Therapeutic drugs are divided into 7 categories
The drugs used to treat allergic rhinitis are classified into the following 7 categories. In order to make everyone look less unfamiliar, I deliberately put the names of commonly used and well-known commodity drugs in brackets (this kind of labeling has no interest in any pharmaceutical company, hereby declare).
1. Glucocorticoids: mainly nasal sprays, including the first generation budesonide (Ranocotte), the second generation fluticasone propionate (Fuxuliang), fluticasone furoate (Wenshi), mometasone furoate (Nishuna). For patients with severe allergic rhinitis, short-term oral hormones may be needed, but for patients with not particularly severe allergic rhinitis, it is not recommended to use systemic hormones for a long time or repeatedly.
2. Antihistamine nasal sprays: including azelastine (acepin), levocabastine (livostin). Compared with hormone nasal sprays, antihistamine nasal sprays work quickly and can be used as needed.
3. Oral antihistamines: including the first-generation diphenhydramine and chlorpheniramine; the second-generation loratadine (carretan), cetirizine (zitermin), and ketotifen; The third generation of fexofenadine (atla), desloratadine (enlis), levocetirizine (youze). The third generation is a metabolite of the second generation, so they are often classified in the second generation clinically.
4. Sodium cromoglycate.
5. Leukotriene receptor antagonists, such as montelukast sodium (shunerning), are generally well tolerated, but due to reports of adverse effects of mental illness, it is not used as a first-line treatment for people with mental illness. That is to say, avoid using it as much as possible.
6. Decongestants, including decongestant nasal sprays, such as oxymetazoline (Dafenlin). After 3 to 7 days of continuous use of the drug, it may cause drug-induced rhinitis or symptom rebound after stopping the drug, so it is generally Short-term use (children no more than 3 days, adults no more than a week) to relieve symptoms; there is also a combination of decongestion and antihistamine preparations, such as Xinkangtaike, Lorata pseudoephedrine (Kubo Tong).
7. Desensitizer: It belongs to specific immunotherapy, which is to give a small amount of allergen extract sublingually or subcutaneously for a long period of time to make the patient gradually tolerate the allergen, thereby reducing the clinical symptoms. Its disadvantages are the high cost, the possibility of systemic and local adverse reactions, and the long treatment time (usually about 3 to 5 years). Therefore, it is mainly aimed at patients with severe or persistent allergic rhinitis who have not been effective with other treatment drugs, or patients who are clearly allergic to a certain allergen.
Follow the doctor's advice, safe and effective
For allergic rhinitis, it is recommended to prevent medication in advance. Especially for patients with seasonal allergic rhinitis, rhinitis is prone to manifestations in April and May in spring and August and September in autumn each year. The onset time is relatively fixed. You can use the drug 2 weeks in advance and continue to apply it until the end of the allergy season. To try to avoid the onset of allergic rhinitis.
At present, hormone nasal spray is the most effective first-line drug for the treatment of allergic rhinitis. It is especially effective in relieving the symptoms of nasal congestion. It has fewer side effects when used at the recommended dosage in the instructions. If hormonal nasal spray alone cannot effectively control the symptoms, it is preferred to add antihistamine nasal spray, or consider adding oral antihistamines and decongestants; if the nasal congestion is particularly severe, it can be short-term (<1 week) Use nasal decongestants, which not only improve nasal ventilation, but also help hormone nasal sprays to work better; if there are too many nasal secretions, you can add ipratropium bromide to inhibit nerve reflexes and reduce Secretions are produced to relieve symptoms; for patients with stubborn allergic rhinitis symptoms, combined with asthma or nasal polyps, you can consider adding montelukast sodium.
For intermittent or mild allergic rhinitis, if the patient does not want to use hormones or want to avoid using hormones as much as possible, they can choose: antihistamine nasal sprays, such as azelastine and levocabastine, used regularly or as needed ; Second-generation oral antihistamines, taken regularly or as needed; nasal spray of cromolyn sodium, used regularly or as needed, it should be noted that the effect of this drug is weak, and it needs to be administered multiple times a day, compliance Not high, but because of its good safety, it is more suitable for children.
In short, in the treatment of allergic rhinitis, it is not recommended to use multiple drugs at the beginning of the medication, but for patients with more severe symptoms, you can choose a proven combination of effective treatment options. At this time, the medication should be prescribed by the doctor under the specific evaluation of the otolaryngologist.
Use points of hormone nasal spray
Now let me focus on hormone nasal spray. It is recommended as a first-line treatment no matter at home or abroad. There is no essential difference between the different hormone nasal sprays. Most of them will take effect within a few hours, but it often takes days or even weeks to reach the maximum effect.
Generally speaking, start treatment from the maximum recommended dose for this age group. Exceeding the maximum recommended dose will not increase the efficacy, so it is not recommended to overuse it. The standard course of treatment is not less than two weeks of medication. There is a medical saying called "minimum inflammatory status", which means that the inflammation is only superficially controlled after the initial medication, but the inflammation continues to exist, usually 2 to 4 weeks after the medication. The doctor will adjust the medication according to the patient's symptom improvement: if the symptoms are significantly alleviated, continue to take the medication for 4 weeks, and the dosage can be appropriately reduced; if the symptoms are not improved, the dosage can be appropriately increased (for example, once a day, now adjusted to daily 2 times) to improve symptoms. After the symptoms are effectively controlled, the dose is reduced slowly (once a week). Some patients can use hormones once every other day or as needed to control their symptoms, that is, maintain the treatment with the minimum effective dose. For some severely ill patients, long-term regular medication is required.
For patients with mild symptoms and infrequent allergic rhinitis, or patients who are known to be allergic to certain drugs, hormonal nasal sprays can be used regularly or as needed. In the case of known allergens, it is recommended to start using it two days before the allergen is exposed, and continue to use it for two days after the allergen exposure ends.
In terms of adverse drug reactions, attention should be paid to the following points:
1. Local nasal mucosal irritation (dryness, burning sensation), occasional nose bleeding. If there are blood stains in your nose, you can temporarily stop using the nasal spray and start using it again when the situation improves. These complications can also be reduced by controlling the dose (such as reducing to the lowest effective dose). Severe nose bleeding may be mechanical damage caused by repeated spraying of drugs, which is often difficult to prevent. Once it occurs, you may need to avoid using hormonal nasal sprays in the future.
2. Although it is very rare, there are reports of nasal septum perforation using hormone nasal spray, so you should always stay away from the nasal septum when spraying the nose.
3. The systemic bioavailability of the second-generation hormone nasal spray is lower than that of the first-generation, the amount of systemic absorption is less, and the possibility of causing systemic side effects is lower.
In addition, pay attention when using hormone nasal spray: When there is nasal scab in the nasal cavity, wash the nasal cavity with normal saline nasal spray or physiological seawater before using hormone nasal spray, because if there is nasal mucus or nasal scab blocking the drug, it may Cause treatment failure; when using hormonal nasal spray, the body of the bottle should be upright or slightly sideways to the nose, keeping the head slightly forward, after spraying the medicine to avoid the head immediately back, because this will cause the medicine to flow from the nose to the throat; When spraying, use your nose to inhale gently. The intensity of the inhalation is similar to that of smelling the fragrance of flowers. Don't inhale hard. If there is liquid medicine flowing to the throat, spit it out in time instead of swallowing it.
