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References / Список литературы
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IMPORTANCE OF IMMUNOLOGICAL CHARACTERISTICS OF SYMPTOMS OF NOSE INFLAMMATION AND COMPOSITION CLEARANCE IN ALLERGIC RHINITIS Ulmasov A.O.1, Madaminova N.E.2, Kosimov K.K.3 Email: Ulmasov17161@scientifictext.ru
'Ulmasov Alijon Obidovich — Assistant; 2Madaminova Nigora Ergashevna — Assistant; 3Kosimov Kobil Kosimovich - Doctor of Medical Sciences, Professor, DEPARTMENT OF OTORHINOLARYNGOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: allergic diseases of the nasal cavity, one of which is allergic rhinitis, significantly reduce the quality of life of patients and are a factor predisposing to the development of bronchial asthma. Currently, many patients with this disease suffer. Patients prone to bronchial asthma struggle with the disease throughout their lives.
The article presents data on the importance of inhalation allergens in the development of allergic rhinitis and describes modern approaches to the diagnosis, treatment and prevention of this disease. In addition, the course in several patients has been described and compared separately. Keywords: allergic rhinitis, allergens, immunological assessment.
ВАЖНОСТЬ ИММУНОЛОГИЧЕСКИХ ХАРАКТЕРИСТИК СИМПТОМОВ ВОСПАЛЕНИЯ НОСА И ОЧИСТКА СОСТАВА ПРИ АЛЛЕРГИЧЕСКОМ РИНИТЕ Улмасов А.О.1, Мадаминова Н.Э.2, Косимов К.К.3
'Улмасов Алижон Обидович — ассистент; 2Мадаминова Нигора Эргашевна — ассистент; 3Косимов Кобил Косимович — доктор медицинских наук, профессор, кафедра оториноларингологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: аллергические заболевания полости носа, одним из которых является аллергический ринит, значительно снижают качество жизни пациентов и являются фактором, предрасполагающим к развитию бронхиальной астмы. В настоящее время страдают многие пациенты с этим заболеванием. Пациенты, склонные к бронхиальной астме, борются с заболеванием на протяжении всей жизни.
В статье представлены данные о значении ингаляционных аллергенов в развитии аллергического ринита и описаны современные подходы к диагностике, лечению и профилактике данного заболевания. Кроме того, курс у нескольких пациентов был описан и сравнен отдельно.
Ключевые слова: аллергический ринит, аллергены, иммунологическая оценка.
UDC 616.211-002
Relevance. Allergic rhinitis (AR) is a disease characterized by the presence of immunologically caused (most often IgE-mediated) inflammation of the nasal mucosa caused by a causal allergen, and clinically manifested daily for at least an hour with two or more symptoms: profuse rhinorrhea, difficulty in nasal breathing, itching in the cavity nose, repeated sneezing and often anosmia [2].
The disease can also be accompanied by extranasal symptoms (eye, headache, hypoxia, postnasal drip, cough, etc.). AR is one of the most common diseases, occurring in 2-25% of children and up to 40% of adults, and, despite the pronounced hypodiagnosis, is one of the 10 most common reasons for visiting a doctor.
In general, the development of AR entails not only a significant decrease in the patient's quality of life and significant pharmacoeconomic costs, but is also associated with a high risk of comorbid pathology, including bronchial asthma [4].
The modern classification of the disease involves a subdivision according to the severity and duration of symptoms [3]. In the latter case, the secretion of persistent (the presence of symptoms> 4 weeks a year or> 4 days a week) and intermittent AR (with a shorter duration of symptoms) persists [5].
In terms of severity, the classification remains as severe / moderate AR (in the presence of at least one such symptom as sleep disturbance, impaired daytime activity, limitation of opportunities for sports or work, difficulty in achieving control) and mild [1].
Purpose of the study. Improvement of treatment methods for recurrent rhinosinusitis.
Materials and research methods. To accomplish the goals and objectives set in the work, the following examination methods were used: retrospective analysis of 60 dispensary cards and case histories of patients with AR, curvature of the nasal septum; screening questionnaires using specially developed thematic maps; clinical and laboratory, functional, instrumental, otolaryngological and allergological methods; cytological examination of smears from the nasal mucosa.
Research results. Chronic rhinitis and anatomical deformations of the intranasal structures should be considered as the leading factors contributing to the dysfunction of the ciliated epithelium of the nasal mucosa and the recurrence of pyoinflammatory processes in the paranasal sinuses. In patients with recurrent sinusitis, vasomotor rhinitis occurred in 72% of cases, hypertrophic rhinitis - in 26% of cases, curvature of the nasal septum - in 39% of patients, ethmoid bulla hypertrophy - in 7% of patients, hypertrophy of the uncinate process - in 2.5% of patients.
In patients with recurrent sinusitis, conditionally pathogenic microflora prevails in the maxillary sinuses, which occurs in 85.4% of cases as a monoculture. The nasal cavity is dominated by saprophytic and opportunistic microflora, in 69.9% of cases present in the form of microbial associations. The data obtained suggest that the causative agent of the disease is the microflora isolated from the punctate of the maxillary sinus. The microflora of the nasal cavity should be considered as "travel", having no etiological significance.
Significant contamination of the nasal mucosa, including gram-negative opportunistic microflora with a wide range of antibiotic resistance, is one of the factors in the formation of local immune deficiency in patients with anatomical anomalies of the nasal cavity.
With recurrent sinusitis, in 58.5% of cases, there is a decrease in the level of secretory immunoglobulin A in saliva - up to 0.0232 ± 0.002 g / l, in nasal secretion - 0.0349 ± 0.0018 g / l, accompanied by an increase in immunoglobulin G in saliva - up to 0.2895 + 0.018 g / l and nasal secretion - up to 0.4350 ± 0.031 g / l.
Computed tomography of SNP, optical endoscopy, examination of mucociliary transport, local immunological status and microflora of the nasal cavity and maxillary sinuses make it possible to obtain complete objective information about the state of the pathological process in the paranasal sinuses in case of recurrent inflammation and to determine the optimal approach to treatment.
In recurrent sinusitis in the case of a deficiency of secretory immunoglobulin A, the most rational is the use of surgical correction of intranasal structures in combination with course intranasal administration of the IRS-19 immunomodulator. The developed approach allows to prevent recurrence of purulent inflammation in the paranasal sinuses and to reduce the incidence of ARVI by 65%.
Output. The main causes of recurrent inflammatory diseases of the nasal cavity and paranasal sinuses have been determined. The optimal volume of clinical trials has been established. An
algorithm for treatment is proposed, taking into account the state of the local immunological status.
The implementation of the research results will reduce the incidence rate in frequently and long-term
ill patients of working age.
In the prevention of allergic rhinitis, it is also of no small importance to educate patients on the
correct use of drugs, various measures for the prevention of exacerbations and self-control.
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