Patient's question:
Which is better for pediatric allergic rhinitis, traditional Chinese medicine or hormone?Doctor's answer:
(1) Avoiding Contact with Allergens: After identifying the allergens causing the disease, efforts should be made to avoid exposure or consumption, such as removing carpets, not wearing down jackets, or using feather bedding. However, some allergens are difficult to avoid, such as the large amount of pollen floating in the air during pollen season, dust mites, and fungi that persist indoors year-round.(2) Medication Treatment:
(1) Antihistamines: Examples include Chlorpheniramine, Diphenhydramine, Astemizole, Loratadine, Cetirizine, Fexofenadine, Levocetirizine, Desloratadine, Terfenadine, Kefexate, Polaramine, Mastoid, Nedocromil, Tranilast, and others. New drugs in this category are continuously being introduced, available in oral or topical nasal formulations.
These medications are only for symptomatic treatment, addressing the symptoms rather than the root cause. They provide some relief for nasal congestion, sneezing, and eye itching but are not highly effective, especially for runny nose. They require long-term use, rebound effects after discontinuation, and varying degrees of systemic side effects, such as drowsiness, blurred vision, dry mouth, urinary retention, poor concentration, tachycardia, impaired judgment and operational ability, delayed reaction, nausea, constipation, and weight gain. Therefore, they should be used with caution in individuals engaged in precision or mechanical work, such as aviation and driving personnel.
(2) Mast Cell Stabilizers: Representative drugs include Sodium Cromoglicate, Nedocromil, Alergostat, Nedocromil, Tranilast, Zafirlukast, and Tolterodine. These drugs have a short duration of action and are less effective than antihistamines and corticosteroids. Their drawback is also symptomatic treatment, addressing symptoms rather than the root cause.
(3) Ketotifen: It has both anti-degranulation effects on mast cells and histamine antagonism. It is also a symptomatic treatment with side effects such as drowsiness. The recommended dosage is 1 mg orally once or twice daily.
(4) Corticosteroids: Also known as hormones. They are now widely used by clinicians and even as first-line medications. Representative drugs include Beclomethasone Dipropionate, Triamcinolone Acetonide, Flunisolide, Budesonide, Fluticasone Propionate, Mometasone Furoate, and Dexamethasone. Commercial names include Beconase, Rhinocort, Nasonex, and Nasacort.
These drugs are effective in relieving nasal congestion and have better effects on runny nose, sneezing, and nasal itching compared to antihistamines. However, they cannot fully control symptoms. Their drawback is also symptomatic treatment, addressing symptoms rather than the root cause, requiring long-term use, rebound effects after discontinuation, and safety concerns remain debated.
(3) Immunotherapy: Also known as specific desensitization therapy. It involves subcutaneous injections of allergen extracts starting with low concentrations and gradually increasing the concentration and dosage. After several months of treatment, a maintenance dose can be established. This method induces the production of large amounts of specific IgG blocking antibodies in the patient's body, which can block allergens from binding to IgE antibodies, reduce the sensitivity of mast cells, and thus achieve the therapeutic goal. Currently, this therapy faces the following issues:
(1) Allergen extracts contain complex components, including allergens, non-allergenic and toxic proteins, and other substances. Since patients are exposed to various allergens in daily life, this treatment is only effective for specific allergens like pollen and dust mites, making it difficult to address all allergen issues.
(2) Due to the difficulty in standardizing allergen extracts, it is challenging to determine an effective treatment dose. Low doses may be ineffective, while high doses may cause unacceptable systemic reactions in patients. Long-term use can lead to severe IgE-mediated allergic reactions, even posing life-threatening risks. Bernstein, a foreign scholar, statistics show that in the 12 years from 1990 to 2001, 41 people died from immunotherapy and skin tests in North America, with a mortality rate of 1 in 2,540,000 injections. Performing immunotherapy at home or in non-standard medical settings without emergency rescue capabilities is dangerous. Therefore, patients with allergic rhinitis should prefer other treatments and use immunotherapy with caution.
(4) Surgical Therapy. Recent methods mainly include the following categories:
(1) Reducing Nasal Mucosal Sensitivity: Radiofrequency ablation, cryotherapy, laser, microwave, and 20% silver nitrate cauterization on the inferior turbinate mucosa can all reduce the sensitivity of the nasal mucosa surface, achieving symptom control.
(2) Reducing Parasympathetic Nerve Excitability: Petrosal nerve sectioning or greater petrosal nerve sectioning can reduce the excitability of the parasympathetic nerves in the nasal cavity, producing a certain therapeutic effect.
Surgical methods include low-temperature plasma radiofrequency ablation, ultrasound-focused treatment, microwave treatment, laser treatment, cryotherapy, and traditional surgical blade treatment. The short-term efficacy of surgery, especially in improving or relieving nasal congestion, thick nasal discharge, and headaches, is confirmed. However, the efficacy for other symptoms such as clear nasal discharge, sneezing, and nasal itching is not significant or ineffective. Despite the claims and advertisements, the long-term efficacy of surgery is not ideal.
Due to the regenerative nature of nasal tissues, the nerves cut postoperatively will regenerate, and the inferior turbinates removed will continue to grow. Surgery does not fundamentally alter the patient's atopic constitution, merely addressing symptoms. Large-scale follow-up surveys show that most patients will experience varying degrees of recurrence within 6 to 2 years postoperatively.
Therefore, for patients with rhinitis, treatment should follow the principle of starting simple and then complex, addressing both symptoms and root causes. Medication treatment should be prioritized to change the patient's atopic constitution, aiming for a curative effect. Of course, for patients with severe nasal anatomical abnormalities, excessively enlarged inferior turbinates, severe nasal septum deviation, or severe nasal polyps that do not respond to long-term medication, surgery remains a good option. However, medication treatment should still be used postoperatively to prevent recurrence.