Allergic rhinitis: are there any problems? Case from clinical practice

Allergic rhinitis (AR) is found in the practice of doctors of various specialties, but making the correct diagnosis and prescribing adequate therapy can take many months and sometimes years. Currently, the problem of AR remains relevant, due to the extreme prevalence of AR, late diagnosis, underestimation of the possible risks of disease progression, complications, and the addition of such a formidable pathology as bronchial asthma. The path of the patient presented in the clinical case is quite typical for many patients with AR and concomitant pathology of nose. A young patient with allergic rhinitis received conservative treatment, and was later operated, but the effect was incomplete and short-lived. Only after 4 years, the patient was first examined by an allergist. Symptoms of AR indicate that the patient has an atopic status that promotes the involvement of various organs and systems in the inflammatory process.

To verify the diagnosis and clarify the entire spectrum of “guilty” allergens, a specific allergological examination was carried out, which included skin testing and determination of specific IgE antibodies. The main participants in allergic inflammation are mast cells, eosinophils, lymphocytes, epithelial and endothelial cells. The effect of mediators on vascular endothelial cells and neuroreceptors of the nasal mucosa leads to the formation of allergic inflammation and the onset of clinical symptoms of AR. One of the main mediators released upon repeated contact with an allergen in a sensitized body is histamine, therefore antihistamines are first-line drugs at any stage of AR therapy. In our clinical case, taking into account complaints, medical history, clinical manifestations, results of laboratory (specific, nonspecific) and instrumental methods, the patient needs treatment of the corresponding first stage of therapy based on symptom control. The effectiveness of 2nd generation H1-antihistamines in the management of symptoms such as pruritus, sneezing, and rhinorrhea is due to histamine-mediated development of the early phase of the allergic reaction, which in turn leads to the onset of the late phase and the chronic co Bilastine can be considered as the drug that most fully meets the requirements of ARIA experts for 2nd generation H1-antihistamines : selective blockade of H1 receptors, high antiallergic effect, rapid onset of clinical effect, duration of action 24 hours, lack of tachyphylaxis and good tolerance. The results of the studies and their analysis show that bilastine is the preferred choice for monotherapy of allergic rhinitis.urse of allergic inflammation in the nasal mucosa.

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