Ведення хворого на алергічний риніт в україні: міжнародні рекомендації та власний досвід

Abstract

Absract. The article provides an overview of the current International Recommendations on Allergic Rhinitis (AR) — ARIA (Allergic Rhinitis and Its Impact on Asthma) and EPOS (European Position Paper on Rhinosinusitis and Nasal Polyps). The issues of terminology, classification, etiology, pathogenesis, and treatment are considered. Emphasis is placed on new points: the phenotype of local AR (entopy), central compartment atopic disease, diagnosis of AR in patients with normal level of IgE and negative prick tests with inhaled allergens, determining the severity of rhinitis by visual 10-point analog scale. The differential diagnosis of AR and COVID-19 is presented (F. Ferreli, 2020; G. Malipiero, 2020). Considering the implementation of international recommendations in practice and own experience, the question of the place of allergenspecific immunotherapy (ASIT) in the algorithms for the treatment of AR is discussed. ARIA recommends ASIT for the fifth stage of treatment, after the ineffectiveness of oral steroids and biological therapy. Own observations of patients with AR prove the safety and efficacy of ASIT in the early stages of sensitization, as the first stage of therapy, which is consistent with the recommendations of other international consensuses. The need for elimination therapy has been proven on the example of the respiratory cytoprotector ectoin. Its mechanisms of action, efficacy and safety are described, according to the literature data, including a systematic review and meta-analysis of studies by Bilstein A. (2021). The own study of patients with AR indicated the prevalence of AR in the Kharkiv region — 12.2 % and 11.3 % in children aged 6-7 years and 13-14 years, respectively. The spectrum in sensitization (pollen — 64.1 %, household — 42.2 % of patients) is given. The problem of comorbidity of pathology is highlighted. The characteristic of the gastrointestinal tract in patients with allergies is given. A conclusion is made about the need to implement the international recommendations, considering the individualization of the approach. Key words: allergic rhinitis, terminology, etiology, pathogenesis, diagnosis, treatment.