Symptoms such as runny nose and sneezing during the change of seasons. I suspect rhinitis, not a cold!
According to data from the Health Insurance Review and Assessment Service, the number of patients with allergic rhinitis increased every year. In the change of seasons, symptoms worsen, and allergic rhinitis, which torments the patients, is likely to lead to complications such as asthma and sinusitis if left unattended. I met with Kwon Hyuk-soo, an Associate professor of allergic medicine at Asan Medical Center in Seoul to find out how to properly treat and manage rhinitis.
Q. Medieus Queen: It's an honor to meet a professor who is famous for empathizing with and treating patient's pain based on your own experience. Please briefly introduce yourself and the allergy internal medicine.
A. Kwon Hyuk-soo, an Associate professor at Asan Medical Center in Seoul (hereinafter referred to as Kwon Hyuk-soo): I work as an Associate professor in allergy medicine at Asan Medical Center in Ulsan University. The allergy medicine diagnoses and treats all allergies and atopic diseases that may occur in the body. It treats allergic rhinitis, asthma, drug allergies, food allergies, urticaria, atopic dermatitis, contact dermatitis, and eosinophilic diseases.
As there is a large constitution in allergic atopic diseases, there are many patients with various allergic diseases such as rhinitis, asthma, and atopic dermatitis at the same time, and they are being treated in various places such as dermatology, otolaryngology, and internal medicine. Allergy medicine is differentiated by providing comprehensive professional treatment in one place for allergic atopic diseases that occur in various organs
Q. Medieus Queen: I know that the number of rhinitis patients increases every year due to environmental pollution, fine dust, and indoor life. What is the exact cause of rhinitis? And when there are any symptoms, should I suspect allergic rhinitis?
A. Kwon Hyuk-soo: These days, many people have no choice but to live at home because of COVID-19. If you have frequent runny noses and symptoms such as sneezing and stuffy nose, you should suspect allergic rhinitis.
House dust mites attached to cloth curtains, sofas, and carpets are the biggest cause of allergic rhinitis. Pollen flying during the change of seasons is also an important cause, and, unfortunately, many patients often mistake it for a cold during the change of seasons. Tree pollen in spring and weed pollen in autumn are the main causes of allergies. Fine dust, air pollution, and indoor chemicals related to new house syndrome also act as factors for worsening allergic rhinitis and cause chronic rhinitis.
Although there are times when you suddenly get allergic reactions that you don't normally get, you might have not felt uncomfortable in the past due to the few symptoms, but you may feel the symptoms more severe due to the recent increase in indoor life.
Allergic rhinitis is literally a disease that causes inflammation in the nose. It is caused by antigens such as indoor dust mites, dandruff of pets, and pollen that can be exposed outdoors. The nasal mucosa swells red, clogs the nose, runny nose, and irritates the nasal mucosa causing itching and sneezing. In particular, being too itchy around the tear duct inside the eye is not an eye problem, but a part of rhinitis symptoms.
Q. Medieus Queen: I understand that rhinitis is difficult to cure and is characterized by repeated recurrences. How is it best to manage and treat?
A. Kwon Hyuk-soo: The most effective anti-inflammatory treatment for allergic rhinitis is an intracranial steroid sprayed on the nose. Only intracranial steroids can improve nasal congestion, itching, and sleep disorders. However, it could be misunderstood that it is not effective after spraying several times due to its low acute effect but this medicine is the most effective if you spray it for more than a week every day. Sometimes, some patients visit hospitals for allergic rhinitis and are prescribed intracranial steroids but do not use them because they are worried about steroid side effects. However, even if most of them are absorbed into the body, they decompose more than 99% and disappear, so they can be used safely and in the long run from 2-year-olds.
Many patients often use antihistamines that have a quick effect, but it is a symptom-relieving drug that improves symptoms, not a drug that controls inflammation. The reason is that as a result of inflammation, many inflammatory substances come out and an antihistamine is a drug that improves only the symptoms caused by histamine of them. Most people take antihistamines steadily and control symptoms, and if it gets severe, they use intracranial steroids, which is the wrong way. The right treatment is to use intracranial steroids regardless of symptoms every day and take antihistamines temporarily only
temporarily when symptoms appear, nevertheless.
For example, brushing with toothpaste to prevent gum inflammation is the same as spraying intracranial steroids every day in rhinitis, and taking anti-inflammatory drugs when gum inflammation is acute is the same as taking antihistamines in rhinitis. To maintain your gums when they are healthy, you just brush your teeth every day without symptoms. As such, you can use safe intracranial steroids for a healthy nose without nose symptoms.
Immunotherapy is required to fundamentally treat allergic rhinitis. It is a treatment that allows antibodies that act as a "vaccine" against allergens to be made in the body. It works in about 80 to 90 percent of patients, and if it lasts for three to five years, it may be good enough to stop all drugs.
Q. Medieus Queen: I understand that house dust mites are the most important cause of rhinitis. What are the lifestyle habits that rhinitis patients should follow to maintain symptoms well?
A. Kwon Hyuk-soo: It is most important to use intranasal steroids first before environmental management and lifestyle improvement. Likewise it's important to improve your diet for gum care, but if you don't brush your teeth every day, it's not effective, just managing the environment and improving habits without using intracranial steroids is not very effective.
If there are indoor dust mites, the environmental management laws mentioned below should be applied.
Environmental Management Method for Reducing Indoor Dust Mites
It is important to control not only the humidity in the air, but also the humidity of carpets, sofas, mattresses, and clothing where house dust mites inhabit. However, it takes about two months for house dust mites to die due to low humidity, and even if they die, bodies can remain and cause allergic reactions, so it is very important to keep managing the indoor environment.
① Humidity in the home is maintained at 40-50%. House dust mites absorb moisture from the surrounding air, so they cannot live if the humidity is low. However, if it is too low, it may be inconvenient for humans to breathe, so about 40% of the figure is appropriate.
② Beddings should be washed regularly (once every two to three weeks) with hot water of 55℃ or higher. House dust mites die at high temperatures. However, it is important to wash with hot water to kill house dust mites and remove antigens by rinsing them again because house dust mites' feces and bodies can remain intact and cause allergies. It is better to buy two sets of bedding and wash them without detergent.
③ It is recommended to wrap the bed mattress and pillow with an allergen-resistant cover. Blankets and bedding covers can be washed at high temperatures to remove house dust mites, but it is very difficult to remove them if house dust mites live in pillow pads or mattresses. Therefore, it is important to prevent using non-permeable special covers to prevent house dust mites from inhabiting and fine excrement from entering at all.
④ Carpets, hairy animals, cloth sofas, cloth curtains, and scattered objects should be removed. House dust mites live attached to fibers, hairs, etc. Therefore, it is important to remove the habitat. As there are many allergies where dust gathers, it is better to keep the house simple so that dust cannot gather.
⑤ Clean frequently with a vacuum cleaner equipped with a HEPA filter. A vacuum cleaner equipped with a HEPA filter (High Efficiency Particulate Filter) must be used at the air outlet. The reason is that in general vacuum cleaners after the antigen is sucked into the machine, large substances are filtered through the filter and small antigens that can cause allergies can be discharged back out of the machine and spread into the air.
Q. Medieus Queen: People with severe rhinitis consider rhinitis surgery a lot, and I know that side effects such as Vinco syndrome occur after surgery. In this regard, I wonder what other side effects and when it is good to perform surgery.
A. Kwon Hyuk-soo: The structure inside the nose is often imagined as a circular tube, but it is not true. The width is narrow and the ceiling is like a high hallway. And on one side of the wall, three shelves are protruding, so imagine a passage that you have to crawl under or between the shelves to get through. Three shelves protruding from the middle wall of both corridors are similar to the nasal septum, and the cheekbones of both sides could be nasal concha. The bottom lower nasal concha is the largest and the top upper nasal concha is the smallest. If inflammation is not treated well for a long time, the nasal concha
will grow bigger and cover your nose tightly. If the middle septum bends to one side, the nose is blocked by narrowing the narrow passageway.
Therefore, surgery to reduce the volume of the nasal concha may be considered if the symptoms of severe rhinitis do not improve or nasal congestion due to severe hypertrophy of the lower nasal concha despite the good use of appropriate drugs centered on intracranial steroids. Especially if the nasal septum is accompanied by allergic rhinitis patients, it can be more helpful to perform nasal septum correction together. Recently, many methods have been used to reduce volume while preserving the nasal mucosa.
After nose surgery, some side effects such as Vinco syndrome occur. There is no nasal congestion, but it is a symptom that makes breathing more stuffy. If many cars move in confusion on a wide but laneless road, the average speed may be slower than efficiently moving cars on a narrower but lane-bound road. Similarly, the nasal concha creates a path for airflow, so that air flows efficiently in a straight line, while a much smaller nasal concha can cause turbulence in the airflow, which can make the flow inefficient without nasal congestion, making it suffocating. In some cases, the mucous membrane shrinks and causes damage to the nasal mucosa that leads to dry and nasal mucosa frequently, making breathing more uncomfortable. Therefore, proper medication should be prioritized, and it is important to select surgery only when it is really necessary, as mentioned above.
Q. Medieus Queen: I wonder if other diseases can develop if rhinitis persists for a long time.
A. Kwon Hyuk-soo: If rhinitis persists for a long time, asthma can occur in about 30% of patients. In addition, chronic sinusitis, sinus infection, middle ear inflammation, chronic cough, and persistent sore throat can occur.
Personally, the most important complication of rhinitis is sleep disorders. If you have allergic rhinitis but do not use proper anti-inflammatory drugs, you will not be able to sleep well during sleep. The sleep very shallowly (micro-arousal) will increase by 10 to 50 times compared to the general public. In addition, breathing problems occur during sleep, which is a very high risk of snoring and sleep apnea. As a result, it is known that chronic fatigue and emotional disorders such as depression and anxiety can occur, and learning disorders can occur in students. Therefore, growing children and adolescents preparing for entrance exams should work harder to use safe intracranial steroids.
Q. Medieus Queen: Finally, if you have any plans or goals that you are preparing, please tell me.
A. Kwon Hyuk-soo: I plan to focus more on the promotion and education of allergic diseases through the Seoul Atopy and Asthma Education Information Center operated by the Korea Asthma Allergy Association. The Korea Asthma Allergy Association was founded in 2003 and has been commissioning the Seoul Atopy and Asthma Education Information Center since 2008. It is established and operated to contribute to the improvement of public health and the establishment of a welfare society by supporting academic, educational, and research activities on allergic diseases and promoting them in the reality that the prevalence of allergic diseases is rapidly increasing and socioeconomic losses are continuously increasing
In particular, I personally plan to promote and educate patients with allergic rhinitis about how effective and safe it is to use intracranial steroids consistently.
A. Kwon Hyuk-soo, an Associate professor at Asan Medical Center in Seoul (hereinafter referred to as Kwon Hyuk-soo): I work as an Associate professor in allergy medicine at Asan Medical Center in Ulsan University. The allergy medicine diagnoses and treats all allergies and atopic diseases that may occur in the body. It treats allergic rhinitis, asthma, drug allergies, food allergies, urticaria, atopic dermatitis, contact dermatitis, and eosinophilic diseases.
As there is a large constitution in allergic atopic diseases, there are many patients with various allergic diseases such as rhinitis, asthma, and atopic dermatitis at the same time, and they are being treated in various places such as dermatology, otolaryngology, and internal medicine. Allergy medicine is differentiated by providing comprehensive professional treatment in one place for allergic atopic diseases that occur in various organs
Q. Medieus Queen: I know that the number of rhinitis patients increases every year due to environmental pollution, fine dust, and indoor life. What is the exact cause of rhinitis? And when there are any symptoms, should I suspect allergic rhinitis?
A. Kwon Hyuk-soo: These days, many people have no choice but to live at home because of COVID-19. If you have frequent runny noses and symptoms such as sneezing and stuffy nose, you should suspect allergic rhinitis.
House dust mites attached to cloth curtains, sofas, and carpets are the biggest cause of allergic rhinitis. Pollen flying during the change of seasons is also an important cause, and, unfortunately, many patients often mistake it for a cold during the change of seasons. Tree pollen in spring and weed pollen in autumn are the main causes of allergies. Fine dust, air pollution, and indoor chemicals related to new house syndrome also act as factors for worsening allergic rhinitis and cause chronic rhinitis.
Although there are times when you suddenly get allergic reactions that you don't normally get, you might have not felt uncomfortable in the past due to the few symptoms, but you may feel the symptoms more severe due to the recent increase in indoor life.
Allergic rhinitis is literally a disease that causes inflammation in the nose. It is caused by antigens such as indoor dust mites, dandruff of pets, and pollen that can be exposed outdoors. The nasal mucosa swells red, clogs the nose, runny nose, and irritates the nasal mucosa causing itching and sneezing. In particular, being too itchy around the tear duct inside the eye is not an eye problem, but a part of rhinitis symptoms.
Q. Medieus Queen: I understand that rhinitis is difficult to cure and is characterized by repeated recurrences. How is it best to manage and treat?
A. Kwon Hyuk-soo: The most effective anti-inflammatory treatment for allergic rhinitis is an intracranial steroid sprayed on the nose. Only intracranial steroids can improve nasal congestion, itching, and sleep disorders. However, it could be misunderstood that it is not effective after spraying several times due to its low acute effect but this medicine is the most effective if you spray it for more than a week every day. Sometimes, some patients visit hospitals for allergic rhinitis and are prescribed intracranial steroids but do not use them because they are worried about steroid side effects. However, even if most of them are absorbed into the body, they decompose more than 99% and disappear, so they can be used safely and in the long run from 2-year-olds.
Many patients often use antihistamines that have a quick effect, but it is a symptom-relieving drug that improves symptoms, not a drug that controls inflammation. The reason is that as a result of inflammation, many inflammatory substances come out and an antihistamine is a drug that improves only the symptoms caused by histamine of them. Most people take antihistamines steadily and control symptoms, and if it gets severe, they use intracranial steroids, which is the wrong way. The right treatment is to use intracranial steroids regardless of symptoms every day and take antihistamines temporarily only
temporarily when symptoms appear, nevertheless.
For example, brushing with toothpaste to prevent gum inflammation is the same as spraying intracranial steroids every day in rhinitis, and taking anti-inflammatory drugs when gum inflammation is acute is the same as taking antihistamines in rhinitis. To maintain your gums when they are healthy, you just brush your teeth every day without symptoms. As such, you can use safe intracranial steroids for a healthy nose without nose symptoms.
Immunotherapy is required to fundamentally treat allergic rhinitis. It is a treatment that allows antibodies that act as a "vaccine" against allergens to be made in the body. It works in about 80 to 90 percent of patients, and if it lasts for three to five years, it may be good enough to stop all drugs.
Q. Medieus Queen: I understand that house dust mites are the most important cause of rhinitis. What are the lifestyle habits that rhinitis patients should follow to maintain symptoms well?
A. Kwon Hyuk-soo: It is most important to use intranasal steroids first before environmental management and lifestyle improvement. Likewise it's important to improve your diet for gum care, but if you don't brush your teeth every day, it's not effective, just managing the environment and improving habits without using intracranial steroids is not very effective.
If there are indoor dust mites, the environmental management laws mentioned below should be applied.
Environmental Management Method for Reducing Indoor Dust Mites
It is important to control not only the humidity in the air, but also the humidity of carpets, sofas, mattresses, and clothing where house dust mites inhabit. However, it takes about two months for house dust mites to die due to low humidity, and even if they die, bodies can remain and cause allergic reactions, so it is very important to keep managing the indoor environment.
① Humidity in the home is maintained at 40-50%. House dust mites absorb moisture from the surrounding air, so they cannot live if the humidity is low. However, if it is too low, it may be inconvenient for humans to breathe, so about 40% of the figure is appropriate.
② Beddings should be washed regularly (once every two to three weeks) with hot water of 55℃ or higher. House dust mites die at high temperatures. However, it is important to wash with hot water to kill house dust mites and remove antigens by rinsing them again because house dust mites' feces and bodies can remain intact and cause allergies. It is better to buy two sets of bedding and wash them without detergent.
③ It is recommended to wrap the bed mattress and pillow with an allergen-resistant cover. Blankets and bedding covers can be washed at high temperatures to remove house dust mites, but it is very difficult to remove them if house dust mites live in pillow pads or mattresses. Therefore, it is important to prevent using non-permeable special covers to prevent house dust mites from inhabiting and fine excrement from entering at all.
④ Carpets, hairy animals, cloth sofas, cloth curtains, and scattered objects should be removed. House dust mites live attached to fibers, hairs, etc. Therefore, it is important to remove the habitat. As there are many allergies where dust gathers, it is better to keep the house simple so that dust cannot gather.
⑤ Clean frequently with a vacuum cleaner equipped with a HEPA filter. A vacuum cleaner equipped with a HEPA filter (High Efficiency Particulate Filter) must be used at the air outlet. The reason is that in general vacuum cleaners after the antigen is sucked into the machine, large substances are filtered through the filter and small antigens that can cause allergies can be discharged back out of the machine and spread into the air.
Q. Medieus Queen: People with severe rhinitis consider rhinitis surgery a lot, and I know that side effects such as Vinco syndrome occur after surgery. In this regard, I wonder what other side effects and when it is good to perform surgery.
A. Kwon Hyuk-soo: The structure inside the nose is often imagined as a circular tube, but it is not true. The width is narrow and the ceiling is like a high hallway. And on one side of the wall, three shelves are protruding, so imagine a passage that you have to crawl under or between the shelves to get through. Three shelves protruding from the middle wall of both corridors are similar to the nasal septum, and the cheekbones of both sides could be nasal concha. The bottom lower nasal concha is the largest and the top upper nasal concha is the smallest. If inflammation is not treated well for a long time, the nasal concha
will grow bigger and cover your nose tightly. If the middle septum bends to one side, the nose is blocked by narrowing the narrow passageway.
Therefore, surgery to reduce the volume of the nasal concha may be considered if the symptoms of severe rhinitis do not improve or nasal congestion due to severe hypertrophy of the lower nasal concha despite the good use of appropriate drugs centered on intracranial steroids. Especially if the nasal septum is accompanied by allergic rhinitis patients, it can be more helpful to perform nasal septum correction together. Recently, many methods have been used to reduce volume while preserving the nasal mucosa.
After nose surgery, some side effects such as Vinco syndrome occur. There is no nasal congestion, but it is a symptom that makes breathing more stuffy. If many cars move in confusion on a wide but laneless road, the average speed may be slower than efficiently moving cars on a narrower but lane-bound road. Similarly, the nasal concha creates a path for airflow, so that air flows efficiently in a straight line, while a much smaller nasal concha can cause turbulence in the airflow, which can make the flow inefficient without nasal congestion, making it suffocating. In some cases, the mucous membrane shrinks and causes damage to the nasal mucosa that leads to dry and nasal mucosa frequently, making breathing more uncomfortable. Therefore, proper medication should be prioritized, and it is important to select surgery only when it is really necessary, as mentioned above.
Q. Medieus Queen: I wonder if other diseases can develop if rhinitis persists for a long time.
A. Kwon Hyuk-soo: If rhinitis persists for a long time, asthma can occur in about 30% of patients. In addition, chronic sinusitis, sinus infection, middle ear inflammation, chronic cough, and persistent sore throat can occur.
Personally, the most important complication of rhinitis is sleep disorders. If you have allergic rhinitis but do not use proper anti-inflammatory drugs, you will not be able to sleep well during sleep. The sleep very shallowly (micro-arousal) will increase by 10 to 50 times compared to the general public. In addition, breathing problems occur during sleep, which is a very high risk of snoring and sleep apnea. As a result, it is known that chronic fatigue and emotional disorders such as depression and anxiety can occur, and learning disorders can occur in students. Therefore, growing children and adolescents preparing for entrance exams should work harder to use safe intracranial steroids.
Q. Medieus Queen: Finally, if you have any plans or goals that you are preparing, please tell me.
A. Kwon Hyuk-soo: I plan to focus more on the promotion and education of allergic diseases through the Seoul Atopy and Asthma Education Information Center operated by the Korea Asthma Allergy Association. The Korea Asthma Allergy Association was founded in 2003 and has been commissioning the Seoul Atopy and Asthma Education Information Center since 2008. It is established and operated to contribute to the improvement of public health and the establishment of a welfare society by supporting academic, educational, and research activities on allergic diseases and promoting them in the reality that the prevalence of allergic diseases is rapidly increasing and socioeconomic losses are continuously increasing
In particular, I personally plan to promote and educate patients with allergic rhinitis about how effective and safe it is to use intracranial steroids consistently.
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