What Are the Signs of an Allergic Reaction to Citrus?

Allergic constitution refers to a person with poor physical immunity. People with allergies are often inherited from their parents. On the other hand, it is related to diet, stress, which leads to poor resistance and insufficient immune function. People with allergies have symptoms such as allergic rhinitis, allergic bronchial asthma, and allergic dermatitis.

Allergic constitution

Allergic constitution refers to a person with poor physical immunity. People with allergies are often inherited by their parents. On the other hand, they are caused by diet and stress.

The following are common allergens:

Food: Seafood, shellfish, peanuts, eggs, milk, coffee and other high-protein protein-containing foods and spicy foods.

Plants: pollen, aloe, tangerine, mulberry, seaweed, etc.

Drugs: Aspirin, penicillin, analgesics, sedatives, antibiotics, contraceptives, etc.

Chemical substances: hair dyes, pesticides, paints, preservatives, sunscreens, alcohol, incense, artificial colors, cold wave agents, rubber, gasoline, etc.

Metal substances: gold, silver, copper, mercury, lead, nickel.

Others: animal fur, leather goods, fibers, mosquito bites.

1. People who have an allergic constitution in their daily diet should pay attention to their diet. Do not eat greasy and spicy foods, and eat less sweets. These foods may worsen allergic symptoms. Eating more vitamin-rich foods can strengthen the body's immune system. Broccoli and citrus are resistant to allergies and should be eaten daily. Eat more high-calorie foods and never eat cold foods. ^[1]

Patients with allergies should pay attention to the balance of diet and nutrition, and eat less oily, sweet and irritating food, tobacco, alcohol, etc. Some foods too

Since the symptoms of allergic skin vary from person to person, their performance varies. Therefore, choose skin care products with great care and follow these principles when purchasing:

1. Do not choose products that are too scented, because they contain too many fragrances, are too complicated, and easily cause allergies.

2, products containing alcohol and fruit acid ingredients should also be used with caution, because it has a large irritation to the skin, no doubt worsens for sensitive skin.

3. Do not use deep cleansing scrubs and exfoliating creams, these are products that aggravate allergies.

4. When purchasing, you should choose products marked "for sensitive skin", or "hypoallergenic" or "tested by a dermatologist".

5. Misuse of cosmetics can cause cosmetic allergies, even "cosmetic dermatitis" and "hormonal-dependent dermatitis", so it is worthy of attention.

Allergic constitution refers to the body state prone to various allergic reactions. An allergic reaction is when an antigen (

The main manifestation of allergic physiques is Combined Allergic Rhinitis and Asthma Syndrome, also known as Allergic Syndrome, including allergic rhinitis, allergic asthma, allergic conjunctivitis, allergic pharyngitis and eczema This is the proposed new medical diagnosis name, which refers to the clinical or subclinical upper respiratory tract allergy (allergic rhinitis) and lower respiratory tract allergic symptoms (asthma) that occur at the same time, and the two often coexist. The link between allergic rhinitis and allergic asthma was observed as early as the 1960s. An epidemiological survey confirms that the incidence of asthma in patients with allergic rhinitis is 4-20 times higher than that of normal people, the incidence of asthma in normal people is about 2-5%, and the incidence of asthma in patients with allergic rhinitis can be as high as 20-40%, and some even think that 60% of allergic rhinitis may develop asthma or have lower respiratory symptoms. The continuity of anatomical structure and physiological function of nasal cavity and bronchi determines the relationship between allergic rhinitis and asthma. Therefore, some scholars have proposed the concepts of "United Airways", "Allergic Nasal Bronchitis" and "Full Airway Syndrome", and believe that upper and lower respiratory diseases require joint diagnosis and joint treatment. Some scholars have also proposed the concept of Atopic syndrome and believe that it should be treated from a systemic perspective. The World Organization of Allergy (WAO) and the journals of Allergy & Clinical Immunology International and International Archives of Allergy and Immunology formally propose the use of diagnostic terms for pediatric allergic rhinitis asthma syndrome.

Because allergic rhinitis and asthma are type allergies, they are very similar in terms of etiology, immunology and pathogenesis, so there are many similarities between the two diagnostic methods and treatment methods. With the help of pediatric allergic rhinitis The new diagnostic name of asthma syndrome, the combined diagnosis and treatment of two diseases, can improve the diagnostic accuracy of both diseases and reduce the repeated use of drugs, thereby greatly reducing the rate of misdiagnosis and improving the clinical efficacy.

Anaphylaxis anatomy and physiology

The nasal cavity is closely related to the bronchi and lungs, both anatomically and physiologically. The respiratory tract refers to the respiratory bronchioles that begin from the nostril and are covered with ciliated epithelium. The upper and lower respiratory tracts are functionally related, and stimulation of the nasal mucosa (such as the nasal mucosa provocation test) can cause changes in airway responsiveness. The nasal inflammatory secretions of patients with allergic rhinitis can flow into the lungs through the nostril and pharynx, which is called postnasal drip syndrome. In particular, nasal inflammatory secretions inadvertently flow into the airway while sleeping in the supine position are likely to be an important cause of the development of allergic rhinitis into asthma, especially nocturnal asthma. Changes in breathing patterns are also one of the factors that lead to the close relationship between allergic rhinitis and asthma. Swelling of the nasal mucosa, turbinate hypertrophy, and retention of secretions can lead to nasal congestion, which forces patients to change from nasal to oral breathing Mainly, this way allergens can avoid the nasal mucosa barrier and directly enter the lower respiratory tract to cause asthma.

However, there are differences between the upper and lower airways. In the upper respiratory tract, occlusion of the nasal cavity is caused by vascular congestion of the nasal mucosa or nasal polyps; in the lower respiratory tract, bronchial ventilation dysfunction is mainly caused by the contraction of the circular smooth muscles of the bronchi and inflammation of the airway mucosa. In terms of the physical mechanism of airflow inhalation, the physical filtering function of the upper airway, resonance, heat dissipation and moisturizing function can block inhaled particles larger than 5-6 microns in the nasal cavity, and keep the air inhaled into the bronchus moist and close to 37 ° C. Disturbances in the physical function of the upper airways can cause steady-state changes in the lower airways. In asthmatic patients, excessive ventilation with the mouth and inhalation of high-flow cold air can reduce FEV1 and increase airway ventilation resistance.

Pathogenesis of allergic constitution

The immunological and pathological changes of the upper and lower respiratory tract in children with allergic rhinitis asthma syndrome are allergic inflammation that occurs in the nasal and bronchial mucosa, respectively. Inflammation of the nasal and bronchial mucosa is very similar in terms of pathogenesis, genetic changes, local pathological changes, abnormal immune function and pathogenesis. For example, allergic inflammation of the nasal mucosa and bronchial inflammation of asthma are usually caused by the same allergen, and their pathogenesis is related to type I allergies. The pathology is allergic inflammation characterized by increased eosinophils in the respiratory tract. The susceptibility of children with allergic rhinitis to asthma syndrome to allergens, that is, atopy is the main factor for the onset of asthma, and the main indicator of atopy in patients with asthma is the total IgE and specific IgE in the body The level increases. The occurrence and development of allergic inflammation of the upper or lower respiratory tract in children with allergic rhinitis asthma syndrome is related to the type and concentration of specific allergens in patients with allergic constitution. Seasonal allergens, such as grass or tree pollen, can cause intermittent symptoms, which are intermittent / seasonal allergic rhinoconjunctivitis and / or asthma. Allergens such as house dust mites, molds, and animal skins that are present throughout the year are more likely to cause persistent symptoms of asthma and / or rhinitis. To some extent, the allergen's sensitization is related to the particle size of the allergen, because pollen is usually about 5 microns in diameter and is very easy to be filtered by the upper respiratory tract barrier. When nasal congestion occurs and mouth breathing is switched to, the filtering function of the upper respiratory tract is avoided, which can cause symptoms of the lower respiratory tract. House dust mites, mold spores, and pet allergens are small (approximately 1 micrometer in diameter), so they can easily enter the lower respiratory tract and induce asthma.

Inflammation of the nasal and bronchial mucosa plays a key role in the pathogenesis of allergic rhinitis and asthma. Although there are different indicators of inflammation in allergic rhinitis and asthma, immunopathology has confirmed that chronic allergic inflammation in the upper and lower respiratory tracts is similar, with similar types of inflammatory cell exudation such as eosinophils, Th2 Cells, mast / basophils, and IgE are involved, and the participating cytokines are similar, such as IL-4, IL-5, IL-13, RANTES, GM-CSF, and various inflammatory mediators.

Allergic rhinitis and asthma are consistent with the systemic immunological response after inhalation of allergens: Allergens can promote the transformation of T lymphocytes to Th2 cells, and T lymphocytes play a leading role in initiating and regulating the airway inflammation response, T Cells synthesize and release cytokines to cause inflammatory cells to aggregate into the airway and activate them, thereby exerting their effector functions; the type and number of cytokines changes, such as increased production of IL-4, IL-5, IL-13 and -interference Decreased hormone synthesis; can increase IgE levels in the body. Like other allergic diseases, the increase in total IgE levels and specific IgE levels in the body is the main feature and important diagnostic indicator of pediatric allergic rhinitis asthma syndrome. The severity of atopic disease is positively correlated; can increase peripheral blood eosinophils and tissue mast cells / basophils.

Based on the above immunological changes, mast cells and eosinophils that bind to IgE are activated upon contact with allergens, releasing histamine, leukotriene, and other mediators. This reaction can cause rapid nasal irritation symptoms in the upper respiratory tract, such as nerve-mediated sneezing and runny nose, and nasal congestion caused by vascular congestion. Rapid symptoms in the lower respiratory tract are bronchospasm and airway inflammation, which can cause cough, sputum, and wheezing.

The focus of research on pediatric allergic rhinitis asthma syndrome is local pathogenesis, such as the synthesis mechanism of local IgE in the respiratory tract and the differentiation mechanism of selective T cells. These local mechanisms determine whether the inflammatory response after inhalation of the allergen is expressed in the upper or lower respiratory tract. Studies have found that epithelial cell shedding is more pronounced in the bronchi than in the nasal cavity. Most patients with asthma have airway remodeling confirmed by electron microscopy, but rhinitis patients can maintain the integrity of the nasal mucosa without such obvious changes. The reason why rhinitis patients can keep the mucosa intact and asthma patients cannot, the reason may be that the nasal mucosal epithelial cells can synthesize and release the anti-inflammatory substances that have a key role. These anti-inflammatory substances can inhibit the inflammatory damage caused by eosinophils.

Marchand et al.'S study of asthma patients with rhinitis found that there are many similarities in the pathological changes of the nasal and bronchial mucosa, including a large amount of eosinophil infiltration, lymphocytosis, goblet cell proliferation, subepithelial microcirculation and Massive exudation of plasma. Modern medicine confirms that the allergic inflammation of the upper respiratory tract of allergic rhinitis can gradually spread to the lower respiratory tract, and allergic pharyngitis, allergic bronchitis, and asthma can occur in succession, forming a full respiratory allergy phenomenon. Because the upper and lower respiratory tract of children with allergic rhinitis and asthma syndrome are allergic inflammation, only the lesions are different, and the continuity of anatomy and the similarity of pathophysiology, so the lower respiratory tract allergic inflammation of asthma is actually The upper is an extension of the upper respiratory tract inflammation of allergic rhinitis. In addition, there is a nerve reflex between the nose and the bronchus, such as nasal-bronchial reflex (the mechanical stimulation of the nasal mucosa of a human or an animal can affect the respiratory rhythm and increase airway smooth muscle tension and glandular secretion. This phenomenon is called nasal -Bronchial reflex) and so on. Based on the above reasons, a new concept of pediatric allergic rhinitis asthma syndrome was proposed clinically.

Allergic constitution diagnosis

The diagnosis and treatment of pediatric allergic rhinitis and asthma syndrome should refer to the work report of allergic rhinitis formulated by the WHO in 2001 and the asthma initiative formulated in 2002, respectively. The former includes "Allergic rhinitis and its impact on asthma" (ARIA), the "Diagnosis and Treatment Guidelines for Allergic Rhinitis" and the ARIA Manual; the latter includes "Global Asthma Prevention and Treatment Initiative" (Global Initiative for Asthma, GINA for short), "Global Asthma Treatment and Prevention Strategy-NHLBI / WHO Conference Work Report" and other documents.

The diagnosis of pediatric allergic rhinitis asthma syndrome is a combined diagnosis of allergic rhinitis and asthma. All patients with allergic rhinitis and / or sinusitis should determine the presence of lower respiratory tract symptoms by carefully consulting their history, symptoms, and signs. Suspects should perform airway reactivity testing or bronchiectasis tests to determine whether they are accompanied by asthma. The GINA public account for children's asthma prevention has a specific explanation for allergic rhinitis, allergic asthma, and variant asthma. For patients with allergic rhinitis who temporarily have no wheezing symptoms, they should be evaluated by non-specific or specific airway responsiveness. Suspicious patients with wheezing symptoms can be tested for bronchiectasis. Patients with asthma as the main manifestation should also be asked if there are intermittent or persistent nasal symptoms, and a rhinoscopy should be performed at the same time, and a specific nasal mucosal provocation test should be performed to determine if necessary. The diagnosis of pediatric allergic rhinitis asthma syndrome mainly depends on medical history, clinical symptoms and immunological examinations.

(1) Typical history of allergies (including family history of allergic diseases, history of eczema or asthma in infants and young children) and typical clinical symptoms.

(2) Clinical symptoms: The main symptoms are allergic symptoms of the upper and lower respiratory tracts, including symptoms such as nasal itching, frequent sneezing, runny nose, nasal congestion, cough and wheezing. These symptoms can occur suddenly, or they can resolve on their own or disappear quickly after treatment. Nasal symptoms tend to worsen in the morning, while asthma tends to worsen at night. Some patients are often accompanied by symptoms of allergic conjunctivitis such as itchy eyes and tears.

(3) Specific immune test

With the standardization of allergens, satisfactory diagnostic reagents have been provided for most inhaled allergens, which has greatly improved the diagnostic level of allergic diseases.

Including allergen skin prick test, serum allergen-specific IgE measurement, allergen nasal mucosa or bronchial challenge test, and bioresonance allergen detection methods. These specific immune tests not only provide evidence for the diagnosis of pediatric allergic rhinitis asthma syndrome, but also help determine the type of allergens and the degree of allergy to the allergens. Therefore, all patients with suspected pediatric allergic rhinitis asthma syndrome should be checked for specific immunodiagnostic tests when available.

According to ARIA, allergic rhinitis should be divided into intermittent and persistent according to the duration of the onset; divided into mild and moderate to severe according to whether the symptoms affect the quality of life; and divided into sneezing and runny type and nasal congestion according to the main symptoms . According to GINA, asthma is divided into acute exacerbation and chronic persistence according to the condition; acute exacerbation is divided into mild, moderate, severe, and critical four degrees; chronic period is divided into intermittent, mild Continuous, moderate and severe.

With the development of the concept of pediatric allergic rhinitis ^[1] asthma syndrome, the condition of pediatric allergic rhinitis asthma syndrome is usually divided into three stages: simple allergic rhinitis without airway hyperresponsiveness Asthma; allergic rhinitis with airway hyperresponsiveness, but no asthma symptoms; allergic rhinitis with asthma and airway hyperresponsiveness. In fact, whether allergic rhinitis can develop into asthma is closely related to the amount and concentration of allergens. Traditional Chinese medicine treats allergic system dermatitis by eliminating the heat that accumulates in the body. At the same time, it is necessary to improve the physique and return the function to normal. Depending on your physique, you can use a gel cream for allergic constitution.

Allergic Constitution Treatment

Once pediatric allergic rhinitis asthma syndrome is diagnosed, combined treatment should be performed. According to the severity of the disease, a corresponding treatment plan is formulated. The treatment principle is combined anti-inflammatory therapy for allergic rhinitis and upper and lower respiratory tract inflammation of asthma, and at the same time, patients with allergic constitution should be treated. Treatment methods include nasal inhalation combined with glucocorticoid therapy for the upper and lower airways, antihistamine therapy, and other immunotherapy.

(1) Combined inhaled glucocorticoid therapy for the upper and lower airways:

Anti-inflammatory treatment of allergic rhinitis and asthma is mainly based on inhaled glucocorticoids. In the past, nasal and oral inhalation were usually used for anti-inflammatory treatment of the upper and lower respiratory tract. Once the patient is diagnosed with pediatric allergic rhinitis asthma syndrome, a special oral and nasal aerosol can (inhalation protection) should be used. Nasal inhalation of glucocorticoids for combined anti-inflammatory treatment of the upper and lower airways. The combination therapy has at least the following benefits: Improve the treatment index: it can avoid the repeated use of drugs, reduce the dose of inhaled glucocorticoids and reduce side effects, thereby greatly improving the treatment index. Reduced medical expenses. Simplify the treatment procedure, thereby improving the compliance of treatment. More importantly, after a period of combined treatment, asthma can be prevented only by controlling allergic rhinitis, making the prevention and treatment of asthma more active and simple.

Studies by Taramarcaz and others have shown that nasal inhalation of glucocorticoids not only improves the symptoms of allergic rhinitis and asthma, but also reduces airway hyperresponsiveness. As a combined treatment of the upper and lower respiratory tracts, when inhaling glucocorticoids nasally with the aid of an aerosol can, the patient should be instructed to inhale as deep as possible in order to inhale the drug into the bronchi.

(2) Anti-allergic drugs:

As pediatric allergic rhinitis asthma syndrome is an allergic disease, anti-allergic drugs should be given as soon as possible once diagnosed. Effective control of allergic rhinitis can prevent most asthma attacks or avoid exacerbation of asthma, so the use of anti-allergic drugs to treat allergic rhinitis is of great significance to improve the prognosis of asthma. Common doses of anti-allergic drugs can effectively treat allergic rhinitis to prevent asthma attacks, and doubling the dose can improve the symptoms of concurrent asthma.

Giving anti-allergic drugs and pseudoephedrine to treat children with allergic rhinitis and asthma syndrome can improve asthma symptoms, increase PEF and reduce the amount of bronchodilators while improving nasal congestion symptoms. In children, upper respiratory tract infections and asthma exacerbations can be controlled by continuous antihistamine therapy. In the Early Treatment of the Atopic Child ETAC study, it was found that continuous application of anti-allergic drugs can reduce the incidence of asthma.

(3) Allergen vaccine treatment:

Commonly known as desensitization treatment, it is one of the important treatments for pediatric allergic rhinitis asthma syndrome, and its efficacy has been confirmed in patients with rhinitis and asthma. Clinically, desensitization is mainly performed for dust mites and various pollens.

Studies have shown that this therapy can change the natural course of pediatric allergic rhinitis asthma syndrome and can maintain its efficacy for several years after stopping treatment. Many scholars advocate sublingual desensitization treatment. Because sublingual desensitization treatment avoids the hassle and pain of repeated injections, it is especially suitable for children. However, more research is needed to compare whether sublingual desensitization treatment has the same effect as injection desensitization treatment.

(4) Anti-IgE monoclonal antibody

It is a recombinant monoclonal antibody (trade name Xoalir) against human IgE, and has achieved significant results in the treatment of allergic rhinitis and asthma. It was formally approved by the FDA in May 2003.

Xoalir is effective in the treatment of moderate-severe asthma and seasonal and perennial allergic rhinitis. Xoalir is known to reduce serum free IgE levels and low regulate IgE receptors in peripheral blood basophils. Number of eosinophils, mast cells, and T cells and B cells.

Studies have shown that Xoalir has significant benefits for asthma patients who have not been able to control high-dose hormones. Clinical data suggest that Xoalir can improve wheezing symptoms, improve quality of life, and control acute attacks in asthmatic patients with persistent allergic rhinitis. Xoalir is often effective in those with more severe asthma.

These impressive clinical data suggest that Xoalir's anti-inflammatory therapeutic mechanism is related to the inhibition of IgE. The clinical dose of Xolair is 125 mg to 375 mg. It is injected subcutaneously every 2 to 4 weeks. The drug can simultaneously improve the symptoms of upper and lower respiratory tract in children with allergic rhinitis asthma syndrome.