- 期刊
非過敏性鼻炎（I）職業性鼻炎，化學性鼻炎，藥物性鼻炎與感染性鼻炎
Non-allergic Rhinitis (I) Occupational Rhinitis, Chemical Rhinitis, Drug-induced Rhinitis and Infectious Rhinitis
摘要
非過敏性鼻炎的症狀與過敏性鼻炎類似，估計全球每年約兩億人口受非過敏性鼻炎侵擾之苦，造成龐大的醫療費用支出。本文將介紹非過敏性鼻炎的分類及其中四種亞型。職業性鼻炎是一種在特定的工作環境下引起之鼻黏膜炎性反應，其臨床表徵為非特異性的，因此診斷上應著重於與工作的相關性及職業致病原暴露的證據。治療上以儘量避免誘發因子為主，搭配症狀治療，如鼻用局部類固醇噴劑、鼻用局部抗組織胺或口服抗組織胺。化學性鼻炎則是因化學分子的暴露造成類似過敏性鼻炎的症狀，診斷及治療基本上和職業性鼻炎相同。藥物性鼻炎，顧名思義是藥物所引起的鼻炎，常見的藥物包括阿斯匹靈、非類固醇消炎藥、alpha型及beta型腎上腺素受體拮抗劑。另有一類特殊的藥物性鼻炎，特稱為rhinitis medicamentosa，是因長時間使用鼻內局部血管收縮劑（如oxymetazoline）後，產生反彈性鼻塞的症狀。藥物性鼻炎的治療上以儘量避免誘發因子為主，搭配症狀治療。感染性鼻炎可因感染源分為病毒性和細菌性，病毒性鼻炎主要症狀為流鼻涕、鼻塞、通常還會發燒，細菌性鼻炎則除了有膿性鼻漏外，可能伴隨咽部發炎症狀或頸部淋巴結腫大，但兩者憑症狀很難區分。大多數病毒性鼻炎的病程為自限性，4到5天左右可自行痊癒。但若鼻炎超過10天則可能有續發的細菌性感染，應該更積極地治療。大多數指南建議在感染性鼻炎症狀出現後7至10天再考慮抗生素治療，以避免過度使用抗生素造成抗藥性的產生。
並列摘要
The symptoms of non-allergic rhinitis are similar to those of allergic rhinitis. Approximately 200 million people worldwide suffer from non-allergic rhinitis annually, resulting in high medical expenses. This article introduces the classification of non-allergic rhinitis and its four subtypes. Occupational rhinitis is an inflammatory reaction of the nasal mucosa caused by a specific working environment. The clinical manifestations are nonspecific; therefore, the diagnosis should focus on evidence of occupational exposure. The mainstay of treatment is avoidance of triggering substances and symptomatic treatment with intranasal corticosteroids, antihistamines, and systemic antihistamines. Chemical rhinitis is caused by exposure to chemical molecules. The diagnosis and treatment are the same as those for occupational rhinitis. Drug-induced rhinitis is an inflammatory response to drugs, including aspirin, non-steroidal anti-inflammatory drugs, and alpha- and beta-adrenergic receptor antagonists. Overuse of topical decongestants such as oxymetazoline can result in rhinitis medicamentosa, a form of drug-induced rhinitis. The treatment of drug-induced rhinitis involves avoiding triggering factors and providing symptomatic treatment. Infectious rhinitis can be divided into viral and bacterial infections, which are difficult to distinguish based on symptoms. The main symptoms of viral rhinitis are a runny nose, nasal congestion, and fever, whereas those of bacterial rhinitis are purulent rhinorrhea, which is sometimes associated with pharyngeal inflammation and neck lymph node enlargement. Viral rhinitis is self-limiting and resolves spontaneously within 4-5 days. However, if rhinitis persists for more than 10 days, it should be treated more aggressively because of the possibility of a secondary bacterial infection. Most guidelines suggest deferring antibiotic treatment for 7-10 days after the onset of symptoms of infectious rhinosinusitis to avoid the overuse of antibiotics.