Pediatric allergic rhinitis and comorbid disorders
Pediatric allergic rhinitis and comorbid disorders
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DOI：
10.1067/mai.2001.115562
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发表时间：
2001-07-01
影响因子：
14.2
通讯作者：
Lack, G
中科院分区：
文献类型：
--
作者：
Lack, G
变应性鼻炎(AR)很少单独发现，需要在与多种共病相关的全身性变态反应性疾病的背景下考虑，包括哮喘、慢性中耳积液、鼻窦炎、淋巴组织肥大伴阻塞性睡眠呼吸暂停、睡眠障碍以及由此产生的行为和教育影响。变应性鼻炎和哮喘的共存是复杂的。首先，哮喘的诊断可能与鼻炎引起的咳嗽和鼻后滴水的症状相混淆。这可能会导致对哮喘的错误诊断或对哮喘严重程度的不当评估，从而导致患者过度治疗。因此，术语“咳嗽变异型鼻炎”被用来描述主要表现为鼻腔后滴液引起的咳嗽的鼻炎。然而，AR在哮喘中也有因果作用；它似乎既是加剧哮喘的罪魁祸首，又在其发病机制中发挥作用。鼻后滴漏伴发鼻咽炎会导致许多其他情况。因此，鼻窦炎是鼻炎的一种常见延伸，也是儿童最常被遗漏的诊断之一。暴露在鼻咽部的过敏原，伴随组胺和其他介质的释放，可导致咽鼓管阻塞，可能导致中车积液。慢性过敏性上呼吸道炎症导致淋巴组织肥大，伴有腺样体和扁桃体组织的突出。这可能与食欲不佳、生长不良和阻塞性睡眠呼吸暂停有关。因此，AR是一系列过敏性疾病的一部分，这些过敏性疾病会严重影响儿童的福祉和生活质量。需要进行前瞻性队列研究，以评估儿童时期AR造成的疾病负担，并进一步评估可能导致的潜在教育损害。由于AR是系统性疾病过程的一部分，其管理需要协调一致的方法，而不是零散的、基于器官的方法。
Allergic rhinitis (AR) is rarely found in isolation and needs to be considered in the context of systemic allergic disease associated with numerous comorbid disorders, including asthma, chronic middle ear effusions, sinusitis, lymphoid hypertrophy with obstructive sleep apnea, disordered sleep, and consequent behavioral and educational effects. The coexistence of AR and asthma is complex. First, the diagnosis of asthma may be confounded by symptoms of cough caused by rhinitis and postnasal drip. This may lead to either inaccurate diagnosis of asthma or inappropriate assessment of asthma severity with over treatment of the patient. The term "cough variant rhinitis" is therefore proposed to describe rhinitis that manifests itself primarily as cough that results from postnasal drip. AR, however, also has a causal role in asthma; it appears both to be responsible for exacerbating asthma and to have a role in its pathogenesis. Postnasal drip with nasopharyngeal inflammation leads to a number of other conditions. Thus sinusitis is a frequent extension of rhinitis and is one of the most frequently missed diagnoses In children. Allergen exposure in the nasopharynx with release of histamine and other mediators can cause Eustachian tube obstruction possibly leading to middle car effusions. Chronic allergic inflammation of the upper airway causes lymphoid hypertrophy with prominence of adenoidal and tonsillar tissue. This may be associated with poor appetite, poor growth, and obstructive sleep apnea. AR is therefore part of a spectrum of allergic disorders that can profoundly affect the well being and quality of life of a child. Prospective cohort studies are required to assess the disease burden caused by AR in childhood and to further assess the potential educational impairment that may result. Because AR is part of a systemic disease process, its management requires a coordinated approach rather than a fragmented, organ-based approach.