Systematical Diagnosis And Treatment On Allergic Rhinitis

Allergic rhinitis (AR) represents a global health problem. It is an extremely common disease worldwide affecting 10 to 25 % of the population. Although allergic rhinitis is not usually a severe disease, it significantly alters the social life of patients and affects school learning performance as well as work productivity. Moreover, the costs incurred by rhinitis are substantial. In addition, allergic rhinitis is associated with asthma, sinusitis, nasal polyposis, otitis media and conjunctivitis. Allergic rhinitis has been identified as one of the top ten reasons for visits to primary care clinics. In our researches, we investigated the epidemic features of allergic rhinitis in western area of China (Chongqing, Chengdu in Sichuan province, Urumchi in Xinjiang province, Nanning in Guangxi province). we observed clinical therapeutic effect and explored the immune mechanism of antiallergic action of high intensity focused ultrasound (HIFU)in allergic rhinitis.In addition, we investigated the effect of culture filtrate protein (CFP) of Mycobacterium tuberculosis on immune function in patients with allergic rhinitis. PARTâ… SURVEY ON EPIDEMIOLOGICAL FEATURES OF ALLERGIC RHINITIS IN WESTERN AREA OF CHINAObjective: To investigate the epidemic features of allergic rhinitis in western area of China (Chongqing, Chengdu in Sichuan province, Urumchi in Xinjiang province, Nanning in Guangxi province).Methods: A questionnaire survey on AR was carried out among students from primary school, middle school and colleges and their parents, by random multistage and cluster sampling, from September to December 2005. Diagnosis criteria of AR were that of ARIA (Allergic rhinitis and its impact on asthma).Results: Totally 26197 questionnaires were completed. The prevalence rate of AR in western areas of China was 34.31%, 32.30%, 34.33%, 37.90%, 30.32% respectively in Chongqing, Chengdu, Urumchi and Nanning. The difference of prevalence rate between male (36.35%) and female (35.68%) was statistically insignificant. According to the classification criteria of ARIA in 2001, 30.47% suffered from intermittent AR; 69.53% suffered from persistent AR; 8.77% were mild cases and 91.23% were moderate-severe cases. According to the classification criteria of Haikou in 1997, 14.43% suffered from seasonal AR. More morbility was in September, March and August. Main motivations were common cold, weather change, dirt and pungent gas. Conclusion: The prevalence rate of AR in western areas of China is high. Most of AR is moderate-severe persistent AR and perennial AR.PARTâ…¡SURVEY ON THE EPIDEMIOLOGICAL FEATURES OF ALLERGIC RHINITIS AT OUT-PATIENT IN WESTERN AREA OF CHINAObjective: To investigate the epidemic features of allergic rhinitis at out-patient in western area of China (Chongqing, Chengdu in Sichuan province, Urumchi in Xinjiang province, Nanning in Guangxi province).Methods: A questionnaire survey on AR,specialist examinations,skin prick tests and pulmonary function were carried out among 2267 AR at out-patient , from Mar. 2005 to Dec. 2006.Results: The incidence rate of sneezing,runny nose,stuffy nose,itchy nose were 88%,89.19%,85.58%,83.58% respectively. 43.80% of AR patients had inherent predisposition that 25.50% had hereditary AR and 13.45% had hereditary asthma. 46.98% of AR patients had other allergic diseases, among 10.50% combined asthma. According to the classification criteria of Haikou in 1997 and ARIA in 2001, Urumchi area mainly was seasonal AR and mild intermittent AR, while other areas mainly were perennial AR and moderate-severe persistent AR. There was a significant impairment in Quality of life that 50% always were upset and 40% had not good sleep and 10% had emotional impairment. In Chongqing, the percent of patients with positive skin tests in inhalation allergens were follow:dust (91.33%),acaridan (83.88%),prevernal pollen (68.97%),late spring pollen (66.67%),estivoautumnal pollen (61.25%),tobacco (58.94%),cockroach (55.28%)。Allergens in food were mainly prawn (62.47%) and crab (60.43%). The pulmonary functions of 83 cases with allergic rhinitis excluding asthma were detected. Compared with control group, allergic rhinitis patients had abnormal pulmonary function that VC,FEV₁%,V₅₀,V₇₅,MMEF reduced while Zrs,R5,R20,X5 increased. There were significant differences(p<0.05).Conclusion: We had initial understood status quo of AR at out-patient in western of China, Strategy of prevention and treatment of AR should be worked out according to the epidemic feature of AR.PARTâ…¢QUALITY OF LIFE SURVEY AND PERSONALITY CHARACTERISTICS ANALYSIS ON PATIENTS WITH ALLERGIC RHINITISObjective:To explore the quality of life (QOL) status and the personality characteristics of patients with allergic rhinitis.Method:One hundred and fifty-five patients with allergic rhinitis were enrolled by random,their QOL scores were assessed by using Chinese version of the SF-36,their psychological scores were assessed by filling out EPQ, SAS, SDS. The demographic characteristics of allergic rhinitis group and health group were compared.Results:Compared with health group,there was a significant impairment in all QOL dimensions in patients with allergic rhinitis(p<0.05).Especially in general health,role-physical and role-emotional dimensions. SAS scores of allergic rhinitis patients had significant increase compared with norm(p<0.001) while EPQ and SDS scores of allergic rhinitis patients had not significant difference(p>0.05).Conclusion: Allergic rhinitis patients experience significant impairment in QOL and they have evident anxiety. Allergic rhinitis is not necessary association with its personal characteristic. PARTâ…£CLINICAL APPLICATION STUDY AND THE REGULATION ON IMMUNE FUNCTION WITH ALLERGIC RHINITIS PATIENTS AFTER HIGH INTENSITY FOCUSED ULTRASOUNDObjective:To observe clinical therapeutic effect and to explore the immune mechanism of antiallergic action of high intensity focused ultrasound in allergic rhinitis.Methods:Thirty-eight patients with allergic rhinitis were treated by the CZB ultrasound therapeutic system. It was used to scan inferior turbinate and the anterosuperior part of nasal septum under nasal endoscopy.The therapeutic effect after HIFU therapy that was evaluated by clinical symptoms controlled counting-scores was evaluated after 1 week and 4 weeks. IL-4,IL-5,IL-10,and IFN-γlevels in culture supernatant of peripheral blood mononuclear cells (PBMCs) were determined by ELISA.Results:The effective power with HIFU treatment was 78.95%,89.48% after 1 week and 4 weeks follow up. Supernatant IL-4,IL-5,IL-10 levels were all significantly increased,while IFN-γlevel was significantly decreased in these patients with allergic rhinitis(p<0.05).After treatment of HIFU,the levels of IL-4 produced by the post-surgery PBMCs were higher than those produced by PBMCs collected before the surgery,but the difference was not statistically significant(p>0.05).There was no significant difference in IL-5,IL-10 levels between pre-surgery and post-surgery, while IFN-γlevel was significantly increased after HIFU treatment(p<0.05).Conclusion:HIFU is a safe and effective device on allergic rhinitis ,it may modulate T-cell immune responses, and tilts the Th₁/ Th₂ balance towards the Th₁-dominant state in peripheral blood,by which HIFU may inhibit allergic airway inflammation and control allergic rhinitis. PARTâ…¤EFFECTS OF CULTURE FILTRATE PROTEIN OF MYCOBACTERIUM TUBERCULOSIS ON TH1/TH2 CYTOKINE IMBALANCE OF ALLERGIC RHINITIS PATIENTSObjective: To investigate the effects of culture filtrate protein of Mycobacterium tuberculosis on the Th cytokine production and its mRNA expression on PBMCs from patients with allergic rhinitis and study its mechanism.Methods: Five ml peripheral venous bloods were obtained from the enrolled thirty patients with allergic rhinitis , and peripheral blood mononuclear cells (PBMCs) were isolated. The optimal CFP concentration that stimulated lympholeukocyte proliferation was measured by MTT method. IL-4,IL-5 , IFN-γlevels in culture supernatant of PBMCs and IL-4 and IFN-γmRNA expression levels were respectively determined by ELISA and RT-PCR before and after CFP treatment.Results: Before CFP treatment, supernatant IL-4,IL-5 levels and IL-4 mRNA expression were all significantly increased,while IFN-γlevel and its mRNA expression were significantly decreased in these allergic rhinitis as compared with normal control(p<0.05). After treatment,supernatant IL-4,IL-5 levels were significantly reduced, while IFN-γlevel was significantly increased. IL-4 mRNA expression was lower than that in before treatment, but still higher than that in the normal control(p<0.05). While IFN-γmRNA expression was higher than that in before treatment and near to normal(p<0.05).Conclusion: CFP could adjust the levels of Th cytokines on the stage of transcription or translation, so it can inhibit Th₂ cell activation and correct the imbalance state of the Th₁ and Th₂ cytokines. It proves that immunomodulator CFP could be useful in the treatment of allergic rhinitis.