confirmed that when the pollen content in outdoor air is 500 grains, the average number of pollen in a well-ventilated room without filter is 165 grains, while that in a room with air filter is 0- 10 grains, so patients can safely spend the pollen season in a room with air filter.
However, it is difficult to avoid pollen by the above methods. It is suggested that patients with allergic rhinitis, asthma, cough, conjunctivitis, pharyngitis and skin allergy caused by pollen transmission season should cooperate with IgE antiallergic therapy (Kangminyuan) and drug antiallergic preventive measures to achieve ideal results.
Second, desensitization therapy.
Also known as specific immunotherapy or desensitization therapy, it is the only method to treat allergic pollen among many treatment measures at present. Its purpose is to improve the tolerance of the body to the corresponding sensitized pollen. From the current research situation, IgE antiallergic therapy (Kangminyuan) can effectively prevent or alleviate the symptoms of hay fever, and the total effective rate can reach 80-90% or even more than 90%. At present, there are three kinds of desensitization therapies commonly used in clinic.
Pre-season desensitization therapy
This is the most commonly used desensitization treatment for hay fever. IgE desensitization therapy (Kangminyuan) is usually started three months before the pollen season, and 2-3 billion Kangminyuan active anti-allergic probiotics are supplemented every day. When it reaches 60 billion live bacteria, the organism can produce enough anti-allergic active strains and reproduce themselves when the pollen season comes, so as to achieve long-term anti-allergic effect. Compared with perennial immunotherapy, the advantage of pre-season desensitization therapy is that it can greatly shorten the course of treatment.
Product name: Kangminyuan Probiotics Granules
Efficacy: It is helpful to reduce the production of specific IgE antibody in serum, quickly relieve allergic symptoms, promote the secretion of spleen cytokine IFN-γ, adjust the balance of immune cell activity, adjust the immune system, improve the immunity of the body, adjust allergic constitution, help maintain the function of digestive tract and reduce the influence of carcinogens on cells.
Anti-allergic patent number: 200710128018.x.
Anti-allergic mechanism:
First, reduce the production of serum IgE antibody.
IgE synthesis is related to individual susceptibility to allergic diseases. 1966, Swedish scholar Johansson and Japanese scholar Ishisaka and his wife first isolated IgE from the serum of ragweed allergic patients, and proved that IgE was the medium of allergic reaction. IgE is a kind of cytophilic antibody, and the serum content of normal people is extremely low, which is 10 ~ 10000 U/ml, while the serum IgE content of allergic patients is significantly higher than that of normal people. Kangminyuan probiotics contain up to 20 billion active strains per box, which can quickly reduce excessive IgE antibodies in human serum and relieve allergic symptoms.
Second, promote spleen cells to secrete interferon IFN-γ.
According to the types of cytokines secreted, helper cells are divided into two subgroups: TH 1 and TH2. TH 1 and TH2 are regulated by cytokines, IL-4 promotes IgE synthesis, and IFN-γ inhibits IL-4-induced IgE synthesis. People with allergic constitution may have more allergen-specific T cells that produce IL-4 and can secrete more IL-4. The balance between TH 1 and TH2 or the ratio of IL-4 to IFN-γ is an important determinant of IgE synthesis. Kangminyuan Probiotics Granule can promote spleen cells to secrete interferon IFN-γ, which is beneficial to regulate allergic constitution.
Storage method: keep it sealed, put it in a cool and dry place or refrigerate.
Adaptive population: people suffering from allergic diseases or allergies, including infants, teenagers, pregnant women, lactating women and adults. Advantages: At present, the desensitization prevention and treatment method for seasonal allergy has been favored by patients who take oral immunomodulators (Kangminyuan anti-allergic probiotic strain), because it is convenient and safe, which is the first choice for allergic patients.
Disadvantages: Many patients with seasonal allergies have no consensus on prevention and treatment in advance. People are always allergic before treatment, so education has a long way to go.
(2) routine immunotherapy
Conventional immunotherapy is a perennial desensitization therapy. Injecting pollen extract with increasing concentration twice a week can reach the maximum tolerance to the corresponding sensitized pollen within 3-4 months. At this time, the body can produce enough specific IgG blocking antibodies, so that the clinical symptoms of pollinosis patients can be alleviated or disappeared. Then, before the next pollen season comes, maintenance injection therapy is adopted once a week 1-2 times or even twice a week/kloc-0 times to shorten the interval of desensitization injection. Conventional immunotherapy usually requires continuous treatment for 3-5 years or longer to consolidate the curative effect. Compared with pre-season desensitization therapy, conventional immunotherapy has a long course of treatment and high cost, but the curative effect is more reliable and lasting, especially for patients with pollen allergy in multiple seasons, such as spring pollen allergy, summer pollen allergy and so on.
Advantages: strong pertinence.
Disadvantages: the adaptation range is narrow, and the course of treatment lasts for several years, so it is difficult for someone to insist on it at high cost.
Anti-allergic drugs:
Mast cell membrane stabilizer
Mast cell membrane stabilizer is the main drug used to prevent and treat pollinosis. These drugs mainly refer to cromoglycine and similar drugs, including cromoglycine disodium, cromoglycine sodium, tranilast and other mast cell membrane stabilizers, as well as drugs discovered in recent years that can not be classified so far, such as nedoromide sodium and azelastine. Continuous use of these drugs before and during the onset season can effectively prevent the onset of asthma.
(1) sodium cromoglycate; It is the most commonly used mast cell membrane stabilizer in clinic, and early inhalation before changing seasons can effectively prevent hay fever. There are two dosage forms: powder aerosol and aerosol. Powder aerosol is inhaled with the help of capsules and rotary inhalers, 20 mg per capsule, 4 times a day. This method is rarely used at present. At present, suspension aerosol is commonly used in clinic. There are two kinds of suspension aerosol, 3.5mg and 5mg each, and the usual dosage is 4-6 times a day. Inhalation usually begins 3 weeks before the start of the season.
(2)qun ist； It is an effective oral protective agent for mast cells. The routine oral dose is 0. 1g, three times a day. It is usually taken 2 weeks before onset.
(3) sodium nedoromide; It is a drug found in recent years to prevent and treat bronchial asthma. At first, it was mistaken for a drug similar to cromoglycate. Now it has been proved that it is completely different from cromoglycate and has been put into clinical use abroad. The commonly used inhalation dose is 4mg, 3-4 times a day.
(4) azelastine; It is a promising new drug for the prevention and treatment of pollinosis, which not only has the function of stabilizing inflammatory cell membranes such as mast cell membranes, but also has the function of antagonizing various inflammatory mediators. Usually the oral dose is 4-8 mg, twice a day.
Antihistamines
Although the first generation antihistamines, such as chlorpheniramine, have a good effect in the prevention and treatment of hay fever, they are gradually abandoned by clinicians because of their strong side effects such as drowsiness. In recent years, it has been found that some second-generation antihistamines, such as terfenadine and histamine, have certain cardiac toxic and side effects, and their usage has begun to decrease, which has been banned in some countries. At present, many third-generation antihistamines have come out, which have neither drowsiness nor heart side effects. These drugs have achieved good results in treating hay fever.
(a) Fexofenadine (fexofenadine)
Clinical studies have shown that fexofenadine has a strong anti-allergic effect. Clinical studies have confirmed that fexofenadine can obviously improve the clinical symptoms of allergic rhinitis, reduce the dosage of bronchial antispasmodic, and improve the pulmonary ventilation function and airway responsiveness in allergic patients such as hay fever for 4 weeks. Taking the improvement of quality of life as the evaluation index, 60 mg/day 1 time was given to 948 patients with seasonal allergic rhinitis, and the results were as follows. At present, fexofenadine has become the main drug for allergic rhinitis, allergic dermatosis, hay fever and other allergic diseases in Europe and America. In addition, in recent years, it has been found that the second generation antihistamines, such as terfenadine, are incompatible with each other and have certain cardiac toxicity, while fexofenadine has not found cardiac toxicity so far. The clinical recommended oral dosage for allergic rhinitis is 120mg once a day or 60mg twice a day. In order to prevent asthma attacks at night or in the morning, you can take 120- 180mg/ time before going to bed.
(2) Levocetirizine
Levocetirizine is a substitute product of the second generation antihistamine cetirizine, which was launched in February of 200 1 year. It is the third generation antihistamine, which is mainly used for allergic rhinoconjunctivitis, hay fever and allergic dermatosis. It has the advantages of quick effect, strong and lasting effect and few side effects. Levocetirizine has a high binding rate with plasma protein after oral absorption, and the effect is obvious after oral administration of levocetirizine 1 hour, which lasts for 24.4 hours respectively, and the drug effect reaches the peak within 6 hours after taking the drug. The commonly used clinical dose for adults is 5mg once a day.
(3) Desloratadine (Desloratadine)
Desloratadine is the main active metabolite of the second generation antihistamine loratadine. Its pharmacological action is similar to loratadine, but it has stronger effect and fewer side effects. Compared with the second generation antihistamines such as loratadine, desloratadine is a safe and effective antihistamine with no toxic effect on the heart. At present, desloratadine has completed phase III clinical research in the United States, and Schering-Plough has submitted a new drug application to the FDA, but it has not been approved for marketing. However, it has been approved for marketing by EU EMEA 200 1 1 and also approved for marketing in China, and can be used to treat various allergic diseases, including allergic rhinitis, hay fever and allergic dermatosis. Compared with the first and second generation antihistamines, it has the advantages of strong action, fast action, long action time and low toxic and side effects. /kloc-Adults and children over 0/2 years old take 5mg a day, although the dose is only 50% of the dose of loratadine, and the antihistamine effect is stronger.
(4) Loratadine
It is a long-acting second-generation antihistamine with no central nervous system inhibition. Baiweitan takes effect quickly and the effect can last for 24 hours. Once a day, each time 10-20mg can effectively control the symptoms of pollen allergy. In recent years, loratadine has been found to have serious cardiac side effects and has been gradually abandoned in clinic.
(3) Cetirizine
It also belongs to the second generation of antihistamines. After oral administration, the action of 1 hour reaches its peak and lasts for 24 hours. The drug can not only antagonize histamine, but also inhibit the infiltration of eosinophils in inflammatory areas. Clinical studies have confirmed that cetirizine can effectively control and improve the symptoms of hay fever, and the commonly used oral dose is 1 time/time 10-20mg each time. It has a slight inhibitory effect on the central nervous system. In recent years, cetirizine has been found to have certain cardiac side effects, and its clinical use is gradually decreasing.
Third, glucocorticoid.
Including inhalation administration and systemic administration, inhalation administration is the main way at present. Glucocorticoid preparations for inhalation include aerosols such as fluticasone, budesonide and beclomethasone dipropionate, which should be inhaled one week before pollen season and stopped about one week before onset season. Inhaled glucocorticoid inhalation therapy is more reliable, and the side effects are greatly reduced compared with systemic medication. Patients who are ineffective in taking oral antihistamines and inhaling cromoglycate sodium may consider inhaling glucocorticoid. Patients with moderate or above hay fever should be treated mainly with inhaled corticosteroids.
For patients with hay fever complicated with asthma, seretide powder or propafenone powder can be used in combination, but it is not suitable for long-term use. For patients whose onset time is less than 3 weeks and the onset time is relatively fixed, triamcinolone acetonide and other sustained-release and long-acting glucocorticoid preparations can also be considered. Once injected, the drug effect can be maintained for 3-4 weeks, and once a year, patients can safely survive the onset season, but the side effects are great, so attention should be paid to its indications and the consent of patients should be obtained. Patients with glucocorticoid contraindications should not use it.
Fourth, symptomatic treatment.
Patients with ocular allergic symptoms can use emetine eye drops (emetine eye drops), cromoglycate eye drops or cortisone eye drops for local use. For patients with hay fever and asthma attack, because the degree of asthma attack is usually lighter than that of general asthma, such as atomizing salbutamol or terbutaline with positive oxygen when asthma symptoms appear, or inhaling β2- agonists such as salbutamol aerosol and formoterol powder aerosol, the symptoms can be quickly controlled, but it is not suitable for frequent use. Seretide powder can also be inhaled, which can control both symptoms and airway allergic inflammation, but it takes 40 minutes to take effect and should not be used frequently. When the condition is serious, you can inhale or orally take β2- receptor agonists or oral theophylline drugs while inhaling or systemically using glucocorticoid. Eliminating phlegm can be combined with expectorants, and oxygen can be absorbed when hypoxia is severe.