《（非洲）Clinical management of allergic rhinitis - the Allergy Society of South Africa Consensus update》由会员分享，可在线阅读，更多相关《（非洲）Clinical management of allergic rhinitis - the Allergy Society of South Africa Consensus update（4页珍藏版）》请在金锄头文库上搜索。
1、GUIDELINEDecember 2006, Vol. 96, No. 12 SAMJClinical Management of Allergic Rhinitis the Allergy Society of South Africa Consensus UpdateInadequately controlled allergic rhinitis in asthmatic patients can contribute towards increased exacerbation of asthma, poorer medical control and an increased de
2、mand on medical resources. If properly diagnosed and treated, a significant improvement in the patients wellbeing and quality of life (QOL) is to be expected, with the added bonus of the pharmaco-economic benefits that result when allergies are cured.Since the first comprehensive South African Conse
3、nsus statement,1 there have been several publications on new forms of therapy for patients with allergic rhinitis.2-4 The Allergy Society highlights advances and recommends the following.1. Classification of allergic rhinitisThe International Allergic Rhinitis and its Impact on Asthma (ARIA) Worksho
4、p report, supported by the World Health Organization (WHO) and compiled by experts from 16 countries, was published in the Journal of Allergy and Clinical Immunology.2 The ARIA document reclassified allergic rhinitis into persistent or intermittent, which may in turn be mild or moderate-severe. This
5、 new classification has been accepted by the World Allergy Organization and the European Academy of Allergy and Clinical Immunology (EAACI) and is now applied globally, replacing the old classification of perennial or seasonal rhinitis. The ARIA classification of allergic rhinitis also brought it in
6、 line with the Global Initiative for Asthma (GINA) classification of asthma, since rhinitis and asthma are considered components of the united airways, which share the same aetiology and pathology. Intermittent refers to rhinitis with symptoms lasting less than 4 weeks or for less than 4 days per we
7、ek. Persistent refers to rhinitis lasting more than 4 days a week for more than 4 weeks per year. Mild rhinitis does not interfere with sleep, sport, leisure or daily activities. Moderate to severe rhinitis affects sleep, work, daily activities, sport, leisure, school or causes troublesome symptoms.
8、3,4Different pharmacological treatments for mild, moderate or severe, intermittent or persistent rhinitis have been assessed using evidence-based medicine criteria3,4 and applied to South Africa.5In view of the long pollen seasons in Gauteng and Limpopo provinces, the Eastern Cape, the Eastern Free
9、State and the Western Cape, most patients who have pollen-induced rhinitis have persistent rhinitis.2. Assessment of rhinitis patients should be more comprehensive, and include non-nasal symptoms and quality of lifePatients with allergic rhinitis typically feel under par and are troubled by their di
10、sease. The QOL of rhinitis subjects has been reported to be worse than that of asthmatics.6 Doctors should assess their rhinitis patients holistically rather than just focusing on the nose.The Juniper Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)6 is a validated method of assessing QOL in
11、 patients with rhinitis and includes the following domains: activities, eye symptoms, nasal problems, practical problems, emotional problems, non-hayfever symptoms and sleep. These are scored using a 0 - 6 severity scoring system and provide a comprehensive assessment of allergic rhinitis patients.
12、Combined with an assessment of their medication requirements, QOL scores can be used to calculate a Global Severity Score (GSS),7 which may also be used to monitor improvement and response to treatment.3. Investigation of allergy in rhinitis patients in South Africa seldom requires large investigati
13、ve panelsSkin-prick testing remains the least expensive method of testing and will effectively diagnose the relevant allergies in over 80% of allergic rhinitis patients. A testing panel should include house dust mites (Der-p-1, Der-f-1), Bermuda grass, rye grass, and cat, dog, cockroach and fungal s
14、pores (Cladosporium, Alternaria and Aspergillus) in all South African regions, but should the history suggest it, plane and oak trees, maize pollen (Zea mays), and cypress and eucalyptus could be added. Pollen allergies in the Savannah, the Northern Province, Mpumalanga and Limpopo Province are inva
15、riably because of sensitivity to Bermuda, rye and eragrostis grass pollens.CLINICAL GUIDELINECorrespondence to: Professor Paul C Potter, Allergy Diagnostic and Clinical Research Unit, UCT Lung Institute, University of Cape Town. Tel. (021) 406- 6889, email ppotteructgsh1.uct.ac.zaP C Potter, G Carte
16、, G Davis, P Desmarais, R Friedman, M Gill, C Gravet, R Green, M Groenewald, M Hockman, P Jeena, O Jooma, G Joyce, A Manjra, M Ossip, R Seedat, J Steer, D Vidjak, L WolffPg 1269-1272.indd 126911/27/06 1:08:57 PMDecember 2006, Vol. 96, No. 12 SAMJGUIDELINESome patients with rhinitis are affected by foods. Non- immunoglobulin E (IgE)-mediated food-induced rhinitis appears to be more common th
