过敏性鼻炎怎样治疗？
过敏性鼻炎的症状：鼻子发痒、连续打喷嚏、流清涕、鼻塞等；过敏性鼻炎,又称变态反应性鼻炎,是鼻腔黏膜的过敏性疾病。它也是孩子在婴幼儿时期发生率最高的过敏性疾病。在门诊中接诊过很多过敏性鼻炎的患儿,老是打喷嚏、流鼻涕,家长起初以为是着凉感冒了,就给孩子吃些感冒药,吃了几天也不见好,而且症状还越来越严重,带孩子到医院一检查才发现.原来孩子患上的是小儿过敏性鼻炎。
过敏性鼻炎的治疗包括避免过敏原接触，鼻腔冲洗，药物治疗，和特异性免疫治疗等。
- 避免过敏原接触
过敏原控制的主要方式是减少患儿暴露于尘螨中。然而，一项 696 例儿童的多中心随机对照试验发现不同的预防措施没有明显区别。因此，过敏性鼻炎及其对哮喘的影响指南并不推荐使用任何化学或物理方法来减少尘螨暴露。
在另一项随机对照试验中，在对猫皮屑过敏的儿童进行环境控制后，过敏性鼻炎症状能显著减少。2010 新版过敏性鼻炎及其对哮喘的影响指南推荐这类过敏患者应避免动物皮屑和真菌的接触。 - 鼻腔冲洗
用盐水冲洗鼻腔是一种治疗过敏性鼻炎廉价且有效的方法。在 20 例过敏性鼻炎患儿的随机对照试验中，高渗盐水（0.9％的生理盐水是等渗透的，超过这个浓度就是高渗，低于这个浓度就是低渗透。）冲洗鼻腔两周能明显减轻鼻痒、鼻塞，流涕，打喷嚏等症状并能减少抗组胺药（具有抗过敏作用的一类药物）的使用。
盐水冲洗可以增强粘液纤毛传输功能，减轻粘膜水肿，减少炎性介质，有效地清除鼻腔细菌，机械性清理鼻腔浓缩的粘液。因为儿童对细喷雾的偏好，所以盐水冲洗是一种比较好的选择。在理想情况下，对于症状持续 1 个月以上的患儿，鼻腔冲洗也可以纳入日常冲洗方案。 - 药物治疗
儿童过敏性鼻炎的药物包括口服或鼻用抗组胺药、鼻用皮质类固醇（大部分是激素类）和白三烯受体拮抗剂（目前白三烯受体拮抗剂已经用于哮喘合并过敏性鼻炎患者的治疗）。指南认为鼻用类固醇应优先用于中重度持久性过敏性鼻炎。抗组胺药
目前，抗组胺药物分为第一代抗组胺药物 (如扑尔敏) 和第二代抗组胺药物（如西替利嗪）。由于第一代抗组胺药容易引起中枢系统的抑制，影响儿童正常生活，正逐步被淘汰。第二代抗组胺药物起效快，抗敏作用强，疗效高，副作用少，疗效持续时间长，能显著降低鼻部过敏症状评分。
对于轻中度间歇性或轻度持续性过敏性鼻炎患儿，过敏性鼻炎及其对哮喘的影响指南推荐，如果有对抗组胺药有反映，抗敏治疗应持续一个月。如果没有改善，应该重新选择治疗药物。研究发现口服和鼻用制剂同样有效，但鼻用制剂起效更快。
同时，父母和患儿应该首先了解抗组胺药可能引起的副作用 (包括嗜睡、头痛、胃肠道不适等)。其中，头痛是最常见的副作用。研究发现西替利嗪和氯雷他定可用于超过 2 岁的儿童。但是盐酸左旋西替利嗪仅能用于 6 岁以上的儿童。 - 鼻用皮质类固醇
糖皮质激素在抑制过敏反映中起着关键作用。研究者发现与安慰剂组相比，糠酸莫米松组能显著减少鼻部过敏症状评分。鼻用皮质类固醇抗敏效果明显优于抗组胺药，同时能有效治疗鼻内充血。糠酸莫米松和氟替卡松丙酸都被批准用于 6 岁以上儿童。然而，欧洲过敏及临床免疫学会认为这两种药物也同样可以用于 2 岁儿童。
在使用鼻用皮质类固醇前，父母和患儿应该首先了解该药的副作用，包括鼻出血，头痛，嗅觉异常等。研究表明，鼻用类固醇与安慰剂出现的副作用相似。 - 其他药物治疗
白三烯是由肥大细胞和嗜酸性粒细胞等炎症细胞产生的炎症介质。研究发现，抗白三烯药物和抗组胺药一样有效，但不能像鼻用糖皮质激素一样有效地改善鼻部过敏症状评分，提高患者生活质量。
抗白三烯药物（如孟鲁司特）适用于间歇性和持续性过敏性鼻炎，是治疗过敏性鼻炎的三线治疗药物，尤其是过敏性鼻炎合并哮喘的患儿。抗白三烯药物能减少支气管痉挛，减轻炎症反应。而孟鲁司特，作为一种长效抗白三烯药物，适用于 6 岁以上患儿。
鼻减充血剂能解除鼻塞，但对其他症状没有帮助。但是，长期使用容易产生反弹性鼻塞。过敏性鼻炎及其对哮喘的影响指南不推荐儿童使用鼻减充血剂治疗过敏性鼻炎。 - 免疫治疗
免疫疗法或脱敏治疗，可以诱导患儿对过敏原产生免疫耐受，预防过敏性鼻炎进一步发展，同时提高患儿生活质量。
免疫治疗可以分为皮下注射或舌下含服两种方式。儿童更适合选则舌下含服免疫治疗。一项 22 个双盲随机对照试验荟萃分析发现，免疫疗法能显著降低儿童及 3-18 岁青少年鼻部过敏症状评分。
舌下含服免疫治疗的副作用包括局部发痒、轻度哮喘、过敏反应等。循证医学显示该治疗很少出现严重副作用。免疫治疗前服用抗组胺药可以减少副反应出现的频率和严重程度。
免疫治疗通常用于 5 岁以上患儿。另外，特异性免疫治疗还可以降低过敏性鼻炎患者发生哮喘的风险。因此，当最大药物剂量仍不能有效控制过敏性鼻炎症状时，免疫治疗或许可以减轻过敏性鼻炎患者的负担并降低哮喘发病风险。
本文只做参考，杏林港湾提醒：因个体差异性，有相关症状的朋友还是到医院呼吸科、耳鼻喉科找专业大夫诊治更为安全、合适！
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