从花粉症看过敏性疾病的整体诊疗策略
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摘要
花粉症是指具有特应性遗传素质的个体吸入致敏花粉后,由特异性免疫球蛋白E(specific Immunoglobulin E,s IgE)介导的非特异性炎症反应及其引发的以变应性结膜炎、鼻炎、哮喘为主的一系列临床症状,其症状具有明显的时间性和地区性,并且易受某些气象因素的影响。引发花粉症的常见致敏花粉包括春季树木花粉,夏季牧草花粉和秋季杂草花粉,在中国北方地区花粉症患者发病时生活质量明显差于尘螨过敏患者,杂草花粉比树木花粉更易诱发哮喘。花粉症的诊断步骤包括病史采集、变应原特异性诊断测量(皮肤试验和血清s IgE检测)、病史与检测结果相关性分析;临床管理原则包括变应原回避,变应原特异性免疫治疗,抗炎药物治疗(例如糖皮质激素、H1抗组胺药物、白三烯受体拮抗剂)。临床经验表明,使用协和花粉变应原制剂诊断准确度高,免疫治疗疗效及安全性均佳,且能有效地阻止过敏性鼻炎发展为哮喘并防止出现新的致敏原,停止治疗后亦具有一定的持续性。
Pollinosis refers to a series of clinical symptoms,such as allergic conjunctivitis,rhinitis,and asthma,that are mediated by specific immunoglobulin E( sIgE) after inhalation of allergic pollens by atopic individuals. The clinical symptoms of pollinosis depend on the season,region,and climate. Common pollens causing pollinosis come from trees,grass,and weeds. In northern China,the quality of life for patients with pollinosis is significantly worse than that for the patients with dust mite allergy. The weed pollen is more likely to induce asthma than the tree pollen. The diagnostic steps for pollinosis include anamnesis,allergen-specific diagnostic tests( skin test and serum sIgE test),and result assessment. Clinical management includes allergen avoidance,allergen-specific immunotherapy,and anti-inflammatory medicines( such as glucocorticoids,H1 antihistamines,and leukotriene receptor antagonists). Clinical data showed that the pollen extracts from the PUMCH Allergen Products Manufacturing and Research Center areparticularly useful in the diagnosis of pollinosis. They have good efficacy and safety,and can prevent allergic rhinitis from developing into asthma and inhibit the emergence of reactions to newallergens effectively. Treatment efficacy can be maintained even after stopping active administration.
Pollinosis refers to a series of clinical symptoms,such as allergic conjunctivitis,rhinitis,and asthma,that are mediated by specific immunoglobulin E( sIgE) after inhalation of allergic pollens by atopic individuals. The clinical symptoms of pollinosis depend on the season,region,and climate. Common pollens causing pollinosis come from trees,grass,and weeds. In northern China,the quality of life for patients with pollinosis is significantly worse than that for the patients with dust mite allergy. The weed pollen is more likely to induce asthma than the tree pollen. The diagnostic steps for pollinosis include anamnesis,allergen-specific diagnostic tests( skin test and serum sIgE test),and result assessment. Clinical management includes allergen avoidance,allergen-specific immunotherapy,and anti-inflammatory medicines( such as glucocorticoids,H1 antihistamines,and leukotriene receptor antagonists). Clinical data showed that the pollen extracts from the PUMCH Allergen Products Manufacturing and Research Center areparticularly useful in the diagnosis of pollinosis. They have good efficacy and safety,and can prevent allergic rhinitis from developing into asthma and inhibit the emergence of reactions to newallergens effectively. Treatment efficacy can be maintained even after stopping active administration.
引文
[1]Raulf M,Buters J,Chapman M,et al. Monitoring of occupational and environmental aeroallergens-EAACI Position Paper[J]. Allergy,2014,69(10):1280-1299. doi:10.1111/all.12456.
[2]D'Amato G,Annesi Maesano I,Molino A,et al. Thunderstorm-related asthma attacks[J]. J Allergy Clin Immunol,2017,139(6):1786-1787. doi:10.1016/j.jaci.2017.03.003.
[3]Wang XY,Ma TT,Wang XY,et al. Prevalence of pollen-induced allergic rhinitis w ith high pollen exposure in grasslands of northern China[J]. Allergy,2018,73(6):1232-1243. doi:10.1111/all.13388.
[4]李丽莎,关凯,崔乐.圆柏花粉变应性鼻炎临床症状的危险因素分析[J].西部医学,2018,30(6):900-904.LI Lisha,GUAN Kai,CUI Le. Factors associated w ith the severity of allergic rhinitis caused by cypress pollens[J]. Medical Journal of West China,2018,30(6):900-904.
[5]李丽莎,关凯.不同致敏变应原所致变应性鼻炎患者164例生活质量调查[J].临床耳鼻咽喉头颈外科杂志,2015,29(3):226-229. doi:10. 13201/j. issn. 1001-1781.2015.03.009.LI Lisha,GUAN Kai. Quality of life in 164 allergic rhinitis patients caused by different aeroallergens[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2015,29(3):226-229. doi:10. 13201/j. issn. 1001-1781.2015.03.009.
[6] Bousquet J,Heinzerling L,Bachert C,et al. Practical guide to skin prick tests in allergy to aeroallergens[J].Allergy,2012,67(1):18-24. doi:10.1111/j.1398-9995.2011.02728.x.
[7]Cox L,Nelson H,Lockey R,et al. Allergen immunotherapy:A practice parameter third update[J]. Journal of Allergy and Clinical Immunology,2011,127(1):S1-S55. doi:10.1016/j.jaci.2010.09.034.
[8]关凯,周俊雄,王瑞琦,等.圆柏花粉点刺液诊断圆柏花粉过敏的临床价值[J].临床耳鼻咽喉头颈外科杂志,2018,32(3):161-166. doi:10. 13201/j. issn. 1001-1781.2018.03.001.GUAN Kai,ZHOU Junxiong,WANG Ruiqi,et al. The clinical value of China Savin pollen extract used for skin prick test[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2018,32(3):161-166. doi:10.13201/j.issn.1001-1781.2018.03.001.
[9]关凯,程璇,尹佳,等.葎草花粉变应原皮试液诊断葎草花粉变态反应的临床评价[J].中华临床免疫和变态反应杂志,2013,7(2):167-173. doi:10. 3969/j. issn.1673-8705.2013.02.014.GUAN Kai,CHENG Xuan,YIN Jia,et al. Clinical evaluation on accuracy and safety of humulus pollen extract used for intradermal test in the diagnosing of humulus pollen allergy[J]. Chinese Journal of Allergy&Clinical Immunology,2013,7(2):167-173. doi:10. 3969/j. issn.1673-8705.2013.02.014.
[10]王瑞琦,张宏誉. 20万项次过敏原特异性IgE检测结果[J].中华临床免疫和变态反应杂志,2012,6(1):18-23. doi:10.3969/j.issn.1673-8705.2012.01.004.WANG Ruiqi, ZHANG Hongyu. Tw o hundred thousands results of allergen specific IgE detection[J]. Chinese Journal of Allergy&Clinical Immunology,2012,6(1):18-23. doi:10.3969/j.issn.1673-8705.2012.01.004.
[11]姚丽娜,张宏誉.北京市气传柏树花粉浓度监测分析[J].中国公共卫生,2009,25(6):749-751. doi:10.3321/j.issn:1001-0580.2009.06.040.YAO Lina,ZHANG Hongyu. Concentration of airborne cypress pollen in Beljing city w ith Burkard sampler[J].Chinese Journal of Public Health,2009,25(6):749-751. doi:10.3321/j.issn:1001-0580.2009.06.040.
[12]姚丽娜,张宏誉.北京市气传蒿属花粉浓度调查[J].临床耳鼻咽喉头颈外科杂志,2009,23(20):913-916.doi:10.3969/j.issn.1001-1781.2009.20.001.YAO Lina,ZHANG Hongyu. Concentration of airborne pollen in Beijing city w ith burkard sampler[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2009,23(20):913-916. doi:10.3969/j.issn.1001-1781.2009.20.001.
[13]尹佳,岳凤敏,王良录,等.夏秋季花粉症患者变应性鼻炎发展至变应性哮喘进程的临床研究[J].中华医学杂志,2006,86(23):1628-1632. doi:10. 3760/j:issn:0376-2491.2006.23.011.YIN Jia,YUE Fengmin,WANG Lianglu,et al. Natural course from rhinitis to asthma in the patients w ith autumnal pollinosis:a clinical study of 1096 patients[J]. National M edical Journal of China,2006,86(23):1628-1632. doi:10.3760/j:issn:0376-2491.2006.23.011.
[14] Bacharier LB,Boner A,Carlsen KH,et al. Diagnosis and treatment of asthma in childhood:a PRACTALL consensus report[J]. Allergy,2008,63(1):5-34. doi:10.1111/j.1398-9995.2007.01586.x.
[15] Bousquet J,Lockey R,Malling HJ. Allergen immunotherapy:therapeutic vaccines for allergic diseases. A WHO position paper[J]. J Allergy Clin Immunol,1998,102(4 Pt 1):558-562.
[16]Robinson DS,LarchéM,Durham SR. Tregs and allergic disease[J]. J Clin Invest,2004,114(10):1389-1397.doi:10.1172/JCI23595.
[17]尹佳.北京协和医院变应原制剂应用指南[M].北京:中国协和医科大学出版社,2014:12-13.
[18]Leng X,Ye ST. One year observation of immunotherapy for Artemisia hay fever in China:a clinical and immunological study[J]. Asian Pac J Allergy Immunol,1987,5(2):167-172.
[19]岳凤敏,张宏誉.蒿属花粉变应原脱敏治疗的评价:149例回顾性调查[J].中华微生物学和免疫学杂志,2001,21(S2):79-80.YUE Fengmin,ZHANG Hongyu. Evaluation of desensitization for Artemisia pollen allergen:Retrospective investigation among 149 cases[J]. Chinese Journal of M icrobiology and Immunology,2001,21(S2):79-80.
[20]关凯,魏庆宇,尹佳.葎草花粉变应原免疫治疗疗效和安全性评估[J].中华临床免疫和变态反应杂志,2012,6(4):279-284. doi:10. 3969/j. issn. 1673-8705.2012.04.007.GUAN Kai,WEI Qingyu,YIN Jia. Efficacy and safety of specific immunotherapy w ith humulus pollen extract[J]. Chinese Journal of Allergy&Clinical Immunology,2012,6(4):279-284. doi:10. 3969/j. issn. 1673-8705.2012.04.007.
[21]关凯,文昭明.变应原免疫治疗致全身反应[J].中华临床免疫和变态反应杂志,2011,5(4):298-302. doi:10.3969/j.issn.1673-8705.2011.04.011.GUAN Kai, WEN Zhaoming. Systemic reactions induced by allergen specific immunotherapy[J]. Chinese Journal of Allergy&Clinical Immunology,2011,5(4):298-302. doi:10.3969/j.issn.1673-8705.2011.04.011.
[22]宋薇薇,林小平,柴若楠,等.东北地区夏秋季花粉症患者变应原特异性免疫治疗的长期疗效[J].中华临床免疫和变态反应杂志,2012,6(4):266-271. doi:10.3969/j.issn.1673-8705.2012.04.005.SONG Weiw ei,LIN Xiaoping,CHAI Ruonan,et al.Long-term efficacy of allergen specific immunotherapy for pollinosis patients in northeast China[J]. Chinese Journal of Allergy&Clinical Immunology,2012,6(4):266-271. doi:10.3969/j.issn.1673-8705.2012.04.005.
[23]Li LS,Guan K. Effect on quality of life of the mixed house dust mite/w eed pollen extract immunotherapy[J].Asia Pac Allergy,2016,6(3):168-173. doi:10.5415/apallergy.2016.6.3.168.
[24]Li LS,Wang RQ,Cui L,et al. Efficacy of montelukast as prophylactic treatment for seasonal allergic rhinitis[J]. Ear Nose Throat J,2018,97(7):E12-E16.
[25]2018 GINA Report. Global strategy for asthma management and prevention[DB/OL]. http://w w w.ginasthma.org,2018-03-29/2018-10-31.
[26]李丽莎,关凯,崔乐,等.单药加倍或多药联合治疗变应性鼻炎效果比较[J].临床耳鼻咽喉头颈外科杂志,2018,32(1):27-32. doi:10. 13201/j. issn. 1001-1781.2018.01.006.LI Lisha,GUAN Kai,CUI Le,et al. Effects of doubledose antihistamine or combined therapy in allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2018,32(1):27-32. doi:10. 13201/j.issn.1001-1781.2018.01.006.
[27]朱鲁平,隗萍,林旸,等.花粉阻隔剂和氯雷他定片治疗变应性鼻炎的疗效比较[J].中国中西医结合耳鼻咽喉科杂志,2017,25(3):190-192,195. doi:10.16542/j.cnki.issn.1007-4856.2017.03.009.ZHU Luping,(KUI/WEI)(Ping),LIN Yang,et al.Comparison of the curative effects betw een pollen blocking agent and loratadine tablet on allergic rhinitis[J].Chinese Journal of Otorhinolaryngology Integrative M edicine,2017,25(3):190-192,195. doi:10. 16542/j.cnki.issn.1007-4856.2017.03.009.
[28]关凯,李丽莎.鼻腔冲洗在变应性鼻炎防治中的应用[J].山东大学耳鼻喉眼学报,2017,31(3):22-27.doi:10.6040/j.issn.1673-3770.0.2017.151.GUAN Kai,LI Lisha. Nasal irrigation and its role in the treatment of allergic rhinitis[J]. Journal of Otolaryngology Ophthalmology of Shandong University,2017,31(3):22-27. doi:10.6040/j.issn.1673-3770.0.2017.151.
[29]李丽莎,王瑞琦,关凯.丙酮酸钠鼻喷剂治疗变应性鼻炎的效果分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(2):103-106. doi:10.13201/j.issn.1001-1781.2017.02.006.LI Lisha,WANG Ruiqi,GUAN Kai. Treatment effect of sodium pyruvate nasal spray on allergic rhinitis[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2017,31(2):103-106. doi:10. 13201/j. issn.1001-1781.2017.02.006.
[30]苏小霞.过敏性体质的中医认识[J].临床合理用药杂志,2016,9(14):150-151. doi:10. 15887/j. cnki. 13-1389/r.2016.14.100.
[31]贯剑,郑湘瑞,何裕民,等.扶正治标法对青少年花粉症患者相关基因表达的影响[J].江苏大学学报(医学版),2008,18(2):135-138. doi:10.3969/j.issn.1671-7783.2008.02.012.GUAN Jian,ZHENG Xiangrui,HE Yumin,et al. Influence on related gene express in hobbledehoy patients w ith hay fever by herb[J]. Journal of Jiangsu University(Medicine Edition),2008,18(2):135-138. doi:10.3969/j.issn.1671-7783.2008.02.012.
[32]宋岚,武静,郄艾芹.中药制剂引发28例花粉症临床分析[J].中国药房,2007,18(12):937-938. doi:10.3969/j.issn.1001-0408.2007.12.025.SONG Lan,WU Jing,QIE Aiqin. Clinical analysis of28 pollenosis cases induced by TCM preparation[J].China Pharmacy, 2007, 18(12):937-938. doi:10.3969/j.issn.1001-0408.2007.12.025.
[33]王旭,张利,王鹰雷.针灸治疗花粉症67例[J].上海针灸杂志,2004,23(8):30. doi:10.3969/j.issn.1005-0957.2004.08.016.
[2]D'Amato G,Annesi Maesano I,Molino A,et al. Thunderstorm-related asthma attacks[J]. J Allergy Clin Immunol,2017,139(6):1786-1787. doi:10.1016/j.jaci.2017.03.003.
[3]Wang XY,Ma TT,Wang XY,et al. Prevalence of pollen-induced allergic rhinitis w ith high pollen exposure in grasslands of northern China[J]. Allergy,2018,73(6):1232-1243. doi:10.1111/all.13388.
[4]李丽莎,关凯,崔乐.圆柏花粉变应性鼻炎临床症状的危险因素分析[J].西部医学,2018,30(6):900-904.LI Lisha,GUAN Kai,CUI Le. Factors associated w ith the severity of allergic rhinitis caused by cypress pollens[J]. Medical Journal of West China,2018,30(6):900-904.
[5]李丽莎,关凯.不同致敏变应原所致变应性鼻炎患者164例生活质量调查[J].临床耳鼻咽喉头颈外科杂志,2015,29(3):226-229. doi:10. 13201/j. issn. 1001-1781.2015.03.009.LI Lisha,GUAN Kai. Quality of life in 164 allergic rhinitis patients caused by different aeroallergens[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2015,29(3):226-229. doi:10. 13201/j. issn. 1001-1781.2015.03.009.
[6] Bousquet J,Heinzerling L,Bachert C,et al. Practical guide to skin prick tests in allergy to aeroallergens[J].Allergy,2012,67(1):18-24. doi:10.1111/j.1398-9995.2011.02728.x.
[7]Cox L,Nelson H,Lockey R,et al. Allergen immunotherapy:A practice parameter third update[J]. Journal of Allergy and Clinical Immunology,2011,127(1):S1-S55. doi:10.1016/j.jaci.2010.09.034.
[8]关凯,周俊雄,王瑞琦,等.圆柏花粉点刺液诊断圆柏花粉过敏的临床价值[J].临床耳鼻咽喉头颈外科杂志,2018,32(3):161-166. doi:10. 13201/j. issn. 1001-1781.2018.03.001.GUAN Kai,ZHOU Junxiong,WANG Ruiqi,et al. The clinical value of China Savin pollen extract used for skin prick test[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2018,32(3):161-166. doi:10.13201/j.issn.1001-1781.2018.03.001.
[9]关凯,程璇,尹佳,等.葎草花粉变应原皮试液诊断葎草花粉变态反应的临床评价[J].中华临床免疫和变态反应杂志,2013,7(2):167-173. doi:10. 3969/j. issn.1673-8705.2013.02.014.GUAN Kai,CHENG Xuan,YIN Jia,et al. Clinical evaluation on accuracy and safety of humulus pollen extract used for intradermal test in the diagnosing of humulus pollen allergy[J]. Chinese Journal of Allergy&Clinical Immunology,2013,7(2):167-173. doi:10. 3969/j. issn.1673-8705.2013.02.014.
[10]王瑞琦,张宏誉. 20万项次过敏原特异性IgE检测结果[J].中华临床免疫和变态反应杂志,2012,6(1):18-23. doi:10.3969/j.issn.1673-8705.2012.01.004.WANG Ruiqi, ZHANG Hongyu. Tw o hundred thousands results of allergen specific IgE detection[J]. Chinese Journal of Allergy&Clinical Immunology,2012,6(1):18-23. doi:10.3969/j.issn.1673-8705.2012.01.004.
[11]姚丽娜,张宏誉.北京市气传柏树花粉浓度监测分析[J].中国公共卫生,2009,25(6):749-751. doi:10.3321/j.issn:1001-0580.2009.06.040.YAO Lina,ZHANG Hongyu. Concentration of airborne cypress pollen in Beljing city w ith Burkard sampler[J].Chinese Journal of Public Health,2009,25(6):749-751. doi:10.3321/j.issn:1001-0580.2009.06.040.
[12]姚丽娜,张宏誉.北京市气传蒿属花粉浓度调查[J].临床耳鼻咽喉头颈外科杂志,2009,23(20):913-916.doi:10.3969/j.issn.1001-1781.2009.20.001.YAO Lina,ZHANG Hongyu. Concentration of airborne pollen in Beijing city w ith burkard sampler[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2009,23(20):913-916. doi:10.3969/j.issn.1001-1781.2009.20.001.
[13]尹佳,岳凤敏,王良录,等.夏秋季花粉症患者变应性鼻炎发展至变应性哮喘进程的临床研究[J].中华医学杂志,2006,86(23):1628-1632. doi:10. 3760/j:issn:0376-2491.2006.23.011.YIN Jia,YUE Fengmin,WANG Lianglu,et al. Natural course from rhinitis to asthma in the patients w ith autumnal pollinosis:a clinical study of 1096 patients[J]. National M edical Journal of China,2006,86(23):1628-1632. doi:10.3760/j:issn:0376-2491.2006.23.011.
[14] Bacharier LB,Boner A,Carlsen KH,et al. Diagnosis and treatment of asthma in childhood:a PRACTALL consensus report[J]. Allergy,2008,63(1):5-34. doi:10.1111/j.1398-9995.2007.01586.x.
[15] Bousquet J,Lockey R,Malling HJ. Allergen immunotherapy:therapeutic vaccines for allergic diseases. A WHO position paper[J]. J Allergy Clin Immunol,1998,102(4 Pt 1):558-562.
[16]Robinson DS,LarchéM,Durham SR. Tregs and allergic disease[J]. J Clin Invest,2004,114(10):1389-1397.doi:10.1172/JCI23595.
[17]尹佳.北京协和医院变应原制剂应用指南[M].北京:中国协和医科大学出版社,2014:12-13.
[18]Leng X,Ye ST. One year observation of immunotherapy for Artemisia hay fever in China:a clinical and immunological study[J]. Asian Pac J Allergy Immunol,1987,5(2):167-172.
[19]岳凤敏,张宏誉.蒿属花粉变应原脱敏治疗的评价:149例回顾性调查[J].中华微生物学和免疫学杂志,2001,21(S2):79-80.YUE Fengmin,ZHANG Hongyu. Evaluation of desensitization for Artemisia pollen allergen:Retrospective investigation among 149 cases[J]. Chinese Journal of M icrobiology and Immunology,2001,21(S2):79-80.
[20]关凯,魏庆宇,尹佳.葎草花粉变应原免疫治疗疗效和安全性评估[J].中华临床免疫和变态反应杂志,2012,6(4):279-284. doi:10. 3969/j. issn. 1673-8705.2012.04.007.GUAN Kai,WEI Qingyu,YIN Jia. Efficacy and safety of specific immunotherapy w ith humulus pollen extract[J]. Chinese Journal of Allergy&Clinical Immunology,2012,6(4):279-284. doi:10. 3969/j. issn. 1673-8705.2012.04.007.
[21]关凯,文昭明.变应原免疫治疗致全身反应[J].中华临床免疫和变态反应杂志,2011,5(4):298-302. doi:10.3969/j.issn.1673-8705.2011.04.011.GUAN Kai, WEN Zhaoming. Systemic reactions induced by allergen specific immunotherapy[J]. Chinese Journal of Allergy&Clinical Immunology,2011,5(4):298-302. doi:10.3969/j.issn.1673-8705.2011.04.011.
[22]宋薇薇,林小平,柴若楠,等.东北地区夏秋季花粉症患者变应原特异性免疫治疗的长期疗效[J].中华临床免疫和变态反应杂志,2012,6(4):266-271. doi:10.3969/j.issn.1673-8705.2012.04.005.SONG Weiw ei,LIN Xiaoping,CHAI Ruonan,et al.Long-term efficacy of allergen specific immunotherapy for pollinosis patients in northeast China[J]. Chinese Journal of Allergy&Clinical Immunology,2012,6(4):266-271. doi:10.3969/j.issn.1673-8705.2012.04.005.
[23]Li LS,Guan K. Effect on quality of life of the mixed house dust mite/w eed pollen extract immunotherapy[J].Asia Pac Allergy,2016,6(3):168-173. doi:10.5415/apallergy.2016.6.3.168.
[24]Li LS,Wang RQ,Cui L,et al. Efficacy of montelukast as prophylactic treatment for seasonal allergic rhinitis[J]. Ear Nose Throat J,2018,97(7):E12-E16.
[25]2018 GINA Report. Global strategy for asthma management and prevention[DB/OL]. http://w w w.ginasthma.org,2018-03-29/2018-10-31.
[26]李丽莎,关凯,崔乐,等.单药加倍或多药联合治疗变应性鼻炎效果比较[J].临床耳鼻咽喉头颈外科杂志,2018,32(1):27-32. doi:10. 13201/j. issn. 1001-1781.2018.01.006.LI Lisha,GUAN Kai,CUI Le,et al. Effects of doubledose antihistamine or combined therapy in allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2018,32(1):27-32. doi:10. 13201/j.issn.1001-1781.2018.01.006.
[27]朱鲁平,隗萍,林旸,等.花粉阻隔剂和氯雷他定片治疗变应性鼻炎的疗效比较[J].中国中西医结合耳鼻咽喉科杂志,2017,25(3):190-192,195. doi:10.16542/j.cnki.issn.1007-4856.2017.03.009.ZHU Luping,(KUI/WEI)(Ping),LIN Yang,et al.Comparison of the curative effects betw een pollen blocking agent and loratadine tablet on allergic rhinitis[J].Chinese Journal of Otorhinolaryngology Integrative M edicine,2017,25(3):190-192,195. doi:10. 16542/j.cnki.issn.1007-4856.2017.03.009.
[28]关凯,李丽莎.鼻腔冲洗在变应性鼻炎防治中的应用[J].山东大学耳鼻喉眼学报,2017,31(3):22-27.doi:10.6040/j.issn.1673-3770.0.2017.151.GUAN Kai,LI Lisha. Nasal irrigation and its role in the treatment of allergic rhinitis[J]. Journal of Otolaryngology Ophthalmology of Shandong University,2017,31(3):22-27. doi:10.6040/j.issn.1673-3770.0.2017.151.
[29]李丽莎,王瑞琦,关凯.丙酮酸钠鼻喷剂治疗变应性鼻炎的效果分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(2):103-106. doi:10.13201/j.issn.1001-1781.2017.02.006.LI Lisha,WANG Ruiqi,GUAN Kai. Treatment effect of sodium pyruvate nasal spray on allergic rhinitis[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2017,31(2):103-106. doi:10. 13201/j. issn.1001-1781.2017.02.006.
[30]苏小霞.过敏性体质的中医认识[J].临床合理用药杂志,2016,9(14):150-151. doi:10. 15887/j. cnki. 13-1389/r.2016.14.100.
[31]贯剑,郑湘瑞,何裕民,等.扶正治标法对青少年花粉症患者相关基因表达的影响[J].江苏大学学报(医学版),2008,18(2):135-138. doi:10.3969/j.issn.1671-7783.2008.02.012.GUAN Jian,ZHENG Xiangrui,HE Yumin,et al. Influence on related gene express in hobbledehoy patients w ith hay fever by herb[J]. Journal of Jiangsu University(Medicine Edition),2008,18(2):135-138. doi:10.3969/j.issn.1671-7783.2008.02.012.
[32]宋岚,武静,郄艾芹.中药制剂引发28例花粉症临床分析[J].中国药房,2007,18(12):937-938. doi:10.3969/j.issn.1001-0408.2007.12.025.SONG Lan,WU Jing,QIE Aiqin. Clinical analysis of28 pollenosis cases induced by TCM preparation[J].China Pharmacy, 2007, 18(12):937-938. doi:10.3969/j.issn.1001-0408.2007.12.025.
[33]王旭,张利,王鹰雷.针灸治疗花粉症67例[J].上海针灸杂志,2004,23(8):30. doi:10.3969/j.issn.1005-0957.2004.08.016.