As it is known, allergic rhinitis is one of the most pressing issues of modern rhinology. At present, special attention is directed to the study of the problem of year-round allergic rhinitis, since in recent years its incidence in economically developed countries has been steadily growing. Often the only complaint of patients is the constant stuffy nose with mucous discharge, so both patients and doctors often underestimate the importance of timely diagnosis and treatment of the disease. According to research, year-round allergic rhinitis can contribute to the development of pathology of the nasopharynx, middle ear and auditory tube, nasal cavity and paranasal sinuses, which often take on a chronic or recurrent form. The treatment proposed in the clinical recommendations, carried out in three main areas, does not always lead to persistent remission of the atopic process. This article covers the course of ENT diseases against the background of respiratory chlamydia and mycoplasmic intracellular infection. The problem of year-round allergic rhinitis associated with respiratory intracellular infection has not been elucidated to date, but the chronization of the process, long uncontrolled course, and the tendency to complications of this pathology of the upper respiratory tract may be related to it.
Currently, allergic rhinitis is a global socioeconomic problem. According to current statistics, from 15 to 30% of the world’s population suffers from year-round or seasonal allergic rhinitis. Increasingly, the attention of Russian clinicians is attracted by the problem of year-round allergic rhinitis as there is an increase in the incidence in patients of the central zone of the Russian Federation with this form of rhinitis due to sensitization to house dust mite allergens, epidermal allergens of domestic animals, insect and mold allergens. Despite a timely diagnosis and received basic treatment, patients suffering from year-round allergic rhinitis often fail to achieve stable remission. Therefore, we can conclude that a more thorough diagnosis of the disease is needed, aimed at identifying other factors that affect the course of the disease. Objective. To develop a scheme for diagnosing a possible persistent respiratory chlamydial infection that affects the course of year-round allergic rhinitis in patients with a tendency to transient remissions. Materials and methods. Computed tomography of the paranasal sinuses, nasal swab for flora, PCR scraping of the nasal mucosa for the detection of Epstein–Barr virus (EBV) DNA, determination of viral DNA of cytomegalovirus infection (CMV) (PCR scraping of the nasal mucosa), determination of DNA in the scraping of epithelial cells of the nasal mucosa (PCR scraping) of human herpes virus type 6 (HHV-6 type). Patients who had pathological changes in computed tomography of the paranasal sinuses, deviations from the normal flora during bacteriological culture, and positive results in the PCR study of the above infections were excluded from the study. Then, PCR scraping of the nasopharyngeal mucosa for the detection of chlamydia pneumoniae, a survey of complaints (SNOT-22 questionnaire), data from an objective examination method (examination of ENT organs using video endoscopic technologies), an immunological examination of blood serum for IgG antibodies to chlamydial infection, further avidity of IgG antibodies to chlamydia pneumoniae and serum IL-6. Conclusion. The proposed diagnostic scheme will allow identifying a possible persistent respiratory chlamydial infection, which is the cause of transient remission of year-round allergic rhinitis, and developing a new integrated approach to the management of patients with year-round allergic rhinitis associated with this infection.
Allergic rhinitis is a widespread disease located at the junction of two specialties: otorhinolaryngology and allergology. Currently, it is characterized by an early onset, often continuously recurring course and refractory to traditional methods of treatment. Unstable remissions, a tendency to complications, and the lack of effectiveness of the therapy suggest that allergic rhinitis occurs against the background of secondary immunodeficiency, a favorable factor for the development of bacterial superinfection on the damaged mucous membrane of the nasal cavity. In conditions of impaired immune homeostasis, the microbial landscape of the nasal mucosa is characterized by polymorphism, bacterial agents can act as an infectious antigen. The article is devoted to a current problem – chronic IgE-independent allergic rhinitis due to allergen-specific lymphocytes or IgG antibodies with the formation of immune complexes. The article reveals the content of the concept of “chronic infectious-dependent allergic rhinitis”, its characteristic features are highlighted and described, the key stages of diagnosis are considered. The importance of knowledge about mediators of chronic eosinophilic inflammation for practitioners is reflected. The work is interdisciplinary in nature, written at the intersection of otorhinolaryngology, allergology and immunology and will be interesting to doctors of various specialties.
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