The Therapeutic Efficacy Of Subcutaneous Specific Immune Therapy And The Effect Of Vadian Neurectomy In The Management Of Allergic Rhinitis

Objective:To assessed the therapeutic efficacy and related problems of subcutaneous Specific immune therapy in the management of allergic rhinitis.Method:Slected 32 patients with severe persistent allergic rhinitis and received subcutaneous Specific immune therapy in the experimental group, and 20 patients with severe persistent allergic rhinitis just received oriented-symptom therapy in the control group. The clinical efficacy was evaluated by "Visual analogue scale(VAS) ", "Rhinoconjunctivitis quality of life questionnaire (RQLQ) "and medication scores before and after therapy to all the patients.Result:People in the experimental group were significantly better than the control group due to the alleviation of symptoms tested by VAS scores, and medication scores at least 1-year after treatment. The total effective rate tested by RQLQ sores was 91%, control group 40%. Adverse events in 5 cases(15%) in the experimental group.Conclution:Subcutaneous specific immune therapy is effective in the management of severe persistent allergic rhinitis.The education to patients shoud be enhanced to make they known more about both the allergic rhinitis and Specific immune therapy,and have a better adherence to doctors and receive total and standard therapy at the same time. Objective:To investigate the effect and the possible mechanism of vadian neurectomy in the management of allergic rhinitis.Method:Experimental group including 24 patients with severe persistent allergic rhinitis were carried out endoscopic vadian neuroctomy. The operational efficacy was evaluated before and after operation by "Visual analogue scale(VAS)" and "Rhinoconjunctivitis quality of life questionnaire (RQLQ)". and 17 patients with fracture of nasal bone as the control group.The expression level of IFN-γ,IL-4, IL-5 and Foxp3 expressed specially on the surface of Tregs and the numbers of Eos cells in nasal mucosa of all the patients were detected by immunohisto chemistry before and 3 months after operation.Result:The therapeutic efficacy evaluated by VAS scores and RQLQ scores is significant, and complete response showed in all 20 cases 3 months after operation.The percentages of IFN-γand Foxp3 positive cells in nasal mucosa were respectively 1.97±0.2729(%),0.5429±0.1123 (%) before operation, and were respectively 4.09±0.3936(%),2.59±0.3519(%) after operation. There was statistically significant difference between pre-and post-operation (P<0.05). The percentages of IL-5 and IL-4 positive cells in nasal mucosa were respectively 10.53±1.42 (%),10.72±1.67 (%) before operation, and were respectively 5.51±0.8053(%),5.23±0.8792(%) after operation. There was statistically significant difference between pre and post operation (P<0.05). The numbers of Eos cells in nasal mucosa was 24.13±4.89/HP before operation, and 9.65±1.78/HP 3 months after operation. The difference was also statistically significant (P<0.05).Conclusion:(1) Endoscopic vadian neurectomy in the management of allergic rhinitis may restrain the intensive Th2 immune response while strengthen the Th1 immune response in nasal mucosa, and to keep its in a balance. (2) Endoscopic vadian neurectomy in the management of allergic rhinitis may increase the numbers of Treg cells, and to enhance the ability to recovering the unbanlanced immune response in local nasal mucosa.