“Doctor, I heard that allergic rhinitis can be treated with desensitization, I am a patient with allergic rhinitis, please remove me Be sensitive! This rhinitis affects me too much!” In the clinic for allergic rhinitis, I often hear such a request from patients. Whether a patient is suitable for desensitization therapy requires careful evaluation by a doctor. Which patients are suitable for desensitization therapy?
Desensitization therapy is a kind of anti-cause treatment, and the cause of allergic rhinitis is allergens, so people who want to take desensitization therapy Patients should first determine which allergens their allergic rhinitis is caused by. At present, the commonly used methods for clinical detection of allergens include skin prick and serum-specific IgE detection. At present, the types of standardized allergen vaccines available for clinical use in China include house dust mites, dust mites and Artemisia annua. Mites are the main allergens of allergic rhinitis patients in most areas of my country. Artemisia annua is highly prevalent in northern regions. For other allergens, such as cat hair, dog hair, mold and other pollen, there is currently no standardized allergen vaccine in China that can be used for desensitization treatment.
Desensitization therapy is a long-term treatment with long-term effects even after treatment is stopped. But it has no immediate effect, most patients need about 4 months to see the effect, and the whole course of treatment is recommended for more than 3 years. Therefore, patients who want desensitization treatment should have confidence in desensitization treatment and accept treatment persistently. Don’t have high expectations for the early efficacy of desensitization therapy, nor stop desensitization therapy prematurely after obtaining better results. In general, the longer the duration of desensitization treatment, the stronger the effect. Desensitization therapy can be divided into subcutaneous desensitization and sublingual desensitization. Subcutaneous desensitization treatment is subcutaneous injection at regular intervals, and sublingual desensitization treatment is administered under the tongue with daily drops. In general, subcutaneous desensitization is more effective than sublingual desensitization.
Desensitization therapy is a treatment different from drugs, but desensitization therapy and drug therapy do not conflict. In the process of desensitization therapy In the early stage, especially when the desensitization treatment fails to take effect, it is still recommended that patients use drugs to control symptoms. This can allow the patient’s allergic symptoms to be quickly controlled and can also promote the dose escalation of desensitization therapy. After the desensitization treatment takes effect gradually, the frequency and severity of the patient’s rhinitis symptoms will gradually decrease, and eventually even no longer occur, and the use of drugs related to allergic rhinitis will gradually decrease to stop. Therefore, patients who want desensitization therapy cannot reject drug therapy. In addition, subcutaneous desensitization therapy can prevent allergic rhinitis from developing into asthma and reduce the generation of new sensitization.
Desensitization therapy is a type of immunotherapy, and it also has contraindications. The following patients cannot receive desensitization therapy: ① Poor control or Severe asthma with poor lung function; ② systemic autoimmune disease during exacerbation; ③ malignant tumor. Desensitization therapy should be used with caution in the following patients: 1) Partially controlled asthma; 2) Concurrent cardiovascular disease; 3) Severe systemic reactions to desensitization therapy; 4) Systemic autoimmune disease in remission; 5) Severe psychiatric disorders ; ⑥ poor compliance; ⑦ primary or secondary immunodeficiency.
Desensitization therapy is a therapeutic vaccine whose main component is extracted from allergens, so it is not a hormone growth and development were not significantly affected. Like other vaccines, desensitization therapy may have adverse effects after vaccination, but the vast majority of patients can tolerate it. Serious adverse reactions are rare and usually occur within 30 minutes of treatment.
Desensitization therapy is a special treatment, but its efficacy also has individual differences, and a small number of patients may have poor efficacy. Generally speaking, the effect of children is better than that of adults. Therefore, it is recommended that patients with allergic rhinitis can start desensitization treatment as soon as possible to reduce the impact of allergic rhinitis on children’s growth and development, and reduce the complications caused by allergic rhinitis. Subcutaneous desensitization therapy can be started after the child reaches 5 years of age, and sublingual desensitization can be appropriate earlier. If both parents have allergic rhinitis, desensitization treatment can reduce the incidence of allergic rhinitis in offspring. Desensitization therapy is not recommended for women who are pregnant or planning to become pregnant. If a patient is found to be pregnant during desensitization therapy, there is currently no clinical evidence that desensitization therapy has adverse effects on the fetus, but the risk should be reassessed, and the patient’s consent should be obtained to decide whether to continue desensitization therapy.
Liu Juan (attending physician of the Department of Otolaryngology, Eye and Otolaryngology Hospital of Fudan University)