Itchy palate and ears

When the roof of the mouth is itchy, people may feel that their nose is not particularly comfortable. Sometimes, people's ears will also become itchy. People may find it very difficult to understand why the ears will also become itchy when the roof of the mouth is itchy? In fact, this is mainly because the upper palate and ears are connected. If the upper palate is uncomfortable, it will of course affect the ears. What does itching on the upper palate and ears mean?

Allergic rhinitis

Allergic rhinitis refers to a non-infectious inflammatory disease of the nasal mucosa that occurs when an atopic individual is exposed to allergens, mainly mediated by IgE (mainly histamine) and involves the release of mediators. It also involves a variety of immune-active cells and cytokines. There are three necessary conditions for its occurrence: specific antigens, which are substances that cause the body's immune response; atopic individuals, which are so-called individual differences and allergic constitutions; and the encounter between specific antigens and atopic individuals. Allergic rhinitis is a global health problem that can lead to numerous morbidities and loss of productivity.

Causes

Allergic rhinitis is a multifactorial disease caused by the interaction between genes and the environment. Risk factors for allergic rhinitis may be present in all age groups.

1. Genetic factors

Patients with allergic rhinitis have an atopic constitution and usually show familial clustering. Studies have found that certain genes are associated with allergic rhinitis.

2. Allergen exposure

Allergens are antigens that induce and react with specific IgE antibodies. They often come from animals, plants, insects, fungi or occupational substances. Its components are proteins or glycoproteins, and very few are polysaccharides. Allergens are mainly divided into inhaled allergens and food allergens. Inhaled allergens are the main cause of allergic rhinitis.

(1) The main mites in subtropical and tropical regions are house dust mites and dust mites. House dust mites feed on human dander and live primarily in mattresses, under beds, pillows, carpets, furniture and stuffed toys. It reproduces fastest in a hot (above 20°C) and humid (relative humidity greater than 80%) environment. House dust mite allergens are contained in particles of their excreta, which are exposed to the air and can be redeposited quickly when contaminated fabrics are disturbed. The concentration of mite allergens in the air is related to the incidence of allergic rhinitis.

(2) Wind-borne pollen: Because of its huge dispersion and long-distance transmission, wind-borne pollen can affect people who are hundreds of kilometers away from the pollen source. Insect-pollinated pollens can only cause allergies if they come into direct contact, such as agronomists and florists. The allergenic capacity of pollen varies with season, geographic location, temperature and plant species. Most people who are allergic to pollen will suffer from conjunctivitis.

(3) Animal dander Animal dander and secretions carry allergens. Cat and dog allergens are widely present in indoor dust and furniture decorations.

(4) Fungal allergens Molds release allergenic spores into indoor and outdoor environments and grow rapidly in hot and humid environments.

(5) Cockroach allergens are found in their feces and carapaces. The particles are large and do not spread in the air.

(6) Food allergens: Food allergy is rare when allergic rhinitis is not accompanied by other systemic symptoms. On the other hand, food allergies are common in patients with multiple organ involvement. For infants, most of them are caused by milk and soy; for adults, common food allergens include: peanuts, nuts, fish, eggs, milk, soy, apples, pears, etc.

Clinical manifestations

The typical symptoms of allergic rhinitis are mainly paroxysmal sneezing, clear watery nasal discharge, nasal congestion and nasal itching. Some are accompanied by decreased sense of smell.

1. Sneezing

There are several paroxysmal attacks a day, more than 3 each time, mostly in the morning or at night or immediately after contact with allergens.

2. Clear nasal discharge

A large amount of clear watery nasal discharge may sometimes drip from the nostrils unconsciously.

3. Nasal congestion

Intermittent or continuous, unilateral or bilateral, with varying degrees of severity.

4. Itchy nose

Most patients experience itching in the nose, while those with hay fever may also experience itching in the eyes, ears, and throat.

examine

1. Physical signs

The nasal mucosa is pale, the bilateral lower nails are edematous, and clear or sticky mucus can be seen in the common nasal passage and nasal floor.

2. Skin prick test

Use standardized allergen reagents to prick the skin on the palmar side of the forearm and observe the results after 20 minutes. Positive and negative controls should be performed for each test, with histamine being used as the positive control and allergen solvent being used as the negative control. Determine the results according to the instructions of the corresponding standardized allergen reagents. Skin prick testing should be done at least 7 days after antihistamines have been discontinued.

3. Serum specific IgE detection

Draw venous blood from the patient for immunological testing, which is not affected by drugs or skin conditions. To confirm the allergens of allergic rhinitis, a comprehensive consideration of clinical manifestations, medical history, skin prick tests, and serum specific IgE test results is required.

4. Nasal provocation test

It is the gold standard for diagnosing allergic rhinitis, but it carries risks and is not used as a routine method in clinical practice.

diagnosis

Clinical symptoms include sneezing, clear watery discharge, nasal congestion, nasal itching and more than 2 (including 2) symptoms, which last or accumulate for more than 1 hour per day. It may be accompanied by eye symptoms such as itchy eyes and conjunctival congestion. Common signs include pale nasal mucosa, edema, and watery nasal discharge. If the allergen skin prick test is positive and/or the serum specific IgE is positive, a nasal provocation test may be performed if necessary.

Differential Diagnosis

Allergic rhinitis needs to be differentiated from the catarrhal stage of acute rhinitis, cerebrospinal fluid rhinorrhoea, and vasomotor rhinitis.

complication

Diseases associated with allergic rhinitis can be divided into those with the same pathogenic pathway (such as allergic reactions) or combined with other diseases (combined infections caused by mucosal swelling and mucus retention). Including asthma, conjunctivitis, chronic rhinosinusitis, adenoids hypertrophy, secretory otitis media, etc. The presence of allergic rhinitis aggravates asthma, and most asthma patients suffer from allergic rhinitis. Outdoor allergens are more likely to cause allergic conjunctivitis than indoor allergens.

treat

1. Avoid contact with allergens

(1) Reduce the number of dust mites in the room; maintain the relative humidity of the living space below 60%, but too low (such as below 30% to 40%) will cause discomfort; sweep the carpet; wash bedding and curtains. Mite allergens are soluble in water, and washing textiles can remove most of the allergens; use air purifiers and vacuum cleaners with filters.

(2) Avoid allergens during the corresponding pollen allergy season.

(3) Patients who are allergic to animal fur should avoid allergens.

2. Medication

The following factors should be considered: efficacy, safety, cost/effectiveness ratio, etc. Intranasal and oral administration are commonly used, and the efficacy may vary between different patients. There is no long-term sustained efficacy after discontinuation of the drug, so maintenance treatment is required for persistent allergic rhinitis. Prolonged treatment does not lead to rapid drug resistance. Intranasal administration has many advantages. High concentrations of drugs can act directly on the nose, avoiding or reducing systemic side effects. However, for patients with other allergic diseases, drugs need to act on different target organs, and intranasal administration is not the best choice. Systemic drug treatment is recommended. Pregnant patients should use various drugs with caution.

(1) Antihistamines Oral or nasal second-generation or new H1 antihistamines can effectively relieve symptoms such as nasal itching, sneezing and runny nose. It is suitable for mild intermittent and mild persistent allergic rhinitis, and can be used in combination with nasal corticosteroids to treat moderate to severe allergic rhinitis.

(2) Nasal corticosteroids can effectively relieve symptoms such as nasal congestion, runny nose and sneezing. For critically ill patients who do not respond to other drug treatments or cannot tolerate nasal medications, oral corticosteroids can be used for short-term treatment.

(3) Anti-leukotriene drugs are effective for allergic rhinitis and asthma.

(4) Chromone drugs are effective in relieving nasal symptoms, and eye drops are effective in relieving eye symptoms.

(5) Intranasal decongestants can relieve nasal congestion symptoms caused by nasal congestion, and the course of treatment should be controlled within 7 days.

(6) Intranasal anticholine drugs can effectively suppress runny nose.

(7) Some Chinese medicines are effective in relieving symptoms. The treatment principles for children and the elderly are the same as those for adults, but special attention should be paid to avoiding adverse drug reactions.

3. Immunotherapy

Immunotherapy induces clinical and immunological tolerance with long-term effects, preventing the development of allergic diseases. Allergen-specific immunotherapy is commonly used by subcutaneous injection and sublingual administration. The treatment course is divided into a dose accumulation phase and a dose maintenance phase, and the total treatment course is no less than 2 years. Standardized allergen vaccines should be used.

(1) Indications: Mainly used for patients with allergic rhinitis who have not responded to conventional drug treatment.

(2) Contraindications: ① Asthma attack; ② The patient is currently using beta-blockers; ③ Combination with other immune diseases; ④ Pregnant women; ⑤ The patient is unable to understand the risks and limitations of treatment.

Immunotherapy may cause local and systemic adverse reactions.

4. Surgical treatment

The indications are that the nasal congestion symptoms have not improved after medication or immunotherapy, there are obvious physical signs, and the quality of life is affected; there are obvious anatomical variations in the nasal cavity, accompanied by functional disorders; combined with chronic rhinosinusitis and nasal polyps, and drug treatment is ineffective. Surgical treatment is not a routine treatment for allergic rhinitis.