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TREATMENT OF ALLERGIC RHINITIS BY MODERN METHODS FROM
THE POINT OF VIEW OF A DOCTOR: THE MAIN PROBLEMS AND
MISTAKES
Xaydarova Shaxrizoda Husan qizi
student of Kimyo International University in Tashkent
Annotation:
Allergic rhinitis (AR) is a chronic pathological process, the main
pathogenetic mechanism of which is inflammation caused by immunoglobulin E
(IgE)–an indirect hypersensitivity reaction that develops as a result of allergens
entering the nasal mucosa and manifesting sneezing, nasal congestion,
itching and nasal discharge of various nature.
Keywords:
Allergic rhinitis, immune system
The relevance of the problem
Allergic rhinitis (AR) is a chronic pathological process, the main pathogenetic
mechanism of which is inflammation caused by immunoglobulin E (IgE)–an indirect
hypersensitivity reaction that develops as a result of allergens entering the nasal
mucosa and manifesting sneezing, nasal congestion, itching and nasal discharge of
various nature. Of the extranasal symptoms, complaints of poor sleep, lacrimation,
redness of the eyes, stuffiness in the ears or hearing loss as a result of dysfunction of
the auditory tubes, emotional instability are more often noted [1]. It is characterized by
itching in the nose, difficulty breathing, sneezing and runny nose. Most often, the
painful condition is associated with seasonal allergies. The occurrence of pathology is
associated with hyperactivity of the immune system, which overreacts to the usual
substances present in the surrounding air. The immune response to an irritant provokes
a reaction from the nasal mucosa that is typical for cases of an attack by viruses and
bacteria: itching, sneezing, exudate separation. Seizures are stopped with
antihistamines. In the case of severe allergic rhinitis, a radical change of lifestyle or
place of residence may be required. Due to the high prevalence in the world, the
problem of allergic pathology in general and AR in particular does not lose relevance.
AR is registered in 20-40% of cases, especially in developed and developing countries.
In the USA alone, according to 2012 data, 19.1 million cases of AR were recorded in
people over 18 years of age and 6.1 million in people under the age of 18 [2]. The costs
of paying for days of disability, doctor visits, laboratory tests, treatment of AR itself
and concomitant pathology, in particular bronchial asthma (BA), conjunctivitis,
exacerbation of chronic rhinosinusitis, place a heavy economic burden on society [3].
We should not forget that the quality of life of allergic patients is significantly reduced.
Patients with AR suffer from allergic symptoms on average 52.5 days a year [4]. The
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most painful symptom is nasal congestion. Violation of nasal breathing leads to the
development of the main extranasal symptoms. About 48% of patients with seasonal
AR and 68% with year-round AR experience problems falling asleep. The quality of
sleep decreases. This is due to the fact that at night, due to the dominance of the
influence of the recurrent nerve, swelling of the nasal mucosa worsens [5]. There are
often periodic awakenings during sleep, snoring with the possible development of
obstructive apnea syndrome [6]. As a result, irritability, fatigue, decreased
concentration and labor productivity against the background of slowing down
psychomotor and mental processes [7].
Phases of allergic reaction and clinical manifestations
Aeroallergens are among the most relevant factors in the development of AR.
Being in the form of a suspension in the inhaled air, they fall on the nasal mucosa and
cause the development of an independent inflammatory process. The highest pollen
content
in the air is observed
from
mid-spring
to early
summer,
when the majority (75%) of plants bloom. At the same time, the volume of sales of
medicines for the treatment of allergic pathology increases sharply [10]. Due to the
development of cross-reactivity between allergens in a number of patients in the
summer months, symptoms of AR persist. An increase in the duration of the presence
of pollen allergens in the air and the formation of pollen by plants against the
background of global climate warming also negatively affects the condition of patients
with AR [11]. After contact with the nasal mucosa, the causally significant allergen is
processed in antigen-presenting cells, which subsequently present its individual
peptides through a type II histocompatibility complex (MHC II) to naive T-
lymphocytes. The latter differentiate into type 2 T-helpers (Th), which play a key role
in the development of the IgE response. At the same time, other immune cells are
recruited in the focus of inflammation, including eosinophils, basophils, mast cells
secreting interleukins (IL) 4, 5, 6, 10 and 13. As a result, isotopic switching of
Blymphocytesinto producing immunoglobulins, mainly class E, plasma cells is
induced. Subsequently, IgE molecules bind to high affinity Fc receptors of mast cells
and basophils. In addition, IdE is a CD23-receptor ligand on mature B-lymphocytes
activated by x crofa ha x, eosinophils, follicular dendritic cells and platelets, upon
binding to which IgE is transported [12]. Symptoms of AR develop with repeated
exposure to a sensitizing allergen after its cross-binding with IgE, coupled with Fc
receptors. This leads to the degranulation of mast cells and basophils, the release of
histamine, tryptase, kininogenase, prostaglandins, leukotrienes and other active
mediators of the inflammatory response. The late phase of the allergic response is
characterized by eosinophilic chemotaxis. Degranulation increases the amount of
biologically active substances in the mucous membrane of the nasal cavity, which
contributes to increased vascular permeability, mucus secretion, irritation of nerve
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endings. Sensory nerve fibers are excited by non-specific stimuli, transmitting a signal
to both afferent and efferent nerves (retrograde axon reflex). As a consequence, the
secretion of neuropeptides (substance P, neurokinin A, etc.), reduction of smooth
muscles, hypersecretion of mucus by goblet cells and an even greater increase in the
permeability of small vessels [13]. Clinically, this is manifested by the mainnasal
symptoms of AR (sneezing, nasal congestion, itching and nasal discharge). Against the
background of prolonged exposure to the allergen, the formation of cytokines
increases, to which pro-inflammatory IL-1-beta, IL-6 and tumor necrosis factor alpha
(TNF-alpha) are added. The inflammatory process is aggravated. As a result of
neurogenic inflammation, the nasal mucosa acquires the property of hyperreactivity
when exposed to non-specific stimuli unrelated to a significant allergen (cold or dry
air, pungent odor, tobacco) AR symptoms occur. In the pathogenesis of AR, both Th1-
and Th2-cytokines are released. Some of them, for example IL-6 and TNF-alpha,
penetrating through the blood-brain barrier, are involved in cognitive disorders in AR,
which is manifested by depression, anxiety or suicidal behavior [8]
Issues to be resolved
There are several problems associated with the diagnosis and treatment of AR.
Firstly, patients with permanent symptoms of AR often do not seek medical help. For
example, in the UK, only 18% of patients with chronic rhinitis, which bothered them
during the previous two years, turned to a general practitioner, in France, 19% of 230
patients with typical symptoms of AR never sought medical help. Large-scale
European studies have shown that 45-46% of patients with the main clinical
manifestations of AR have never undergone a comprehensive diagnosis for this disease
[14]. This is due to the fact that patients do not realize the severity of an allergic disease
and do not consider it possible to waste time on a visit to a doctor. They do not see a
connection between nasal and extranasal manifestations of AR, they independently try
to pick up symptomatic therapy drugs at the pharmacy. According to available data, in
2018 the majority of patients with AR (69.5%) purchased drugs based on their own
preferences, without asking the opinion of a pharmacist. Only 14.9% of them were able
to optimally choose medicines. 86.7% of patients explained their preferences for a
certain medication during self–treatment with their own positive experience, 4.2% with
recommendations from friends or family members, 3.5% with the provisions of the
instructions for drugs, 3.5% with the cost of different groups of medicines. 2.8% of
patients selected treatment by trial and error [15]. It should not be forgotten that patients
with AR have a high risk of developing AD. The lack of drug control of AR,
underestimation by patients of the severity of the condition can subsequently lead to
the development of poorly controlled AD [16]. With self-treatment, only 6.3% of
patients with AR and BA were able to make an adequate choice of drug therapy [15].
Secondly, the standard of diagnostic measures for the detection of allergic pathology,
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fixed in clinical recommendations, is not observed. As the analysis of the outpatient
service of several polyclinics in Moscow showed, despite the presence of many
detailed guidelines for the diagnosis and treatment of AR, in 2017, a comprehensive
examination of patients with suspected AR was carried out only in 6.5% of cases. In
52.7%, the diagnosis was made empirically – based on complaints and anamnesis of
the disease, skin tests were prescribed to 31.3% of patients, rhinocytogram – 10.2%.
The indicators of total and specific IgE in blood serum were determined at 7.9% [17].
As a consequence, underdiagnosis of AR, an increase in the risk of disease progression,
the possibility of AD joining. Thirdly, the treatment regimens of patients are violated.
In accordance with ARIA recommendations, therapy of patients with AR and BA
should be stepwise. According to data for 2017, antihistamines (AGP) were prescribed
only in 27.3% of cases, and in 14% in the form of monotherapy, allergen-specific
immunotherapy (ASIT) was carried out extremely rarely (1.9%). Leukotriene receptor
antagonists were received by 9.7% of patients (together with either AGP or intranasal
glucocorticosteroids (GCS)). Irrigation therapy was recommended in 35.6% of cases.
There were no other barrier methods in the appointments. The leading positions were
occupied by topical GCS – 77.8% of cases, and in 64% – in the form of monotherapy
[18]. Finally, another problem is related to compliance with medical recommendations.
Even with an adequate diagnosis to identify a significant allergen and wellchosen
complex therapy, it is important that the patient takes the necessary medications daily
in the indicated doses throughout the entire treatment period. In Germany, a study was
conducted on the level of compliance with the intake of second-generation AGP (Erius
5 mg once a day) by adult patients with AR. It was found that with a duration of
treatment of 41.6 days, 98.1% of patients followed the doctor's instructions. The
combination of AR with BA had a negative effect on adherence to therapy, most likely
due to the large number of medications taken. A low level of compliance was almost
twice as common in patients with concomitant AD (3.1 vs. 1.8%). Sex and age
characteristics, duration of the disease, severity of nasal symptoms and the level of
quality of life at the beginning of therapy did not affect compliance with the treatment
regimen. With high compliance, a good therapeutic effect of AGP was observed. The
researchers also analyzed compliance with sublingual immunotherapy (SLIT,
sublingual immunotherapy) with an average duration of 23.36 weeks. A high level of
compliance was observed in 79.6% of cases, and in contrast to the treatment of AGP,
gender (female), the severity of nasal symptoms and concomitant asthma positively
influenced compliance with the treatment regimen. During the first year of SLIT
therapy, 71% of patients registered high adherence, which decreased in subsequent
years, which is typical for the treatment of many chronic diseases [19]. It follows from
the above that it is difficult to count on achieving the best result without close
interaction between the doctor and the patient. The allergist must follow the algorithm
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of diagnostic measures, work in a team with an otorhinolaryngologist, if necessary with
specialists of another profile - a pulmonologist, ophthalmologist, neurologist. When
prescribing therapy, it is necessary to be guided by the latest consent documents, more
often combine basic therapy with ASIT, which today is considered the only method
capable of influencing all pathogenetic links in the development of the disease and
forming immune tolerance to allergens (immunity to them is manifested in the absence
of clinical symptoms of AR). The pharmaceutical industry, specializing in the
production of drugs for ASIT, actively uses the latest achievements in the field of
immunology and bioengineering. New routes of drug administration, new
hypoallergenic recombinant allergen derivatives and immunogenic peptides, their
combinations with monoclonal antibodies, etc. are proposed [20]. In addition, it is
necessary to take into account the psychology of patients. Many of them believe that it
is not necessary to treat AR, it is enough to periodically use decongestants to eliminate
nasal congestion and travel outside the region of permanent residence during the
flowering period of plants. To convince patients of the need for treatment, as well as
to reduce the risk of complications, multiple reminders of possible negative prospects
for the development of the allergic process, persistent recommendations to follow the
prescribed treatment regimen and constant dynamic monitoring can help.
Treatment
For allergic rhinitis, step-by-step therapy is used, based on the severity of
clinical symptoms. Upon reaching The control of symptoms, the volume of prescribed
drugs and their dose decrease, in the absence of control, They increase. Antihistamines
of the second generation belong to the first-line medicines, are prescribed at the First
manifestations of the disease and are used as monotherapy or in combination with other
medications, Such as leukotriene receptor blockers, topical GCS. Ebastin (Espa-Bastin,
Germany) is a second–generation AGP, available in tablet form of 10 and 20 mg. The
effect of the drug begins 1-3 hours after administration. In numerous studies, the drug
has demonstrated a favorable safety profile, high bioavailability. The rate of Onset of
the clinical effect does not depend on food intake. The drug is compatible with alcohol,
does not Affect the ability to drive a vehicle. Against the background of the use of the
drug, there is a regression of all nasal manifestations with seasonal and year-round AR.
In addition to selective binding to H1 -histamine Receptors, ebastin reduces the release
of pro-inflammatory cytokines, such as TNF-alpha, granulocytemacrophageColony
stimulating factor, IL-8, which additionally provides an anti-inflammatory effect and a
Decrease in the chemotaxis of granulocytes, including eosinophils, into the nasal
mucosa. This double action Of modern second-generation AGPS more effectively
contributes to the regression of exacerbation of the Chronic inflammatory process in
AR, and consequently, the prevention of complications and the addition of Other
comorbid conditions.
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Conclusion
The administration of patients with AR is considerably a ball-bust task. It is all-
important to appropriate into Explanation the characteristic characteristics of patients,
supervise their deed of examination Recommendations, remuneration consideration to
extranasal manifestations of the affliction and contemplate Each situations of
characteristic and therapeutical magnitudes.
Literature
1.
Skoner A.R., Skoner K.R., Skoner D.P. Allergic rhinitis, histamine, and otitis media
// Allergy Asthma Proc. 2009. Vol. 30. № 5. Р. 470–481.
2.
Amritwar A.U., Lowry C.A., Brenner L.A. et al. Mental health in allergic rhinitis:
depression and suicidal behavior // Curr. Treat. Options Allergy. 2017. Vol.4. № 1.
P. 71–97.
3.
Brożek J.L., Bousquet J., Baena-Cagnani C.E. et al. Allergic rhinitis and its impact
on asthma (ARIA) guidelines: 2010 revision // J. Allergy Clin. Immunol. 2010. Vol.
126. № 3. P. 466–476.
4.
Lamb C.E., Ratner P.H., Johnson C.E. et al. Economic impact of workplace
productivity losses due to allergic rhinitis compared with select medical conditions
in the United States from an employer perspective // Curr. Med. Res. Opin. 2006.
Vol. 22. № 6. P. 1203–1210.
5.
Min YG. The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis.
Allergy Asthma Immunol Res. 2010;2:65–76. [PMC free article] [PubMed]
[Google Scholar]
6.
Bernstein JA. Allergic and mixed rhinitis: Epidemiology and natural history.
Allergy Asthma Proc. 2010;31:365–369.
7.
Blaiss MS. Allergic rhinitis: Direct and indirect costs. Allergy Asthma Proc.
2010;31:375–380.
8.
Broide DH. Allergic rhinitis: Pathophysiology. Allergy Asthma Proc. 2010;31:370–
374.
9.
Kim D, Baraniuk JN. Neural aspects of allergic rhinitis. Curr Opin Otolaryngol
Head Neck Surg. 2007;15:268–273.
10.
Blaiss M., Reigel T., Philpot E. A study to determine the impact of rhinitis on
sufferers’ sleep and daily routine // J. Allergy Clin. Immunol. 2005. Vol. 115. №
2. Р. 197.
11.
Bozkurt B., Serife Ugur K., Karamanli H. et al. Polysomnographic findings in
persistent allergic rhinitis // Sleep Breath. 2017. Vol. 21. № 2. P. 255–261.
12.
Хушвакова, Н. Ж., Хамракулова, Н. О., Исхакова, Ф. Ш., & Неъматов, Ш.
(2020).
ОПТИМИЗИРОВАННЫЙ
МЕТОД
ЛЕЧЕНИЯ
ОСТРОГО
КАТАРАЛЬНОГО СРЕДНЕГО ОТИТА У ДЕТЕЙ. Евразийский Союз
Ученых, (11-2 (80)), 18-20.
13.
Davron B. J. et al. Elimination Of Perforation Of The Bottom Of The Maxilla Jaw
Sinus With Application Of Osteoplastic Material //Central Asian Journal of Medical
and Natural Science. – 2021. – Т. 2. – №. 1. – С. 162-166.
14.
Ризаев Ж., Кубаев А., Бузрукзода Ж. Современный подход к комплексной
реабилитации пациентов с приобретенными дефектами верхней челюсти
Ta'lim innovatsiyasi va integratsiyasi
47-son_4-to’plam_Iyun -2025
102
ISSN:3030-3621
(обзор литературы) //Журнал стоматологии и краниофациальных
исследований. – 2021. – Т. 2. – №. 3. – С. 77-83
15.
Trikojat K., Buske-Kirschbaum A., Plessow F. et al. Memory and multitasking
performance during acute allergic inflammation in seasonal allergic rhinitis // Clin.
Exp. Allergy. 2017. Vol. 47. № 4. P. 479–487.
16.
Campbell A.P., Hoehle L.P., Phillips K.M. et al. Depressed mood is associated with
loss
of
productivity in allergic rhinitis // Allergy. 2018. Vol. 73. № 5. P. 1141–1144.
17.
Исхакова Ф. Ш., Хамракулова Н. О., Хушвакова Н. Ж. Оценка эффективности
лечения бактериального рецидивирующего синусита //Прорывные научные
исследования как двигатель науки, Сборник статей, Часть. – 2018. – Т. 2.
18.
Хушвакова Н. Ж., Давронова Г. Б., Исхакова Ф. Ш. Усовершенствование
методов лечения приобретенной сенсоневральной тугоухости //Российская
оториноларингология. – 2015. – №. 4. – С. 102-105.
19.
Stinson K.A., Albertine J.M., Hancock L.M. et al. Northern ragweed ecotypes
flower earlier and longer in response to elevated CO2: what are you sneezing at? //
Oecologia. 2016. Vol. 182. № 2. P. 587–594.
20.
Iskhakova Z. S., Iskhakova F. S., Narzieva D. B. THE USE OF OSTEOGENIC
MATERIAL TO REPLACE JAW CAVITY DEFECTS //Applied Information
Aspects of Medicine (Prikladnye informacionnye aspekty mediciny). – 2022. – Т.
25. – №. 4. – С. 20-25.
21.
Хушвакова Н. Ж., Исакова Ю. Н., Нуралиев У. К. Оптимизация
консервативного
лечения
хронического
тонзиллита
//Российская
оториноларингология. – 2014. – №. 3 (70). – С. 111-113.
22.
Хушвакова Н. Ж., Давронова Г. Б., Исхакова Ф. Ш. ОПТИМИЗАЦИЯ
ЛЕЧЕНИЯ ПРИОБРЕТЕННОЙ СЕНСОНЕВРАЛЬНОЙ ТУГОУХОСТИ
//Новые технологии в оториноларингологии. – 2014. – С. 118-124.
23.
Давронова Г. Б., Исхакова Ф. Ш. Эффективность озонотерапии при
нейросенсорной тугоухости сосудистого генеза //In Situ. – 2016. – №. 5. – С.
41-43.
24.
Schatz M, Zeiger RS, Chen W, Yang SJ, Corrao MA, Quinn VP. The burden of
rhinitis in a managed care organization. Ann Allergy Asthma Immunol.
2008;101:240–247.
25.
Бузрукзода Ж., Ахтамов Ш., Щербакова Ф. Анализ гендерных различий
строения челюстей жителей города самарканда по данным конусно-лучевой
компьютерной томографии //Медицина и инновации. – 2021. – Т. 1. – №. 4. –
С. 238-241.
26.
Bekmuratov L. R. et al. CARDIOVASCULAR DISEASES IN PATIENTS WITH
DIABETES MELLITUS //TA'LIM VA RIVOJLANISH TAHLILI ONLAYN
ILMIY JURNALI. – 2023. – Т. 3. –№. 1. – С. 193-198.
