alergiuli riniti

definicia: alergiuli riniti warmoadgens IgE-ganpirobebul cxviris lorwovanis anTebas.

epidemiologia: alergiuli riniti erT-erTi yvelaze xSiri qronikuli procesia 18 wlamde
asakis pacientebSi. daavadebis gavrceleba sxvadasxva populaciaSi meryeobs 5-dan 50%de. dadgenilia, rom msoflioSi 500 milion adamians aReniSeneba alergiuli riniti. alergiuli
riniti globalur problemas warmoadgens, vinaidan igi mkveTrad auaresebs pacientis
cxovrebis xarisxs, aqveiTebs skolis moswrebasa da Sromisunarianobas,
warmoadgens
asTmis ganviTarebis risk-faqtors, xSir SemTxvevaSi ganapirobebs sinusitis, koniuqtivitis da
sxv. problemebis ganviTarebas da axasiaTebs maRali ekonomikuri danaxarjebi.
alergiuli riniti da asTma xSirad Serwymulia, rac daedo safuZvlad koncefcias _ "erTiani
sasunTqi sistema, erTiani daavadeba"
etiologia: daavadebas iwvevs sxvasxva saxis alergenebis, upiratesad sainhalacio
anu aeroalergenebis zemoqmedeba. sainhalacio alergenebs yofen or nawilad kargareTa
(xeebis, balaxis, yvavilis mtveri) da karSida (cxovelebis bewvi, mtvris tkipa, obi da sxv.)
alergenebad. kargareTa alergenebis zemoqmedebiT uxSiresad vlindeba sezonuri (alergiuli
rinitis simptomebi gamoxatulia sezonurad), xolo karSida alergenebis SemTxveaSi wliuri
(perineal) riniti. alergiuli riniti SesaZlebelia ganpirobebuli iyos agreTve kvebiTi alergenebiT.
paTogenezi: atopiisadmi ganwyobil pacientebSi alergenis moxvedra iwvevs
specifikuri IgE produqcias. alergenis zemoqmedebiT SesaZlebelia ganviTardes swrafi tipis
an gviani tipis pasuxi. swrafi tipis reaqcia dakavSirebulia poxier ujredebze
IgE
molekulebisa da antigenis fiqsaciiasTan, rasac moyveba poxieri ujredebis degranulacia da
anTebiTi mediatorebis maT Soris histaminis gamonTavisufleba. mogvianebiTi tipis reaqcia
vlindeba antigenis zemoqmedebedan 4-8 sT_Si da dakavSirebulia bazofilebis,
eozinofilebis, mononuklearuli ujrdebiT infiltraciasTan. mocemuli ujredebidan xdeba
proanTebiTi mediatorebis leikotrienebis, interleikinebis (IL)3, IL-5, IL-13, da granulocitebisa
da makrofagebis koloniis mastimulirebeli faqtorebis (GM-CSF) gamonTavisufleba, rac
moqmedebs lorwovan garsze da iwvevs anTebiT cvlilebebs.
klinikuri surTi: alergiuli rinitis ZiriTad simptomebs miekuTvneba:
rinorea (cxviridan gamonadeni). SeiZleba iyos wina da ukana rinorea (ukana
Canadeni). Cveulebriv gamonadeni serozuli xasiaTisaa.
cxviris gaWedva (obstruqcia)
cemineba
cxviris qavili.
cxviris qavilis gamo xSir SemTxvevaSi vlindeba e.w. alergiuli saluti (cxviris wveris
qavli gaSlili xelisguliT), romelic xanmokle periodis ganmavlobaSi amcirebs cxviris
obstruqcias. mocemuli manevris xSiri ganmeorebis gamo SesaZlebelia ganviTardes cxviris
naWdevi.
cxviris obstruqciis gamo bavSvi pirRia sunTqavs da vlindeba e.w. adenoiduri saxe.
alergiuli rinitis dros SesaZlebelia gamovlindes paraorbitaluri alergiuli saTvale anu alergiuli
naTeba, muqi feris SeSupebuli paraorbitaluri midamo SeSupebuli quTuToebiT.
alergiul riniti SemTxvevaTa nawilSi asocirdeba alergiul koniuqtivitTan, romelsac
SesaZlebelia Tan axldes cremldena. pacientebi SesaZlebelia uCiodnen Tavis tkivils, xvelas,
iSviT SemTxevaSi ynosis daqveiTebas. pacientTa umravlesobas simptomebi umwvavdeba
Ramis da dilis saaTebSi. Rame xSirad vlindeba xvrinva, Zilis darRveva, agzneba.
klasifikacia:

ukanasknel periodSi sezonuri da wliuri alergiuli rinitis klasifikaciasTan erTad ufro

xSirad iyeneben janmrTelobis msoflio organizaciis da ARI_s klasifikacias, romlis mixedviTac
alergiuli riniti iyofa orad intermisiul da persistiul formad.

intermisiuli
<4 dRe kviraSi
Aan <4 kvira

msubuqi
normaluri Zili
profesiuli aqtioba
normaluri yoveldRiuri
aqtivoba, sporti,
dasveneba
simptomebi ar awuxebs
pacients

persistiuli
>4 dRe kviraSi
Dda >4 kvira

saSualo/mZime
darRveuli Zilis riTmi
daqveiTebuli yoveldRiuri
aqtivoba da
Sromisunarianoba
daqveiTeba
simptomebi mkveTria da
awuxebs pacients

diagnostika.
alergiuli rinitis SemTxvevaSi SesaZlebelia Catardes Semdegi gamokvlevebi:
kanis testebi
SratSi alergen specifikuri IgE gansazRvra (SedarebiT iSviaTad saerTo IgE)
nazalur CamonarecxSi eozinofilebis Seswavla
rinoskopia
cxviriT sunTqvis pikuri nakadi
kanis testebi warmoadgens erT-erT saukeTeso meTods alergen sfecifikuri IgE
dasadgenad. mocemuli testebi sensitiuri, swrafi da ara ZviradRirebulia, axasiaTebs dabali
riski da minimaluri diskomforti. kanis testebi ar gamoiyeneba 1 wlamde asakSi, vinaidan
am asakSi xSirad ver viTardeba alergenebze dadebiTi pasuxi. testis Catarebamde
mizanSewonilia medikamenturi mkurnalobis SeCereba (antihistaminebis II Taobis 5-7 dRe, I
Taobis 3-4 dRe, antileikotrienebis 1 dRe). Sratis specifikuri IgE gansazRvra warmoadgens
aleternatiul meTods, gamoiyeneba pacientebTan Zlieri dermografizmiT, gamoxatuli
dermatitriT, aseve im SemeTxvevaSi Tu kanis testebze pacients aqvs uaryofiTi reaqcia.
nazaluri CamonarecxSi eozinofilebis gamovlena safiqrals xdis alergiuli rinitis arsebobas,
xolo nazalur CamonarecxSi neitrofilebis aRmoCena gvafiqrebinebs infeqciuri genezis
rinitis arsebobaze. sisxlSi eozinofilia da Sratis serTo IgE donis gansazRvra alergiuli rhinitis
sadiagnostiko SedarebiT nakleb sensitiur meTods warmoadgens.
diferenciuli diagnostika
alergiuli rinitis diferencireba unda moxdes araalergiuli rinitisagan.
araalergiul rinitis yvelaze xSir gamovlinebas warmoadgens infeqciuri riniti, romelic
SeiZleba iyos mwvave an qronikuli. mwvave uxSiresad ganpirobebulia rinovirusuli
infeqciiT da simptomebi grZeldeba 7-10 dRe. qronikuli riniti uxSiresad asocirdeba
sinusitTan.

araalergiuli arainfeqciuri riniti (vazomotoruli riniti) vlindeba rinoreiTa da

ceminebiT. ganpirobebulia gamRizianeblis zemoqmedebiT, mtveri, sigaretis kvamli,
mZafri surneli, civi haeris, cxare sakvebi, auzze-qloriani wyali da sxv.
2

medikamentur riniti topikuri nazaluri dekongenstantebis didi raodenobiT da

xangrZlivad gamoyenebis SemTxvevaSi. bavSvebSi SedarebiT iSviaTia.
alergiuli riniti xSir SemTxvevaSi saWiroebs diferencirebas cxviris obstruqciisagan,
romelic ganpirobebulia anatomiuri problemebiT: maT Soris qoanebis atrezia (Tandayolili
anomalia, romlis drosac cxvirsa da xaxas Soris vlidneba membranuli an Zvlovani Zgide.
vlindeba axalSobilebSi, cianoziT, romelic ixsneba piriT sunTqvisas), nazaluri popipozi
(cxviris obstruqcia, rinorea serozuli gamWvivale sekretiT), cxviris ucxo sxeuli. Zlier
iSviaTad SesaZlebelia hgamovlindes cxviris hemangioma, limfoma, dermoiduli kista.
mkurnaloba: alergiuli rinitis mkurnalobis mizania daavadebis simptomebis swrafi
kupireba da alergiuli rinitis gamovlinebebis prevencia. mkurnaloba efuZneba Semdeg
ZiriTad principebs:
1. alergenTan kontaqtis gamoricxva (SesaZleblobis mixedviT)
2. alergiuli rinitis farmakoTerapia
3. imunoTerapi
4. pacientis ganaTleba.
alergenebis zemoqmedebisagan Tavis arideba mkurnalobis erT-erTi ZiriTadi principia.
karSida alergenebis zemoqmedebis Sesamcireblad
mizanSewonilia cxoveluri
alergenebisagan Tavis arideba, oTaxidan xaliCebis mocileba, saxlis sveli wesiT dalageba,
alergiuli tipis kvebiTi produqtebis SezRudva.
kargareTa alergenebis Tavis aridebis
saSualebas iZleva kondicioneris gamoyeneba (rac iZleva alergiuli sezonis dros fanjris
daxurvis SesaZleblobas).
alergiuli rinitis mkurnaloba moicavs Semdegi preparatebis gamoyenebas:
1-blokatorebi: alergiuli rinitis ZiriTad samkurnalo preparatebs mikeuTvneba
antihistaminuri preparatebi. alergiuli rinitis samkurnalod upiratesoba eniWebaT meore
Taobis antihistaminuri preparatebis gamoyenebas, romelTac ar aqvT sedaciuri efeqti.
dadgenilia, rom pirveli Taobis antihistaminuri preparatebi ZilianobasTan erTad iwveven
yuradRebis koncentraciis darRvevas, kognituri funqciis daqveiTebas. bavSvTa asakSi
gamoiyeneba Semdegi preparatebi: cetirizini, dezloratadini (6 Tvis asakis Semdeg),
loratadini (2 wlis asakis Semdeg) da feqsofenadini 6 welze meti asakis bavSvebSi.
SesaZlebelia gamoyenebuli iyos topikuri (adgilobrivi) antihistaminuri preparati,
rogoricaa azelastini. azelastinis cxviris sprei gamoiyeneba 5 wlis asakis Semdeg.
kortikosteroidebi gamoiyeneba adgilobrivi anu intranazaluri steroidebi, am mizniT
iyeneben beklametazons, mometazons, flutikazons, triamcinolons da budezonids.
adgilobrivi steroidebi iwveven lorwovanis anTebiTi cvlilebebis, SeSupebis dalorwos
produqciis Semcirebas da iwvevn nazaluri simptomebis swraf kupirebas. gverdiT
movlenebs miekuTvneba lokalurad wvis SegrZneba, cemineba, romelic vlindeba
pacienTTa 10 %-Si.
dekongestantebi. nazaluri obstruqciis Semcirebis mizniT SesaZlebelia gamoyenebuli
iqnes dekongestantebi oralurad an intra nazalurad. oraluri dekongestantebi, rogoricaa
fsevdoefedrini SesaZlebelia gamoyenebuli iyos antihistaminebTan kombinaciaSi.
oraluri dekongestantebis gverdiT efeqts miekuTvneba agzneuZiloba, gulis frialis
SegrZneba, tremori. topikuri nazaluri dekongestantebi xsnian nazalur obstruqcias,
Tumca maTi gamoyeneba ar aris mizanSewonili 5 dReze metad, rom ar gamoiwvion
medikamenturi riniti
ipratropiumis bromidi (atroventi) SesaZlebelia gamoyenebuli iyos seriozuli rinoreis
SemTxvevaSi. SemTxvevaTa nawilSi gamoiyeneba kromonebi, antihistaminur
preparatebTan erTad, Tumca mocemuli preparatebi moiTxoven xSir gamoyenebas.
3

 antileikotrienuli preparatebi sezonuri alergiuli rhinitis dros efeqturia montelukastis

gamoyeneba, rogorc monoTerapia an antihistaminur preparatebTan erTad.
imunoTerapia gamoiyeneba im SemTxvevaSi, rodesac alergiuli rinitis medikamenturi
mkurnaloba araefeqturia. imunoTerapia ar gamoiyeneba mcire asakis bavSvebSi,
gasaTvaliswinebelia, rom imunoTerapiis dros SesaZlebelia ganviTardes anafilaqsiuri
reaqcia.
alergiuli rinitis safexurebrivi Terapia mocemulia sqemaze.

saSualo/mZime
intermisiuli

msubuqi
intermisiuli

msubuqi
persistiuli

saSualo/mZime
persistiuli

intranazaluri steroidebi
lokaluri kromonebi
antileikotrienebi

meore Taobis arasedatiuri H1 -antihistaminurebi

intranazaluri dekongestanti (10 dReze) an oraluri dekongestanti
antileikotrienebi
alergenebisa da iritantebis Tavidan acileba

imunoTerapia