- 期刊
非過敏性鼻炎（II）與懷孕或賀爾蒙有關的鼻炎、血管運動性鼻炎、老年人的鼻炎與嗜酸性細胞非過敏性鼻炎症候羣
Non-allergic Rhinitis (II) Rhinitis of Pregnancy and Hormonally-induced Rhinitis, Vasomotor Rhinitis, Age-related Rhinitis, and Non-allergic Rhinitis with Eosinophiliasyndrome
摘要
大部分懷孕的婦女，即便懷孕之前沒有鼻炎的情況，在懷孕的後期也常有鼻塞的情形，此稱為懷孕性鼻炎，和女性賀爾蒙有關。懷孕性鼻炎通常對藥物治療沒有反應，但生產後即消失。若婦女在懷孕前即有過敏性鼻炎時，在懷孕後過敏性鼻炎症狀可能會加重、減輕、或不變。在治療有過敏性鼻炎的懷孕婦女時，我們必須考慮到藥物可能對腹中胎兒或哺乳中的嬰兒的影響，特別在懷孕初期及器官形成時期，更須小心謹慎。老年人常會有鼻子的問題，但並不是所有老年性鼻炎的原因皆為過敏。以鼻腔生理老化的觀點來探討老年性鼻炎是最適當的，當老化過程中，鼻腔通道會因周圍軟骨支撐力不夠而變得狹窄，老化同時也會造成鼻黏膜腺體的萎縮退化、和血流的減少。除此之外，許多老年人常服用的藥物，如利尿劑、β-blocker、抗焦慮劑、及抗暈眩藥物等，皆會進一步造成鼻腔的乾燥與阻塞。血管運動性鼻炎是一種非過敏性鼻炎，血管運動性鼻炎和鼻過敏的症狀幾乎相同，但純粹的血管運動性鼻炎病人的皮膚過敏試驗為陰性反應，且血中特異性IgE濃度不會上升，許多血管運動性鼻炎病人會在氣候變化時出現流鼻水、打噴嚏或鼻塞等鼻炎症狀，這是因為外界環境刺激使病人的自律神經失調，除天氣外，濕度、飲食、壓力，甚至性慾都可能使病人出現鼻炎的症狀。血管運動性鼻炎的病人若是以流鼻水為主要表現時，可使用抗乙烯膽鹼類的鼻噴劑治療，效果良好。嗜酸性細胞非過敏性鼻炎症候羣（nonallergic rhinitis with nasal eosinophilia syndrome, NARES）主要的原因可能和自發性、嗜酸性白血球增多的發炎反應有關，並伴隨著非特異性的組織胺釋放，NARES的臨床症狀和經年性過敏性鼻炎相仿，此類鼻炎的病人雖然會在黏膜分泌物中發現嗜酸性白血球會增加，但與過敏性鼻炎的不同在於NARES血中特異性IgE呈陰性反應。
並列摘要
Most women havenasal congestion in the later stages of pregnancy, even without a history of rhinitis. This condition is known as pregnancy rhinitis and is related to hormone levels. Pregnancy rhinitis does not respond to medication and progresses after delivery. Women with allergic rhinitis before pregnancy may experience worsening, improvement, or no change in symptoms during pregnancy. When treating pregnant women with allergic rhinitis, the impact of medication on the fetuses and infants of pregnant and breastfeeding women, respectively, must be considered. In particular, during early pregnancy and organogenesis, treatment is performed only when the benefits outweigh the risks. Nasal problems are common among older adults. Not all older adults with rhinitis have an allergic response. The etiology of geriatric rhinitis can be best explained by examining the physiology of an aging nose. With aging, nasal airway narrowing occurs secondary to the weakening of the supporting cartilage. Aging may also cause nasal glandular atrophy and decreased microvascular blood flow. Medications commonly used in older adults, such as diuretics, beta-blockers, anxiolytics, and anti-vertigo drugs, also contribute to nasal dryness and congestion. Vasomotor rhinitis is the most common cause of non-allergic rhinitis. The clinical symptoms of vasomotor rhinitis are almost identical to those of allergic rhinitis. However, the skin prick test is commonly negative, and serum-specific immunoglobulin E levels are not elevated in patients with pure vasomotor rhinitis. A patient experiences a runny nose, sneezing, and nasal obstruction with environmental changes. These symptoms are typically elicited by a strong smell, tobacco smoke, changes in sex hormone levels, environmental pollutants, physical exercise, and alcohol consumption. Patients with vasomotor rhinitis and predominant symptoms of rhinorrhea often respond to treatment with intranasal anticholinergics such as ipratropium bromide. Non-allergic rhinitis with eosinophilia syndrome (NARES) is a clinical disorder characterized by symptoms consistent with perennial allergic rhinitis, in which the absence of atopy has been demonstrated and eosinophilia is identified on nasal cytology. The pathophysiology of NARES may involve eosinophilic, self-perpetuating inflammation and nonspecific histamine release.