Posts tagged: (b) of allergi

diagnostic clues

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By , March 5, 2012 12:44 pm

center for allergy Allergy physician or too in terms of asthma, allergic rhinitis syndrome diagnosis easier. But for the pediatrician or primary care physicians, because of allergic rhinitis and allergic conjunctivitis, upper respiratory allergies related to the diagnosis of the problem across the curb section, easily overlooked by clinicians, coupled with general out-patient pediatric clinic and the primary mirror is usually not equipped with a nose , there are many atypical cases of allergic rhinitis, asthma, allergic rhinitis, resulting in syndrome diagnosis is easily missed or incomplete. ENT doctor diagnosed asthma in children missed or incomplete as well. Qingdao Li Minghua Fifth People’s Hospital allergy clinic

for typical history, symptoms and signs of allergic rhinitis asthma syndrome, you need a specialist based on history, symptoms, signs and diagnosis-specific immunity comprehensive and careful analysis to rule out eosinophilia non-allergic rhinitis, such as autonomic rhinitis only after other types of rhinitis, allergic rhinitis and other specific upper respiratory allergy diagnosis.

a child’s diagnosis of upper respiratory allergy

(a) diagnostic clues

1. history with a history of allergic inquiry and analysis rhinitis, allergic conjunctivitis, upper respiratory allergy diagnosis is very important. Ask parents and other family members of children with allergic rhinitis, allergic conjunctivitis, allergic asthma, urticaria and eczema and other allergies for the diagnosis of upper respiratory allergy of some help, infant eczema, allergic asthma and other personal medical history more helpful in the diagnosis of inquiry. Disease and the environment, history of the relationship between the season can become allergic rhinitis diagnosis and help provide the basis for finding allergens. If careful history, many patients with allergic rhinitis are able to provide specific allergens suspicious clues for the diagnosis to help.
2. typical clinical presentation allergic rhinitis, allergic conjunctivitis, upper respiratory allergies in children mainly of early repeated rubbing nose (to pull the nose), rubbed my eyes, such as performance, it is because nasal itching and itchy eyes caused by children often sneezing, runny, stuffy nose, tearing and eye secretions increase. The allergic rhinitis and allergic conjunctivitis in children with typical clinical presentation is often complained when the treatment is to help doctors diagnose one of the main basis. The disease usually has a fast onset, subside very soon features. Persistent allergic rhinitis and many more early morning wake up the majority of attacks, their incentives more with indoor allergens, such as room dust, dust mites, mold, or the temperature change is too large. Intermittent allergic rhinitis and allergic conjunctivitis is more concerned with pollen allergy, pollen released into the atmosphere in the season to attack heavy day, season after the signs and symptoms disappear soon.
3. specific immune diagnostic test

specific immune diagnostic tests to distinguish between allergic and non allergic most important means by which the most clinical value of the nasal allergen provocation test or conjunctival provocation test, which is the diagnosis of allergic rhinitis and allergic conjunctivitis reliable basis for . Serum and nasal secretions of IgE detection, such as skin test specificity is an important diagnostic indicator.
(b) of allergic rhinitis and allergic conjunctivitis was diagnosed :

allergic rhinitis and allergic conjunctivitis diagnosis depends on history, symptoms and immune bund inspection, a detailed history of allergic rhinitis are allergic conjunctivitis and diagnosis, differential diagnosis, to determine the severity of the expected results of the evaluation and treatment is very important.
1. With a typical history of atopic disease (including family history of allergic disease, I have a history of other allergies such as infant eczema, hives or asthma history) and typical clinical symptoms.
2. The main symptoms of allergic rhinitis showed nasal itching, sneezing frequently, runny nose, stuffy nose and other symptoms, the symptoms of allergic conjunctivitis such as ocular itching, tearing and eye secretions increase, these symptoms may disappear on their own or after treatment.
3. typical signs: of the inferior turbinate mucosa pale, grayish blue, mucosal edema or allergic rhinitis is typical of the signs, red and conjunctival hyperemia and increased secretions are signs of allergic conjunctivitis.
(c) the classification of allergic rhinitis:

time according to exposure to allergens, allergic rhinitis has been sub- for seasonal allergic rhinitis and perennial allergic rhinitis, but this classification is not very satisfactory. ARIA based on the following five kinds of situations that this classification is inappropriate: ① some regions drifting pollen and fungi are perennial in nature, there is no significant seasonal; ② perennial allergic rhinitis is not any day of the year have symptoms; ③ most patients sensitive to a variety of allergens, Ji almost throughout the year have different severity of symptoms, when exposed to pollen and fungal allergens seasonal increase after the show; ④ patients allergic to pollen usually fungi allergy, resulting in disease and allergenic pollen season is not consistent with drift period; ⑤ even in patients with pollen allergy is not the only period in the pollen drift have nasal inflammation in seasonal pollen released into the atmosphere outside, may also have low concentrations of pollen drift , leading to persistence of nasal inflammation, but mild inflammatory response, may show symptoms of rhinitis, or only mild symptoms and not for patients with attention, so the nasal inflammation in patients with hay fever is a long-standing, and proposed the exist)
For the above, ARIA proposed a new classification of allergic rhinitis, according to the severity of symptoms of rhinitis and its impact on quality of life of patients classified as At the same time according to the course is divided into Provides intermittent allergic rhinitis duration of symptoms less than 4 days per week throughout the year no more than 4 weeks; sustained duration of symptoms of allergic rhinitis more than 4 days per week throughout the year at more than 4 weeks. According to this classification, allergic rhinitis can be divided into four categories: ① intermittent mild; ② intermittent – severe; ③ persistent mild; ④ persistent – severe. See Figure 62-2.

Figure: Classification of allergic rhinitis

intermittent

number of days of symptoms:

· <4 days / week

· or duration <4 weeks

· and duration> 4 weeks

;

· work, Pok learning normal

· no bothersome symptoms

Second, the diagnosis of lower respiratory tract allergies

2 receptor agonist solution or aerosol spray; ② 0.1% epinephrine 0.01ml / kg subcutaneously (maximum of not more than 0.3ml / second). 4 years old children before and after treatment to monitor peak flow values ​​(PEF) or monitoring forced expiratory volume in 1 second (FEV1), ≥ 15% increase after treatment were positive. Can not monitor PEF or FEV1 children, can clinical observation, during any one kind of test than the 15 to 30 minutes, if the apparent ease breathing, wheezing was significantly reduced as positive. Remission for more than 5 years old children (the lungs is not known and wheeze), and FEV1 in the expected value of 80% or more, consider doing bronchial challenge test or exercise test, if positive can also be diagnosed as asthma.

(2) the use of bronchodilators for diagnostic treatment can temporarily alleviate the cough attack (basic diagnostic criteria);

– severe

one or more of the following:

· does not sleep

· daily activities, physical exercise, recreation and other affected

· does not work or Pok learning

· have disturbing symptoms

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