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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
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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 persistiuli
<4 dRe kviraSi >4 dRe kviraSi
Aan <4 kvira Dda >4 kvira

msubuqi saSualo/mZime
• normaluri Zili • darRveuli Zilis riTmi
• profesiuli aqtioba • daqveiTebuli
• normaluri yoveldRiuri yoveldRiuri aqtivoba
da Sromisunarianoba
aqtivoba, sporti,
dasveneba daqveiTeba

• simptomebi ar awuxebs • simptomebi mkveTria da


pacients 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.

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 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.
 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:
 Н1-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
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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.
 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
msubuqi persistiuli
saSualo/mZime persistiuli
intermisiuli
msubuqi
intermisiuli
intranazaluri steroidebi
lokaluri kromonebi

antileikotrienebi

meore Taobis arasedatiuri H1 -antihistaminurebi


intranazaluri dekongestanti (10 dReze) an oraluri dekongestanti

antileikotrienebi
alergenebisa da iritantebis Tavidan acileba imunoTerapia