CURRENT TRENDS IN THE MANAGEMENT OF ALLERGIC DISEASES
CURRENT TRENDS IN THE MANAGEMENT OF ALLERGIC DISEASES
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DOI：
10.1111/j.1398-9995.1994.tb04236.x
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发表时间：
1994-01-01
期刊：
影响因子：
12.4
通讯作者：
MICHEL, FB
中科院分区：
文献类型：
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作者：
BOUSQUET, J;DHIVERT, H;MICHEL, FB
过敏性疾病的治疗策略是基于过敏原避免，药物治疗和免疫治疗。应始终尝试避免过敏原，即使它很少完全，需要几天或几周才能有效。药物治疗旨在减轻由过敏原触发和炎症引起的症状。在季节性变态反应性疾病中，短疗程足以逆转非特异性高反应性和症状。然而，在慢性过敏性疾病中，炎症是重要的，症状并不总是容易控制。此外，根据哮喘和鼻炎管理指南的建议，治疗应该延长（1,2）。现在有了有效且耐受性良好的药物，有些药物可以联合治疗鼻炎或哮喘。在鼻炎中，一线治疗仍然是基于非镇静性抗组胺药和局部皮质类固醇。也可使用cromoglyate和其他药物。对于哮喘，抗炎治疗是一线治疗。对于轻度患者，可以使用cromoglyate， nedocromil或低剂量吸入类固醇。对于更严重的疾病，建议高剂量吸入皮质类固醇。支气管扩张剂被用作“抢救”药物，尽管许多症状严重的患者需要定期接受支气管扩张剂治疗。长效β - 2激动剂最近被引入，但它们在哮喘治疗中的确切地位尚未完全确定。免疫疗法于1911年首次推出，它是基于医生几十年的经验，而不是理性思考。标准化的过敏原提高了免疫治疗的疗效，但这种治疗的安全性有待提高。免疫疗法的新研究正在进行中，显示出希望。过敏性疾病的药物治疗和免疫治疗的一个主要问题是依从性差。
Treatment strategies for allergic diseases are based on allergen avoidance, pharmacotherapy and immunotherapy. Allergen avoidance should always be attempted, even if it is rarely complete and needs several days or weeks to be effective. Pharmacotherapy is aimed at reducing symptoms arising from allergen triggers and inflammation. In seasonal allergic diseases, a short treatment course is sufficient to reverse non-specific hyperreactivity and symptoms. In chronic allergic diseases, however, inflammation is of major importance and symptoms are not always readily controlled. Moreover, the treatment should be prolonged as proposed by Guidelines for the Management of Asthma and Rhinitis (1, 2). Effective and well-tolerated drugs are now available and some may be combined for rhinitis or asthma therapy. In rhinitis, first-line therapy is still based on non-sedating antihistamines and topical corticosteroids. Cromoglycate and other drugs may also be used. For asthma, anti-inflammatory therapy is the first-line treatment. In mild sufferers, cromoglycate, nedocromil or low-dose inhaled steroids can be used. For more severe disease, high doses of inhaled corticosteroids are proposed. Bronchodilators are used as 'rescue' medications, though many patients with severe symptoms need regular bronchodilator therapy. Long-acting beta2-agonists have been introduced recently, but their exact place in the management of asthma is not yet fully established. Immunotherapy was first introduced in 1911 and was based on decades of physicians' experience, rather than on rational thought. Standardized allergens have improved the efficacy of immunotherapy, but the safety of this treatment needs to be improved. New research on immunotherapy is underway which shows promise. A major problem for both pharmacotherapy and immunotherapy in allergic disease is poor compliance.