Nowadays, the problem of allergic diseases is becoming more and more urgent. Every year there is an increase in the number of patients visiting the allergy office with various allergic manifestations. The most common allergic manifestations are: allergic rhinitis, allergic conjunctivitis, allergic bronchial asthma.
In the treatment of respiratory allergic diseases, three groups of drugs are most often used:
- antihistamines (histamine receptor blockers);
- corticosteroid hormones.
Antihistamines are used in various dosage forms: in tablets and syrup (Zyrtec, Kestin, Claritin, etc.), nasal sprays and eye drops (Allergodil, Histimet), both to prevent the development of allergy symptoms, and to relieve those who already have place of symptoms. The most modern antihistamines for oral administration include Telfast, Erius and Xizal. A special place among antihistamines in allergological practice is occupied by zaditen ketotifen). In addition to the effects characteristic of all antihistamines, it has an anti-inflammatory effect in bronchial asthma and atopic dermatitis. Most often I prescribe ketotifen for a long time; its anti-inflammatory effect develops after 2 – 3 weeks of admission. Cromones (mast cell stabilizers) – cromoglycate and nedocromil – are mainly used as prophylactic anti-inflammatory drugs. These drugs do not quickly relieve allergy symptoms; the therapeutic effect develops against the background of long-term use. A distinctive feature is their very high safety, which is very important in case of concomitant pathology. I use eye drops for allergic conjunctivitis (cromohexal, lecrolin, cromoglin and high-crom), nasal sprays for allergic rhinitis (cromohexal and cromoglin). Despite the pronounced antiallergic activity, local (topical) corticosteroid hormones (aldecin, nasobek, tafen nasal, flixonase and nazonex) have a fairly high safety, but require additional control from both an allergist-immunologist and an otorhinolaryngologist. They are used for severe symptoms or when antihistamines or cromones do not work well enough. As with the cromones, the healing effect develops gradually.
Particular attention is paid to the treatment of bronchial asthma. Medicines used to treat bronchial asthma are represented by two main groups:
- symptomatic medicines to eliminate bronchospasm, relieve an attack of suffocation;
- anti-inflammatory drugs for long-term treatment of bronchial asthma, suppression of allergic inflammation in the bronchi.
The action of symptomatic drugs of bronchodilators or bronchodilators is aimed at restoring bronchial patency and relieving bronchospasm. These drugs also include “ambulance” drugs for quickly relieving an attack of suffocation (ventolin, salamol, salbutamol and berotek). They are prescribed in accordance with the need and for basic therapy. In order to prevent bronchospasm, I increasingly use long-acting bronchodilators (serevent, oxis and foradil) in the treatment of bronchial asthma. The main drugs of basic anti-inflammatory therapy, the action of which is aimed at suppressing allergic inflammation in the bronchi, are glucocorticoid hormones, cromones and antileucotrienic drugs. Unlike emergency drugs, basic therapy drugs are prescribed for long-term prophylaxis of asthma exacerbations. Inhaled forms of cromones (tiled, intal and cromohexal) are considered the safest drugs for long-term treatment of bronchial asthma, but are effective only in milder forms of the disease. Antileukotriene anti-asthma drugs for oral administration – acolate and singular “fight” with leukotrienes; it is the action of histamine and leukotrienes that determines the development of allergic inflammation (they are mediators of allergic inflammation). Antileukotriene drugs have been created specifically for the treatment of bronchial asthma, but I also observe the effectiveness of these drugs in atopic dermatitis and allergic rhinitis. These drugs do not belong to hormones, there are no serious side effects behind them. Among all drugs for long-term treatment and control of bronchial asthma, gluco-corticosteroids (inhalation hormones – aldecin, beclazon, becladget, pulmicort and flixotide) show the greatest efficiency; These are the first line drugs in the treatment of moderate and severe bronchial asthma. In severe cases and with severe exacerbations of the disease, systemic steroid hormones are prescribed in tablets or injections (prednisone, dexamethasone, etc.). Reception for several days (up to 10 days) usually does not cause any significant side effects, but the therapeutic effect is significantly improved, especially in the torpid course of bronchial asthma.
Practice shows that in most cases one medicine is not enough, especially when the manifestations of the disease are pronounced. Therefore, in order to enhance the therapeutic effect, I often combine drugs (for example, seretide and symbicort are combined inhalers for the treatment of bronchial asthma). I carry out antibiotic therapy in the presence of a clinic of bacterial infection, taking into account adequate immunocorrection when confirming the development of systemic transient and immune deficiency.
In the conditions of our clinic, patients with allergic rhinitis, allergic conjunctivitis, allergic asthma, we conduct allergen-specific immunotherapy (ASI), while using the allergenic vaccine in gradually increasing doses to achieve remission of the disease or reduce the severity of symptoms of the disease. Allergenic vaccines (therapeutic vaccines for allergic diseases) are purified water-salt extracts of allergens or individual allergenic components isolated from them. The subcutaneous and sublingual route of administration of the allergen is mainly used. Depending on the duration of the courses, they carry out year-round, pre-season, seasonal ACi. The choice of method (pre-seasonal, seasonal, year-round) is determined by the etiology of the allergic disease. The most commonly used preseason ASi, the most effective mainly for hay fever. Year-round administration of pollen allergens (with a decrease in the dose of the administered allergen during the pollination period) gives the best clinical effect. I sometimes combine AS with basic and symptomatic therapy of allergic diseases (antihistamines, cromoglycate, nedocromil, inhaled glucocorticosteroids, b2-agonists, anticholinergics, methylxanthines). In medical and preventive work, I also pay great attention to a hypoallergenic diet, taking into account the cross-reaction of allergens.
Thus, in the implementation of a complex of therapeutic and prophylactic measures, several aspects are distinguished: medical, psychological, physical, professional. The medical aspect occupies one of the leading places and consists in correct and timely diagnosis, adequate treatment and secondary prevention. In the dynamic observation of patients with bronchial asthma and allergic rhinitis, psychological adaptation to long-term inhalation therapy and serious work on the elimination of the allergen are of great importance.