ALLERGIC RHINITIS: PRINCIPLES OF DIAGNOSIS AND TREATMENT ACCORDING TO MODERN GUIDELINES. ANALYTICAL REVIEW

Abstract

Climate change and the spring-summer-autumn flowering period of grasses, weeds, shrubs and trees that most strongly contribute to the spread of allergic reactions usually cause pollen (ragweed, birch, willow, dandelion, hazel, timothy, poplar fluff, ragweed, cereals, linden blossoms, etc.) that is easily carried by the air, causing a variety of unpleasant symptoms in people with hypersensitivity, as a result of which they suffer from allergic rhinitis. Allergic rhinitis is a disease characterized by inflammation of the nasal mucosa, which leads to attacks of sneezing, rhinorrhea and nasal congestion, and is often accompanied by itching of the eyes, nose and palate. Postnasal drip, cough, irritability and fatigue are also common symptoms. This is one of the most common allergic diseases, which affects about 40% of Ukrainian citizens every year (1.8 million citizens suffer from allergic rhinitis), however, proper prevention and treatment will help not only minimize symptoms and improve well-being, but also help avoid complications, such as chronic sinusitis or even asthma. At the same time, allergic rhinitis is a disease that significantly reduces the quality, safety and duration of life of the patient and the working capacity of citizens. Pathogenetic therapy of allergic rhinitis involves influencing the key links of the inflammatory reaction of the early and late phases of the disease. Before starting pharmacological therapy, all patients should be recommended to exclude contact with the allergen. According to current recommendations, first-line drugs are second-generation systemic antihistamines or ING/INC. If monotherapy is ineffective, combination pharmacotherapy may be prescribed (evidence level A). The “gold standard” of combined pharmacotherapy is the combination of ING/INC, but specific combinations (INC and systemic antihistamines, systemic antihistamines and decongestants) may be prescribed by different recommendations for the specific therapy of a certain type of allergic rhinitis (seasonal or perennial allergic rhinitis). ALRs are second-line drugs in the absence of effect from antihistamine/INC therapy, but they can potentially be a means of choice in the treatment of patients with seasonal allergic rhinitis and concomitant diseases (asthma, etc.). Other categories of drugs used in the treatment of allergic rhinitis (anticongestants, cromones, anticholinergics) can be used as additional therapy in the presence of specific indications (for example, to reduce nasal airway resistance, severity of nasal secretion or nasal congestion). The use of systemic corticosteroids is recommended only by individual clinical protocols as an adjunct in severe disease and severe nasal congestion. There are no recommendations in favor of the effectiveness of alternative medicine methods in the treatment of allergic rhinitis, with the exception of acupuncture (evidence level D). In the absence of an adequate response to treatment, patients are shown SIT, the implementation of which requires an assessment of the risks and expected effects in a carefully selected group of patients. Surgical treatment is used in some cases, in the absence of a response to conservative therapy, due to a decrease in the effectiveness of such treatment due to the anatomical features of the structure of the patient's nasal cavity (evidence level B-C). Pharmacoeconomic calculations for the introduction of new, modern drugs into clinical and pharmacological practice during outpatient treatment of allergic rhinitis or their use for prophylactic purposes are required for further research.