变应性鼻炎研究新进展

梁美君; 徐睿; 许庚

doi:10.13201/j.issn.1001-1781.2015.03.003

变应性鼻炎研究新进展

- 中山大学附属第一医院耳鼻咽喉科(广州, 510080)

详细信息

通讯作者: 许庚,E-mail:entxgfess@163.com

中图分类号: R765.21

收稿日期: 2015-01-07

Recent advances in allergic rhinitis

More Information

Corresponding author: XU Geng, E-mail: entxgfess@163.com

Received Date: 07 January 2015

摘要

- 鼻炎 /
- 变应性 /
- 发病机制 /
- 流行病学
Abstract: Allergic rhinitis(AR)clinically expressed by sneezing,rhinorrhea,nasal itching and congestion is an allergen-driven mucosal inflammatory disease which is modulated by immunoglobulin E.Epidemiological studies have indicated that prevalence of AR continues to increase,and it has been a worldwide health problem that places a significant healthcare burden on individuals and society.Given the evolving understanding of the process by which an allergen is recognized and the roles of mediators which account for AR progress,the pathogenesis of AR has become clearer.Current studies have demonstrated local allergic rhinitis(LAR)that patients with both suggestive symptoms of AR and a negative diagnostic test for atopy may have local allergic inflammation is a prevalent entity in patients evaluated with rhinitis,but further research remains needed.Management of AR includes allergen avoidance,pharmacological treatment and allergen-specific immunotherapy.Recently montelukast has exhibited previously undocumented anti-inflammatory properties,leukotriene receptor antagonists therefore may serve a more important role in the treatment of AR.Not only has immunotherapy proved its efficacy,but also been able to alter disease course and thereby mitigate progression to asthma.Thus immunotherapy can be initiated while receiving pharmacotherapy,especially in children with AR.As clinical guidelines,the ARIA(Allergic Rhinitis and its Impact on Asthma)provides basic principles of effective treatment of AR.Besides,choosing an appropriate treatment strategy should be based on the severity and chronicity of patient's symptom.The aim of this review was to provide an update mainly on the pathophysiology,epidemiology,and management of AR.
- rhinitis /
- allergic /
- pathogenesis /
- epidemiology

HTML全文

参考文献(40)

[1]	GALLI S J, TSAI M, PILIPONSKY A M. The development of allergic inflammation[J]. Nature, 2008, 454:445-454.
[2]	MONTICELLI L A, SONNENBERG G F, ABT M C, et al. Innate lymphoid cells promote lung-tissue homeostasis after infection with influenza virus[J]. Nat Immunol, 2011, 12:1045-1054.
[3]	HALIM T Y, KRAUSS R H, SUN A C, et al. Lung natural helper cells are a critical source of Th2 cell-type cytokines in protease allergen-induced airway inflammation[J]. Immunity, 2012, 36:451-463.
[4]	HALIM T Y, STEER C A, MATHÄ L, et al. Group 2 innate lymphoid cells are critical for the initiation of adaptive T helper 2 cell-mediated allergic lung inflammation[J]. Immunity, 2014, 40:425-435.
[5]	BARRETT N A, MAEKAWA A, RAHMAN O M, et al. Dectin-2 recognition of house dust mite triggers cysteinyl leukotriene generation by dendritic cells[J]. J Immunol, 2009, 182:1119-1128.
[6]	BARRETT N A, BOYCE J A. Activation of group 2 innate lymphoid cells:a new role for cysteinyl leukotrienes[J]. J Allergy Clin Immunol, 2013, 132:214-216.
[7]	PETERS-GOLDEN M, HENDERSON W R Jr.. Leukotrienes[J]. N Engl J Med, 2007,357:1841-1854.
[8]	ZIEGLER S F, ARTIS D. Sensing the outside world:TSLP regulates barrier immunity[J].Nat Immunol, 2010, 11:289-293.
[9]	HARADA M, HIROTA T, JODO A I, et al. Thymic stromal lymphopoietin gene promoter polymorphisms are associated with susceptibility to bronchial asthma[J]. Am J Respir Cell Mol Biol, 2011, 44:787-793.
[10]	SOUMELIS V, RECHE P A, KANZLER H, et al. Human epithelial cells trigger dendritic cell-mediated allergic inflammation by producing TSLP[J]. Nat Immunol, 2002, 3:673-680.
[11]	ZIEGLER S F. Thymic stromal lymphopoietin and allergic disease[J]. J Allergy Clin Immunol, 2012, 130:845-852.
[12]	SIRACUSA M C, SAENZ S A, WOJNO E D, et al. Thymic stromal lymphopoietin-mediated extramedullary hematopoiesis promotes allergic inflammation[J]. Immunity, 2013, 39:1158-1170.
[13]	KABATA H, MORO K, FUKUNAGA K, et al. Thymic stromal lymphopoietin induces corticosteroid resistance in natural helper cells during airway inflammation[J]. Nat Commun, 2013, 4:2675-2675.
[14]	GAUVREAU G M, O'BYRNE P M, BOULET L P, et al. Effects of an Anti-TSLP Antibody on Allergen-Induced Asthmatic Responses[J]. N Engl J Med,2014,370:2102-2110.
[15]	BOUSQUET J, KHALTAEV N, CRUZ A A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update(in collaboration with the World Health Organization, GA (2) LEN and AllerGen)[J]. Allergy, 2008, 62(Suppl 86):8-160.
[16]	韩德民, 张罗, 黄丹,等. 我国11个城市变应性鼻炎自报患病率调查[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(5):378-384.
[17]	ASHER M I, MONTEFORT S, BJÖRKSTÉN B,et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood:ISAAC Phases One and Three repeat multicountry cross-sectional surveys[J]. Lancet, 2006, 368:733-743.
[18]	KONG W J, CHEN J J, ZHENG Z Y, et al. Prevalence of allergic rhinitis in 3-6-year-old children in Wuhan of China[J]. Clin Exp Allergy, 2009, 39:869-874.
[19]	ZHANG Y M, ZHANG J, LIU S L, et al. Prevalence and associated risk factors of allergic rhinitis in preschool children in Beijing[J]. Laryngoscope, 2013, 123:28-35.
[20]	ERIKSSON J, EKERLJUNG L, LÖTVALL J,et al. Growing up on a farm leads to lifelong protection against allergic rhinitis[J]. Allergy, 2010, 65:1397-1403.
[21]	SHAABAN R, ZUREIK M, SOUSSAN D,et al. Rhinitis and onset of asthma:a longitudinal population-based study[J]. Lancet, 2008, 372:1049-1057.
[22]	GUERRA S, SHERRILL D L, MARTINEZ F D,et al. Rhinitis as an independent risk factor for adult-onset asthma[J]. J Allergy Clin Immunol, 2002, 109:419-425.
[23]	HUGGINS K G, BROSTOFF J. Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests[J]. Lancet, 1975, 306:148-150.
[24]	RONDÓN C, ROMERO J J, LÓPEZ S, et al. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis[J]. J Allergy Clin Immunol, 2007, 119:899-905.
[25]	RONDÓN C, DOÑA I, LÓPEZ S,et al. Seasonal idiopathic rhinitis with local inflammatory response and specific IgE in absence of systemic response[J]. Allergy, 2008, 63:1352-1358.
[26]	MØLGAARD E, THOMSEN S F, LUND T, et al. Differences between allergic and nonallergic rhinitis in a large sample of adolescents and adults[J]. Allergy, 2007, 62:1033-1037.
[27]	RONDÓN C, CAMPO P, GALINDO L, et al. Prevalence and clinical relevance of local allergic rhinitis[J]. Allergy, 2012, 67:1282-1288.
[28]	RONDÓN C, FERNÁNDEZ J, LÓPEZ S, et al. Nasal inflammatory mediators and specific IgE production after nasal challenge with grass pollen in local allergic rhinitis[J]. J Allergy Clin Immunol, 2009, 124:1005-1011.
[29]	BROZEK J L, BOUSQUET J, BAENA-CAGNANI C E, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines:2010 revision[J]. J Allergy Clin Immunol, 2010, 126:466-476.
[30]	TINTINGER G R, FELDMAN C, THERON A J, et al. Montelukast:more than a cysteinyl leukotriene receptor antagonist[J]. Scientific World Journal, 2010,10:2403-2413.
[31]	ANDERSON R, THERON A J, GRAVETT C M, et al. Montelukast inhibits neutrophil pro-inflammatory activity by a cyclic AMP-dependent mechanism[J]. Br J Pharmacol, 2009, 156:105-115.
[32]	SCAIFE A, MILLER D, SPITERI-CORNISH D, et al. Inhibitory effects of Montelukast on mediator release by nasal epithelial cells from asthmatic subjects with or without allergic rhinitis[J]. Respir Med, 2013,107:1859-1865.
[33]	SANTOS C B,HANKS C, MCCANN J, et al. The role of montelukast on perennial allergic rhinitis and associated sleep disturbances and daytime somnolence[J]. Allergy Asthma Proc, 2008, 29:140-145.
[34]	GOH B S, ISMAIL M I, HUSAIN S. Quality of life assessment in patients with moderate to severe allergic rhinitis treated with montelukast and/or intranasal steroids:a randomised, double-blind, placebo-controlled study[J]. J Laryngol Otol, 2014,128:242-248.
[35]	中华耳鼻咽喉头颈外科杂志编委会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 变应性鼻炎诊断和治疗指南(2009年,武夷山)[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(12):977-978.
[36]	NOVEMBRE E, GALLI E, LANDI F, et al. Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis[J]. J Allergy Clin Immunol, 2004, 114:851-857.
[37]	FIOCCHI A, FOX A T. Preventing progression of allergic rhinitis:the role of specific immunotherapy[J]. Arch Dis Child Educ Pract Ed, 2011, 96:91-100.
[38]	HANKIN C S, COX L, BRONSTONE A, et al. Allergy immunotherapy:Reduced health care costs in adults and children with allergic rhinitis[J]. J Allergy Clin Immunol, 2013, 131:1084-1091.
[39]	KOPP M V. Role of immunmodulators in allergen-specific immunotherapy[J]. Allergy, 2011, 66:792-797.
[40]	COX L, NELSON H, LOCKEY R, et al. Allergen immunotherapy:a practice parameter third update[J]. J Allergy Clin Immunol, 2011, 127:S1-S55.