Entering the peak pollen period, the number of pollen allergy patients increased significantly, and the chief physician of the allergy department of Beijing Tongren Hospital answered questions on allergy issues

What to do with spring pollen allergies?

A vibrant spring, the sun is shining, the warblers are flying, and pollen allergies are on schedule. Since Beijing entered the peak pollen period, the number of pollen allergy patients who have recently visited hospitals has increased significantly.

For allergies, patients have many questions: Why is it that it has always been good, but overnight allergies? Why are there more and more people with allergies around me, is it a psychological effect? I am allergic, am I immune stronger than others? Why did desensitization increase allergens after one year?

Recently, a reporter from the Beijing News contacted Zhang Yuan, chief physician of the allergy department of Beijing Tongren Hospital, to answer questions about allergies one by one.

allergic

The root cause of the allergy is in the genes whether the onset is in the environment

Beijing News: Pregnancy, moving, colds, many people's allergies are "strange". How exactly do allergies come about? Can it be triggered by extraneous events?

Zhang Yuan: Whether a person is allergic to certain substances depends on genes, but whether the onset, the time and intensity of the onset, depends on whether he is exposed to the corresponding environment. For example, some people are allergic to artemisia grass, which is common in the north, but live in a city south of the Yangtze River, and without exposure to this substance, he may have no symptoms for the rest of his life.

There is also a common situation where there was no problem before, and suddenly the onset occurs in a certain year, because allergies also have a cumulative effect. Individuals have a threshold at which allergen exposure accumulates to a certain extent before triggering corresponding clinical symptoms and target organ diseases.

Beijing News: Is allergy a hereditary disease? Who are the high-risk groups?

Zhang Yuan: Allergy is a complex disease, heredity plays a certain role in it, there is a tendency to gather in families, but it cannot be called a hereditary disease, not that parents have it, children must have. This is true of any complex disease, such as diabetes and high blood pressure, and has a higher risk of developing it with a family history, but it is not necessarily the disease.

As for high-risk groups, our team has done many national epidemiological surveys on allergic rhinitis, and no clear high-risk factors for allergies have been found, and there are no significant differences between genders, ages and ethnicities. However, the degree of exposure to allergens in the environment and the occurrence of allergies are related, for example, our epidemiological survey in the grassland area of Inner Mongolia with high pollen concentrations showed that the incidence of pollen-induced allergic rhinitis in this area is about twice the national average.

Beijing News: There are more and more people with allergies, is it an illusion?

Zhang Yuan: According to our team's two longitudinal epidemiological surveys in the previous period, the average prevalence of allergic rhinitis in China was 2005.11% in 1, and the prevalence reached 2011.17% in 6, an increase of about 6.6% in 5 years, suggesting that the prevalence of allergic diseases is indeed gradually increasing, and we have also found this trend in outpatient clinics. This change may be related to the environment and climate change.

Beijing News: Are there more and more children with allergies because the environment in which they grew up became cleaner when they were young?

Zhang Yuan: This statement comes from a more important hypothesis, called the hygiene hypothesis, which holds that the more infections children get, the lower the chance of developing allergic diseases in the future, which was more popular about twenty years ago, but controversial, not reached a consensus, and then gradually faded, at least it cannot explain the occurrence of all allergic diseases.

Beijing News: Does allergy mean that immunity is stronger than normal?

Zhang Yuan: I can't say that. Under normal circumstances, the human body's type 1 and type 2 helper T cell response is in an organic balance, allergy refers to type 2 helper T cell response is hyperactive, not too strong immunity, but more extreme than normal people, which is a sick condition, so there is a type I allergic disease.

Regarding the relationship between allergies and immunity, many patients will also ask whether to enhance exercise and improve immunity, so that you can avoid allergic diseases, which is almost impossible, because allergic constitutions will not change easily, especially in adulthood. However, strengthening exercise and regular work and rest can make the frequency of clinical symptoms relatively reduced and symptoms reduced.

Beijing News: Are there any psychogenic allergies?

Zhang Yuan: Human emotions can indeed guide physical symptoms, such as being very nervous and unhappy, nasal symptoms, especially nasal congestion, may be aggravated, which is a parasympathetic process; Conversely, we rarely feel stuffy when we're excited and focused. These are not specific symptoms of allergies.

Beijing News: Will there be more and more allergens?

Zhang Yuan: In fact, it is the cumulative effect of allergen exposure, especially in children. For example, a patient, doing desensitization treatment, turned out to be only allergic to dust mites, and when he did a three-year review, he found that new allergens were added, because his exposure to other allergens in these three years also increased little by little. Some people will attribute it to desensitization that he has increased the allergen, which is not true.

Desensitization therapy has several important benefits, starting with blocking the natural course of onset and reducing the chance of developing asthma and other symptoms; Secondly, it can reduce the chance of patients adding new allergies, which have been reported in domestic and foreign literature, and may not be desensitized, and the allergens will increase after three years.

intervene

Pay attention to climate change and protect yourself in advance

Beijing News: After the pollen season, how are you receiving patients?

Zhang Yuan: Our outpatient volume is relatively fixed, but the proportion of pollen allergy patients has increased significantly, and some patients have severe clinical symptoms, and normal work and study have been seriously affected.

What impressed me was that there were both old and new patients. Because of the education on pollen allergy received in the past few years, old patients know their symptoms and normal treatment cycle very well, and they follow the doctor's advice, simply come over and prescribe medicine in advance; There are also some patients who have a bias in the overall cognition of this disease, and have not used regular medication in the past, and the symptoms are already very serious when they come, and the appeal is also very strong.

Indeed, the symptoms of allergies are also mild, including allergic rhinitis, conjunctivitis, and some people feel that it is just a little uncomfortable and does not pay much attention. In fact, allergy is a systemic disease of the whole body, if not well controlled, especially in the pollen stage, which is a very strong and rapid stage of exposure, it is easy to trigger asthma.

As doctors, we should share more professional knowledge, so that patients can have a correct understanding of the disease, and hope that patients can pay attention to the disease itself, rather than only paying attention to the serious clinical symptoms.

Beijing News: What are the factors that affect pollen allergy symptoms?

Zhang Yuan: First of all, pollen allergy has a strong temporal regularity. The pollen allergy season in Beijing is divided into two major peak periods, one is the spring pollen period and the other is the autumn pollen period. Currently in the spring pollen period, there are two main peaks in the spring pollen period, the first peak is about from January into March to mid-April around, pollen vegetation starts from elm trees, slowly to willows, and then cypresses; There may be a second peak after mid-April, with vegetation including ash, birch, pine and more. The autumn pollen period is generally from the beginning of autumn to the National Day, and the most common plants include artemisia, humulus, quinoa, ragweed, etc.

The patient's clinical symptoms are strongly correlated with pollen concentration exposure. We see that if the pollen broadcast concentration of the Bureau of Meteorology is very high, the number of patients visiting the clinic in the next few days will be relatively large, and the clinical symptoms will be relatively heavy; Climate change also has an impact, such as more lightning at the junction of spring and summer, lightning will cause pollen to burst, and there will be significantly more acute asthma attacks in the emergency department. If there is heavy rainfall on the first day and the pollen is knocked to the ground, after the next day is clear, the pollen concentration in the air will be higher, and the patient's allergy symptoms will be more serious.

Therefore, it is recommended that patients with hay fever should pay attention to climate change in addition to pollen concentration, and take precautions in advance, such as wearing masks and strengthening nasal irrigation. If you have obvious eye symptoms, you can wear an eye patch. If you identify your pollen allergen, it is recommended that patients should take medication regularly throughout the pollen season.

Beijing News: When is it appropriate for children to intervene in allergies? Can I use the medication normally?

Zhang Yuan: Children's allergies are also recommended by the guidelines, and parents are advised to follow the pediatrician's instructions and drug instructions, so don't worry too much.

The natural progression of allergies is a very important point for childhood allergies. When infants and young children are born, food allergies are the mainstay, diarrhea, eczema and other symptoms will occur, and with age, there is a high probability of gradually transitioning to respiratory diseases such as rhinitis and asthma. Early identification and avoidance of allergens can play a good role in blocking the natural process of allergies.

treat

Desensitization therapy can be eradicated, but the variety is limited

Beijing News: Can allergies be eradicated?

Zhang Yuan: Allergen-specific immunotherapy, commonly known as desensitization therapy is a unique treatment method for allergic diseases, which can be understood as the treatment of removing the roots of the people, which refers to a treatment method that allows patients to repeatedly contact with gradually increasing doses of allergen extracts on the basis of identifying the main allergens that cause allergic diseases, so that the body's immune system produces tolerance to such allergens, thereby controlling or reducing allergic symptoms. The treatment period is generally 3-5 years.

Beijing News: How wide is the therapeutic range of desensitization therapy?

Zhang Yuan: The more mature standardized vaccines in China are dust mites and artemisia. Both allergies are applicable.

Beijing News: Who is suitable for desensitization?

Zhang Yuan: First of all, it is recommended to compare patients with a single allergen allergy, if you have other allergens, such as dust mites are also allergic to pets, and you can't give up small animals, you can also choose to desensitize dust mites, at least about half of the causes can be removed, reduce the burden of allergens; Secondly, the specific IgE concentration for allergens is preferably relatively high, so that the response to immunotherapy is stronger.

If you have a lot of allergens, regular medication is recommended. Of course, in special cases, especially when the effect of conventional treatment is not ideal, you can also fully communicate with the doctor to develop a personalized treatment plan.

Beijing News: Can you desensitize both at the same time?

Zhang Yuan: At the same time, desensitization is theoretically possible, for example, there are many patients who are allergic to the two allergens of dust mites and artemisia. However, the vaccine against Artemisia was only launched the year before last, and it is still a new thing in China, so it is desensitized at the same time and has little experience. Theoretically, if the desensitization of two allergens is carried out at the same time, we recommend that at least wait until the desensitization treatment of one allergen has entered a relatively stable maintenance period before starting immunotherapy of the second allergen, and closely monitor the adverse reactions of patients and actively respond during the treatment process. Of course, it is best to carry out corresponding clinical treatment after there is evidence-based evidence of desensitization of two allergens at the same time in China.

Beijing News: Can you desensitize directly in your life? For example, when I was a child, I drank milk and diarrhea, but I have always drunk it, and now it seems to be better.

Zhang Yuan: Some children have food allergies when they are young, and they can indeed tolerate them when they grow up, but inhalation allergies are less likely to occur self-tolerance. There are also people who are intolerant to food for life, and even suffer extreme allergies and shock as soon as they eat. Everyone's physique is different. Patients with a history of food allergies are advised to actively record the types of foods they are allergic to and stock up on certain antihistamines in case they need them.

Beijing News: The process of desensitization is also a cumulative process, will it aggravate allergies?

Zhang Yuan: This is a problem that is fully considered when formulating the desensitization treatment plan, so the process of desensitization is to gradually increase the dose, rather than exposing the patient to a large dose at once. With long-term treatment, the maintenance amount is achieved, and then a long-term effect is maintained.

Medication

Patients must follow the doctor's advice when to stop taking the drug

Beijing News: Is it possible for allergies to heal on their own?

Zhang Yuan: This possibility is extremely small. The first thing to make sure is that he has checked for allergens and confirmed that it is an allergy, not just an allergy-like symptom. Secondly, the severity of allergies is also related to the concentration of allergens in the environment and their own status.

Beijing News: Some patients feel that allergies are difficult to cure, and there is no point in checking allergens, it is better to use drugs directly.

Zhang Yuan: The significance of checking allergens, first of all, is to clarify the diagnosis, relying on symptoms to judge belongs to "impression diagnosis", if there is no laboratory basis, in fact, it cannot be diagnosed. Some patients find that there is no allergen after examination, he is actually non-allergic rhinitis is more likely, belongs to eosinophilia or vasomotor rhinitis, they react more violently to temperature changes, irritating odors or particles than ordinary people, and are more common in clinical practice. Of course, it is also possible that "local allergic rhinitis" occurs only locally in the nasal cavity.

Clarify the allergen, can achieve three benefits, the first is to avoid allergens in life as much as possible, such as allergies to kittens and dogs, that can be avoided; Second, suitable for desensitization treatment, for dust mites and artemisia allergies, desensitization treatment can be carried out; Third, for patients with pollen allergy, knowing the pollen dispersal cycle of their allergy, they need to carry out protective and standardized drug treatment in advance.

Beijing News: Will anti-allergic drugs cause drug dependence and tolerance? There are also patients who say that they have gained dozens of pounds with hormones, will they really gain weight?

Zhang Yuan: At present, the first-line clinical drugs for allergies, such as nasal hormones, nasal antihistamines, oral antihistamines and leukotriene antagonists, are not dependent and basically not resistant. Patients feel that the poor response of the drug may be related to the degree of disease, and the rebound after stopping the drug is related to the characteristics of the disease, because the patient is exposed to the allergen environment again.

At present, the big misunderstanding in treatment is that patients have poor treatment compliance, often use for a few days to feel that the symptoms are relieved, and stop the drug on their own. In fact, there is a time difference between the control of symptoms and the complete control of inflammation, so we often recommend that patients look at the drug insert, which generally writes 28 days of medication, which is the data obtained after animal experiments and so on, and it may be easier to completely control inflammation around the week. Therefore, patients must follow the doctor's advice.

Patients worry that the more medicine they take, the more harmful substances they ingest in their body, or they are afraid when they hear about hormones and worry that they will gain weight. In fact, this is also a misunderstanding. First, we use drugs to control diseases, especially chronic diseases, in the hope that the progression of the disease does not lead to more serious problems. The so-called side effects of hormones refer to long-term use, generally injection or oral systemic administration, the unit is milligrams, the most important first-line drug for allergic rhinitis is nasal spray hormone, which plays a comprehensive anti-inflammatory role, but the amount of nasal spray hormone is very low, are administered according to micrograms, this low dose, re-enter the blood, feedback to the whole body, side effects are almost negligible.

remind

The pollen allergy season in Beijing is divided into two major peak periods, one is the spring pollen period and the other is the autumn pollen period. Currently in the spring pollen period, there are two main peaks in the spring pollen period, the first peak is about from January into March to mid-April around, pollen vegetation starts from elm trees, slowly to willows, and then cypresses; There may be a second peak after mid-April, with vegetation including ash, birch, pine and more. The autumn pollen period is generally from the beginning of autumn to the National Day, and the most common plants include artemisia, humulus, quinoa, ragweed, etc.

It is recommended that patients with hay fever should pay attention to climate change in addition to pollen concentration, and take precautions in advance, such as wearing masks and strengthening nasal irrigation. If you have obvious eye symptoms, you can wear an eye patch. If you identify your pollen allergen, it is recommended that patients should take medication regularly throughout the pollen season. ——Zhang Yuan, chief physician of the Department of Allergology, Beijing Tongren Hospital

Beijing News reporter Dai Xuan