The Korean Journal of Medicine

  • 제85권5호
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  • Pages.463-468
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  • 2013
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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알레르기 비염의 치료

Treatment of Allergic Rhinitis

  • 허규영 (고려대학교 의과대학 내과학교실)
  • Hur, Gyu-Young (Department of Internal Medicine, Korea University College of Medicine)
  • 발행 : 2013.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

Allergic rhinitis (AR) is defined as chronic inflammatory reactions to common allergens in the nasal mucosa with at least two AR symptoms including rhinorrhea, nasal congestion, sneezing, nasal/ocular pruritus, and postnasal drainage. AR is a common health problem, and it affects around 10-25% of general population. Its prevalence is increasing according to the environmental changes. AR and asthma frequently coexist in the same patient, therefore we should consider it and check for asthma to diagnose AR. Antihistamines and nasal corticosteroids are recommended as the 1st line treatment of AR. Decongestants may be effective for nasal congestion, and leukotrienes are helpful to improve both nasal and bronchial inflammations in patients with AR and asthma. Allergen specific immunotherapy is useful in IgE mediated AR and can prevent the progression to asthma and new sensitizations. Appropriate AR treatment including medications and immunotherapy can improve symptoms and reduce medications. Finally improvement of quality of life can be achieved.

키워드

참고문헌

  1. Vignola AM, Chanez P, Godard P, Bousquet J. Relationships between rhinitis and asthma. Allergy 1998;53:833-839. https://doi.org/10.1111/j.1398-9995.1998.tb03988.x
  2. Matsuno O, Miyazaki E, Takenaka R, et al. Links between bronchial asthma and allergic rhinitis in the Oita Prefecture, Japan. J Asthma 2006;43:165-167. https://doi.org/10.1080/02770900500499053
  3. Lundbäck B. Epidemiology of rhinitis and asthma. Clin Exp Allergy 1998;28(Suppl 2):3-10.
  4. Bush RK. Does allergen avoidance work? Immunol Allergy Clin North Am 2011;31:493-507. https://doi.org/10.1016/j.iac.2011.05.005
  5. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, revised 2012. Available from: http://ginasthma.org/local/uploads/files/GINA_Report_Mar ch13.pdf.
  6. Sheikh A, Hurwitz B, Shehata Y. House dust mite avoidance measures for perennial allergic rhinitis. Cochrane Database Syst Rev 2007;(1):CD001563.
  7. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008;63(Suppl 86):8-160. https://doi.org/10.1111/j.1398-9995.2007.01620.x
  8. Roberts G, Xatzipsalti M, Borrego LM, et al. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Eur J Allergy Clin Immunol 2013;68:1102-1116.
  9. Matsui EC. Role of environmental control in the management of asthma and allergy. J Allergy Clin Immunol 2012; 129:271.e1-3. https://doi.org/10.1016/S0091-6749(12)00543-X
  10. Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010;126:466-476. https://doi.org/10.1016/j.jaci.2010.06.047
  11. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ 1998;317:1624-1629. https://doi.org/10.1136/bmj.317.7173.1624
  12. Kelly HW, Sternberg AL, Lescher R, et al. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med 2012;367:904-912. https://doi.org/10.1056/NEJMoa1203229
  13. Schenkel EJ, Skoner DP, Bronsky EA, et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics 2000;105:E22. https://doi.org/10.1542/peds.105.2.e22
  14. Bel EH. Clinical practice: mild asthma. N Engl J Med 2013;369:549-557. https://doi.org/10.1056/NEJMcp1214826
  15. Mortuaire G, de Gabory L, François M, et al. Rebound congestion and rhinitis medicamentosa: nasal decongestants in clinical practice: critical review of the literature by a medical panel. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:137-144. https://doi.org/10.1016/j.anorl.2012.09.005
  16. Meltzer EO, Berman GD, Corren J, et al. Addition of ibuprofen to pseudoephedrine and chlorpheniramine in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2004;93:452-459. https://doi.org/10.1016/S1081-1206(10)61412-3
  17. Jacobsen L, Nũchel Petersen B, Wihl JA, Løwenstein H, Ipsen H. Immunotherapy with partially purified and standardized tree pollen extracts: IV. results from long-term (6-year) follow-up. Allergy 1997;52:914-920. https://doi.org/10.1111/j.1398-9995.1997.tb01251.x
  18. Johnstone DE, Dutton A. The value of hyposensitization therapy for bronchial asthma in children: a 14-year study. Pediatrics 1968;42:793-802.
  19. Pajno GB, Barberio G, De Luca F, Morabito L, Parmiani S. Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy: a six-year follow-up study. Clin Exp Allergy 2001;31:1392- 1397. https://doi.org/10.1046/j.1365-2222.2001.01161.x
  20. National guideline for the management of asthma. J Asthma Allergy Clin Immunol 1998;18:339-384.
  21. Kim TB, Kim KM, Kim SH, et al. Sensitization rates for inhalant allergens in Korea; a multi-center study. J Asthma Allergy Clin Immunol 2003;23:483-493.
  22. Lim SB, Park IY, Lee KY, Hong CS. Study on allergen of immunotherapy in allergic diseases. Korean J Asthma Allergy Clin Immunol 1988;8:138-149.
  23. Adkinson NF Jr, Eggleston PA, Eney D, et al. A controlled trial of immunotherapy for asthma in allergic children. N Engl J Med 1997;336:324-331. https://doi.org/10.1056/NEJM199701303360502
  24. Hur GY, Lee HY, Choi GS, et al. Clinical features of patients in remission after house dust mite allergen immunotherapy in adult asthma. Korean J Asthma Allergy Clin Immunol 2007;27:257-262.
  25. Oh JW. Development of pollen concentration prediction models. J Korean Med Assoc 2009;52:579-591. https://doi.org/10.5124/jkma.2009.52.6.579
  26. Hur GY, Kim TB, Kim ST, et al. Allergy Immunotherapy. Korean J Asthma Allergy Clin Immunol 2010;30:153-183.
  27. Dahl R, Kapp A, Colombo G, et al. Sublingual grass allergen tablet immunotherapy provides sustained clinical benefit with progressive immunologic changes over 2 years. J Allergy Clin Immunol 2008;121:512-518.e2. https://doi.org/10.1016/j.jaci.2007.10.039
  28. Dahl R, Kapp A, Colombo G, et al. Efficacy and safety of sublingual immunotherapy with grass allergen tablets for seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006;118:434-440. https://doi.org/10.1016/j.jaci.2006.05.003
  29. Durham SR, Yang WH, Pedersen MR, Johansen N, Rak S. Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006;117: 802-809. https://doi.org/10.1016/j.jaci.2005.12.1358
  30. Gauvreau GM, Hessel EM, Boulet LP, Coffman RL, O'Byrne PM. Immunostimulatory sequences regulate interferon- inducible genes but not allergic airway response. Am J Respir Crit Care Med 2006;174:15-20. https://doi.org/10.1164/rccm.200601-057OC
  31. Wilson DR, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis: systematic review and metaanalysis. Allergy 2005;60:4-12. https://doi.org/10.1111/j.1398-9995.2005.00699.x
  32. Kleine-Tebbe J, Ribel M, Herold DA. Safety of a SQ-standardised grass allergen tablet for sublingual immunotherapy: a randomized, placebo-controlled trial. Allergy 2006;61: 181-184. https://doi.org/10.1111/j.1398-9995.2006.00959.x
  33. Andre C, Perrin-Fayolle M, Grosclaude M, et al. A double- blind placebo-controlled evaluation of sublingual immunotherapy with a standardized ragweed extract in patients with seasonal rhinitis: evidence for a dose-response relationship. Int Arch Allergy Immunol 2003;131:111‐118. https://doi.org/10.1159/000070926
  34. Bowen T, Greenbaum J, Charbonneau Y, et al. Canadian trial of sublingual swallow immunotherapy for ragweed rhinoconjunctivitis. Ann Allergy Asthma Immunol 2004; 93:425-430. https://doi.org/10.1016/S1081-1206(10)61408-1
  35. Chang TW, Shiung YY. Anti-IgE as a mast cell-stabilizing therapeutic agent. J Allergy Clin Immunol 2006;117: 1203-1212. https://doi.org/10.1016/j.jaci.2006.04.005
  36. Holgate S, Casale T, Wenzel S, Bousquet J, Deniz Y, Reisner C. The anti-inflammatory effects of omalizumab confirm the central role of IgE in allergic inflammation. J Allergy Clin Immunol 2005;115:459-465. https://doi.org/10.1016/j.jaci.2004.11.053
  37. Kopp MV. Omalizumab: anti-IgE therapy in allergy. Curr Allergy Asthma Rep 2011;11:101-106. https://doi.org/10.1007/s11882-010-0173-4

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