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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.0530

摘要内容如下：

重要性

过敏性鼻炎影响约15%的美国人口（约5000万人），并与哮喘、湿疹、慢性或复发性鼻窦炎、咳嗽以及紧张性头痛和偏头痛有关。

观察

当上皮屏障的破坏使过敏原穿透鼻道粘膜上皮，诱导2型辅助性T细胞炎症反应并产生过敏原特异性IgE时，就会发生过敏性鼻炎。过敏性鼻炎通常表现为鼻塞、鼻漏、鼻后引流、打喷嚏以及眼睛、鼻子和喉咙发痒的症状。在一项国际研究中，过敏性鼻炎最常见的症状是鼻漏（90.38%）和鼻塞（94.23%）。非变应性鼻炎患者主要表现为鼻塞和鼻后引流，常伴有鼻窦压力、耳塞、声音低沉和疼痛，以及咽鼓管功能障碍，对鼻用皮质类固醇的反应较小。季节性变应性鼻炎患者的典型体检结果是鼻甲水肿和苍白。常年性变应性鼻炎患者的鼻甲通常出现红斑和炎症，伴有浆液性分泌物，在体检时与其他形式的慢性鼻炎相似。非变应性鼻炎患者的特异性IgE空气过敏原检测结果为阴性。间歇性变应性鼻炎定义为症状发生少于连续4天/周或少于连续4周/年。持续性变应性鼻炎定义为症状出现频率超过连续4天/周和超过连续4周/年。过敏性鼻炎患者应避免刺激过敏原。此外，轻度间歇性或轻度持续性过敏性鼻炎的一线治疗可能包括第二代H1抗组胺药（如西替利嗪、非索非那定、地氯雷他定、氯雷他定）或鼻内抗组胺药（如氮卓斯汀、奥洛他定），而持续性中重度过敏性鼻炎患者应首先使用鼻内皮质类固醇（如氟替卡松、曲安西龙、布地奈德、莫米松）治疗相反，非变应性鼻炎患者的一线治疗包括鼻内抗组胺药单药治疗或与鼻内皮质类固醇联合治疗。

结论和相关性

过敏性鼻炎伴有鼻塞、打喷嚏、眼睛、鼻子和喉咙发痒等症状。应指导过敏性鼻炎患者避免刺激过敏原。治疗方法包括第二代H1抗组胺药（如西替利嗪、非索非那定、地氯雷他定、氯雷他定）、鼻内抗组胺药（如氮卓斯汀、奥洛他定）和鼻内皮质类固醇（如氟替卡松、曲安西龙、布地奈德、莫米松），应根据症状的严重程度和频率以及患者的偏好进行选择。

英文原文如下：

Abstracts

Importance  Allergic rhinitis affects an estimated 15% of the US population (approximately 50 million individuals) and is associated with the presence of asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches.

Observations  Allergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE. Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat. In an international study, the most common symptoms of allergic rhinitis were rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis present primarily with nasal congestion and postnasal drainage frequently associated with sinus pressure, ear plugging, muffled sounds and pain, and eustachian tube dysfunction that is less responsive to nasal corticosteroids. Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates. Patients with perennial allergic rhinitis typically have erythematous and inflamed turbinates with serous secretions that appear similar to other forms of chronic rhinitis at physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens. Intermittent allergic rhinitis is defined as symptoms occurring less than 4 consecutive days/week or less than 4 consecutive weeks/year. Persistent allergic rhinitis is defined as symptoms occurring more often than 4 consecutive days/week and for more than 4 consecutive weeks/year. Patients with allergic rhinitis should avoid inciting allergens. In addition, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine), whereas patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine. In contrast, first-line therapy for patients with nonallergic rhinitis consists of an intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid.

Conclusions and Relevance  Allergic rhinitis is associated with symptoms of nasal congestion, sneezing, and itching of the eyes, nose, and throat. Patients with allergic rhinitis should be instructed to avoid inciting allergens. Therapies include second-generation H1 antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine), intranasal antihistamines (eg, azelastine, olopatadine), and intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) and should be selected based on the severity and frequency of symptoms and patient preference.

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