Why should a doctor prescribe the treatment of chronic vasomotor rhinitis? What are the causes of the development of the disease and its main symptoms? What prevention methods can be used?

In recent years, a significant increase in the prevalence of chronic rhinitis has been noted among diseases of the upper respiratory tract. Among the chronic forms of rhinitis, vasomotor rhinitis occupies a large place. What it is?

Chronic vasomotor rhinitis is a disease affecting the nasal mucosa due to dysregulation of general or local vascular tone.

ICD-10 code (International Classification of Diseases 10th revision) - J30.0.

According to the etiological factor, an allergic or neurovegetative form of the disease is distinguished.

The disease can be caused by physical, chemical or toxic factors. Other types of vasomotor rhinitis:

• psychogenic, in which vascular imbalance develops due to the lability of the autonomic nervous system;
• idiopathic;
• mixed.

Reasons for the development of the disease

The basis of the pathogenesis of the neurovegetative form of vasomotor rhinitis is dysfunction of the autonomic nervous system, both the autonomic nervous system of the nasal cavity, and general vegetative-vascular dystonia.

An imbalance between the sections of the autonomic nervous system in vasomotor rhinitis occurs due to an increase in the tone of one or a decrease in the tone of its other section. This pathological process can be initiated by many external and internal factors.

The consequence of an imbalance in the autonomic nervous system may be gastroesophageal or laryngopharyngeal reflux, which is also a trigger factor for the disease.

The trigger factor is often a respiratory viral infection. Non-specific causes can be: tobacco smoke, pungent odors, ozone, pollutants, alcohol intake, a sharp change in the temperature of the inhaled air.

Cold air is the main nonspecific triggering factor for the chronic form of the disease. The increased content of ozone in the inhaled air damages the epithelium, increases vascular permeability. Leukocytes and mast cells begin to migrate into the mucous membrane, stimulating the production of neuropeptides - mediators that are involved in the formation of nasal hyperreactivity in vasomotor rhinitis.

Mechanical factors that can cause pathological symptoms in the presence of nasal hyperreactivity:

• nose trauma, including surgical;
• deformities of the nasal septum, the presence of sharp ridges and spikes that are in contact with the side wall of the nasal cavity;
• forced exhalation through the nose;
• increased flashing.

The consequence of an imbalance in the autonomic nervous system may be gastroesophageal or laryngopharyngeal reflux, which is also a trigger factor for the disease.

The allergic form of vasomotor rhinitis occurs as a result of exposure to various allergens:

• pollen of plants during their flowering;
• book and house dust;
• bird feather;
• hair, pet dander;
• daphnia (dry fish food);
• food products: citrus fruits, honey, strawberries, milk, fish;
• perfumery.

The pathogenesis of allergic rhinitis is a specific IgE-dependent reaction between the allergen and tissue antibodies, which results in the release of mediators of the allergic reaction (histamine, serotonin, tryptase), which are involved in the formation of nasal hyperreactivity and the development of clinical signs.

Symptoms of chronic vasomotor rhinitis

The main symptoms of the disease are:

• prolonged difficult nasal breathing;
• nasal congestion;
• persistent or intermittent clear discharge from the nose;
• sensation of mucus running down the back of the throat;
• headache and decreased sense of smell, lacrimation.

As a result of increased permeability of blood vessels, an increase in the volume of the inferior turbinates occurs, which leads to the appearance of nasal congestion. This symptom occurs in the form of attacks and is characterized by the appearance of profuse mucous or watery discharge from the nose and paroxysmal sneezing.

When turning and changing the position of the head, nasal congestion can alternately change from one half to the other. Persistent obstruction of nasal breathing appears as a result of hypertrophy of the turbinates, which develops in chronic rhinitis. Also, patients may have signs of vegetovascular dystonia:

• acrocyanosis;
• low blood pressure;
• drowsiness;

Diagnostics

Basic and additional diagnostic measures aimed at identifying the disease:

• detailed collection of complaints and anamnesis;
• anterior, posterior rhinoscopy;
• x-ray examination of the nose and paranasal sinuses;
• functional examination of the nose;
• endoscopic examination of the nasal cavity;
• bacterioscopic and bacteriological examination of discharge from the nasal cavity, determination of sensitivity to antibiotics;
• cytological examination of the nasal mucosa;
• computed tomography according to indications;
• determination of IgE;
• conducting allergy tests.

During rhinoscopy, depending on the form of vasomotor rhinitis, the following signs can be visualized:

• hyperemia and swelling of the mucous membrane of the nasal cavity, its pallor or cyanosis, polyposis changes;
• pathological discharge, mucus;
• crusts;
• thinning of the bone structures of the nasal cavity;
• false hypertrophy of shells;
• vitreous edema.

To detect changes in the nasal mucosa, a test with anemization with adrenomimetics is performed. After lubrication of the mucous membrane of the turbinates with a 0.1% solution of adrenaline, they decrease to normal sizes with edema. If the turbinates are enlarged due to hyperplasia of the bone skeleton, their size does not change significantly.

The cause of nasal hyperreactivity needs to be established. In cases where it is not possible to establish a relationship between symptoms and a specific trigger factor, vasomotor rhinitis is defined as idiopathic.

In a clinical blood test with an allergic form of vasomotor rhinitis, eosinophilia is detected, leukocytosis is possible when a secondary infection is attached.

To exclude concomitant acute and chronic pathologies of the ENT organs (presence of sinusitis, adenoids, curvature of the nasal septum, etc.), an X-ray examination of the nose and paranasal sinuses is performed.

The cause of nasal hyperreactivity needs to be established. In cases where it is not possible to establish a relationship between symptoms and a specific trigger factor, vasomotor rhinitis is defined as idiopathic.

According to the indications, the patient is referred for a consultation with an allergist, pulmonologist, neurologist.

Vasomotor rhinitis should be differentiated from hypertrophic rhinitis.

Treatment of chronic vasomotor rhinitis

The approach to the treatment of the disease should be comprehensive, taking into account concomitant diseases and the general condition of the body. The goal of therapy is to restore nasal breathing and improve the quality of life.

Medical treatment includes:

• systemic antihistamines (Zirtek, Loratadin);
• local antiallergic drugs in the form of drops, spray or gel (Azelastine, Levocabastin);
• decongestants (vasoconstrictor drugs - Tizin, Oxymetazoline) in a short course, no more than 7-8 days;
• endonasal blockade with procaine;
• intramucosal administration of glucocorticoids (Nasobek, Avamys, Flixonase).

A rational approach to the use of vasoconstrictor drops is very important, since their long-term use makes it necessary to increase their dose in order to achieve a greater effect. This, in turn, can lead to the following undesirable phenomena:

• headaches;
• increased blood pressure;
• reactive hyperplasia of the nasal mucosa, especially the inferior turbinates;
• hyperplasia of the bone skeleton;
• aggravation of the imbalance of the autonomic nervous system;
• obstruction of the lumen of the nasal cavity, which can no longer be eliminated by decongestants.

To restore the state of the epithelium of the nasal mucosa, it is recommended to use special immunomodulatory drugs (IRS 19).

Irrigation of the nasal cavity with saline, sea water or antiseptic solutions (Miramistin, Octenisept) has a positive effect.

Physiotherapeutic methods have a normalizing effect on microcirculation in the mucous membrane in chronic rhinitis:

• exposure to UHF currents (ultra-high-frequency therapy) or microwaves endonasally;
• endonasal ultraviolet irradiation through a tube;
• exposure to helium-neon laser;
• endonasal electrophoresis 0.25–0.5% zinc sulfate solution, 2% calcium chloride solution;
• ultraphonophoresis with hydrocortisone ointment, Splenin;
• insufflation (blowing) of Rinofluimucil, Octenisept (at a dilution of 1: 6) into the nose;
• acupuncture.

In a clinical blood test with an allergic form of vasomotor rhinitis, eosinophilia is detected, leukocytosis is possible when a secondary infection is attached.

How to cure chronic vasomotor rhinitis with the ineffectiveness of conservative therapy? Surgery may be the solution. According to indications, the following is performed:

• submucosal vagotomy of the inferior turbinates;
• ultrasonic or microwave disintegration of the inferior turbinates;
• submucosal laser destruction of the inferior turbinates;
• sparing lower conchotomy.

Laser technologies make it possible to optimize surgical aids in the treatment of vasomotor rhinitis and reduce the time of rehabilitation of patients. A high-energy, low-power laser is used. Upon contact, it does not cause extensive tissue necrosis, which has a positive effect on the healing time of the laser wound.

In the chronic course of vasomotor rhinitis, a periodic examination by an otorhinolaryngologist is necessary. This is associated with a high risk of developing chronic inflammatory diseases of the paranasal sinuses, middle ear, pharynx, and larynx.

Patients are advised to follow a diet with a restriction of spicy foods, sweet, excessively hot food. Non-drug treatment also includes breathing exercises, which is aimed at preventing the common cold and diseases of the upper respiratory tract. Judging by the positive reviews, regular exercise helps to improve the overall physical and psychological state.

It is necessary to treat common diseases (neurosis, endocrine dysfunction, diseases of internal organs). Eliminate provoking factors, active and passive smoking.

Prevention

The main preventive measures:

• elimination of exogenous and endogenous factors that support the disease;
• sanitation of purulent-inflammatory diseases of the oral cavity, nasopharynx, paranasal sinuses;
• therapy of somatic diseases: pathologies of the cardiovascular system, kidneys, diabetes mellitus, obesity, etc.;
• improvement of hygienic living conditions;
• spa treatment;
• maintaining a healthy lifestyle;
• hardening procedures, impact on reflex zones (contrast shower, short-term dousing of cold water on the soles of the feet);
• vitamin therapy and washing the nasal cavity with saline or antiseptic solutions at home in the autumn-spring period;
• breathing exercises.

Video

We offer you to watch a video on the topic of the article.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

How many codes does allergic rhinitis have in ICD-10

Nature has endowed man with immunity, which protects him from various alien and harmful misfortunes. However, in some people, the immune system can surprise with hypersensitivity to certain substances inside or outside the home - allergies. This is the body's reaction to something that it should not react to under normal conditions. One of the symptoms of the disease is an allergic rhinitis, due to which the meeting with the allergen ends at the level of the nose and is manifested by the development of an inflammatory process of non-infectious origin. This disease is considered by medicine as a separate pathology, therefore, in ICD 10, allergic rhinitis has its own code, or rather there are several of them, depending on its type.

What is allergic rhinitis MBC 10

The causes of this pathology are not yet fully understood, but the mechanisms are known. It has been established that acute allergic rhinitis develops as an immediate hypersensitivity reaction, which means that a runny nose appears within minutes after meeting with an allergen.

An important role in the occurrence of such reactions is played by hereditary and constitutional predisposition.

Triggers for allergic rhinitis:

• flowering plants, and their pollen;
• mold in residential areas;
• particles of house dust from carpets, upholstered furniture, toys;
• traces of saliva, urine and animal hair;
• down, feathers from pillows and blankets;
• bed and dust mites;
• synthetic detergents;
• medicines and certain foods.

In response to the entry of an allergic molecule into the nasal mucosa, many inflammatory inductors are released, which increase the production of mucus in order to wash away foreign particles. This mucus is swallowed and enters the intestines along with allergens (for the immune system, these are antigens), in response, the body produces protective antibodies. A large number of antigen-antibody complexes circulate in the blood, sufficient to develop acute non-infectious rhinitis. The pathological process over time can go further to other organs, for example: bronchi, lungs, kidneys.

Classification

The International Classification of Diseases is used by healthcare professionals to systematize different diseases, with data updated every 10 years. According to the latest version, acute and chronic allergic rhinitis is singled out as an independent pathology in the J30-J39 group. The following types of nosology under consideration fall under the exact definition according to ICD 10:

• J0 Vasomotor rhinitis - is considered as an inadequate response of the vascular plexuses of the nose to various stimuli. It is associated with a violation of autonomic innervation in general neuroses or systemic diseases.
• J1 Allergic rhinitis (pollinosis, hay fever) - causes pollen of plants (ragweed, poplar fluff, lilac flowers, etc.). Its peak is in spring and late summer.
• J2 Other seasonal allergic rhinitis is an acute inflammatory process of an intermittent nature.
• J3 Other allergic rhinitis is a year-round form of persistent rhinitis that occurs under the constant influence of allergens inside the house (dust, mold, fluff, wool, etc.). This also includes occupational rhinitis associated with the inhalation of allergens in the workplace (flour, paint, drugs, etc.).
• J4 Allergic rhinitis of unspecified origin - when the diagnosis is still in question after examination and differential diagnosis with other diseases.

Each of these rhinitis can proceed as acute and chronic. Symptoms for all types of the disease are similar - sneezing, nasal congestion, profuse watery discharge, itching.

How to help

Treatment of allergic diseases will be effective only if contact with the guilty allergen is completely eliminated, otherwise medications will bring only temporary relief. Due to the lack of the possibility of its detection, in practice it is very difficult to rid the patient of this pathology. Treatment in this case is reduced to symptomatic measures necessary to alleviate the patient's condition, restore his working capacity and improve the quality of life. Preparations for internal use with antihistamine and anti-inflammatory effects, local remedies (nasal drops and sprays of a similar effect) are prescribed. In severe cases resort to the use of corticosteroid therapy.

A prerequisite for the treatment of allergic rhinitis is a change in the usual environment and the nature of nutrition as an addition to taking medication.

Housing should be as free from dust collectors as possible (carpets, upholstered furniture, open bookcases), it is advisable to purchase an air purifier and humidifier, avoid contact with pets, adhere to a strict hypoallergenic diet. With an unidentified allergen, therapy can be long and serious, bringing temporary relief.

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Allergic rhinitis according to ICD 10

Allergic rhinitis does not affect life expectancy, does not change mortality rates, but is chronic and significantly disrupts the normal functioning of a person.

Predisposing factors

The following factors contribute to the development of acute rhinitis:

• chronic fatigue;
• Constant stress at work
• sleep deprivation;
• Hypovitaminosis and constitutional features of the body;
• Contaminated air;
• hereditary predisposition.

Prevalence

Pollinosis is a very common disease. The number of patients in Russia ranges from 18 to 38%, in the USA 40% of children suffer from it, more often boys. Children under 5 years of age rarely get sick, the rise in incidence is observed at the age of 7–10 years, the peak incidence occurs at the age of 18–24 years.

The prevalence of pollinosis over the past 10 years has increased more than five times.

Classification

Allergic rhinitis can be year-round - a persistent course, and seasonal - an intermittent course.

• Perennial rhinitis (persistent). The attack becomes chronic. A runny nose bothers at least 2 hours a day and more than 9 months a year. It is observed upon contact with household allergens (wool, saliva, dander and feathers of pets, cockroaches, mushrooms and house plants). This chronic runny nose is characterized by a mild course without disturbing sleep and performance.
• Seasonal rhinitis. An attack of a runny nose occurs after contact with an allergen for several hours during the flowering period of plants. Acute rhinitis lasts less than 4 days a week and less than 1 month a year. It proceeds in more severe forms, disrupting night sleep and human performance.
• Episodic. It rarely appears, only after contact with allergens (cat saliva, ticks, rat urine). Allergy symptoms are pronounced.
• Since 2000, another form has been distinguished - professional runny nose, which affects confectioners, livestock specialists, flour millers, pharmacists (pharmacists), employees of medical institutions and woodworking enterprises.

Severity

Allocate mild, moderate and severe course of the disease.

1. With a slight runny nose, sleep is not disturbed, normal professional and daily activities are maintained, and severe painful symptoms are not disturbed.
2. In severe and moderate rhinitis, at least one of the following symptoms is observed:
   • sleep disturbance;
   • distressing symptoms;
   • disruption of daily/professional activities;
   • a person cannot play sports.

With a progressive course of the disease for more than 3 years, bronchial asthma appears.

ICD 10

ICD 10 is a unified classification of diseases for all countries and continents, in which each disease received its own code, consisting of a letter and a number.

According to ICD 10, hay fever is a disease of the respiratory system and is part of other diseases of the upper respiratory tract. The code J30 is assigned to vasomotor, allergic and spasmodic rhinitis, but it does not apply to allergic rhinitis with asthma (J45.0)

ICD 10 classification:

• J30.0 - vasomotor rhinitis (chronic vasomotor neurovegetative rhinitis).
• J30.1 - Allergic rhinitis caused by pollen of flowering plants. Otherwise called pollinosis or hay fever.
• J30.2 - other seasonal allergic rhinitis.
• J30.3 Other allergic rhinitis, eg perennial allergic rhinitis.
• J30.4 - allergic rhinitis of unspecified etiology.

Clinic and diagnostics

Acute allergic rhinitis is manifested by periodic disruption of normal breathing through the nose, clear liquid watery discharge, itching and redness of the nose, and repeated sneezing. The basis of all symptoms is contact with the allergen, i.e. a sick person feels much better in the absence of a substance that provokes an attack of an allergic disease.

A distinctive feature of acute pollinosis from the usual infectious (cold) rhinitis is the preservation of the symptoms of the disease unchanged throughout its entire period. In the absence of an allergen, a runny nose goes away on its own without the use of drugs.

The diagnosis is established on the basis of the symptoms of the disease, history and laboratory tests. To confirm the diagnosis, skin tests and a contact examination using modern sensors are carried out. The most reliable method is recognized as a blood test for specific antibodies from the immunoglobulin E (IgE) class.

Treatment

The main point in treatment is the exclusion of allergens. Therefore, in a house where there is an allergic person, there should be no pets and items that collect dust (soft toys, carpets, fleecy bedding, old books and furniture). During the flowering period, it is better for a child to be in the city, away from fields, parks and flower beds, it is better to hang wet diapers and gauze on the windows at this time to prevent the allergen from entering the apartment.

An acute attack is relieved with antihistamines (Allergodil, Azelastine), cromones (Cromoglycate, Necromil), corticosteroids (Fluticasone, Nazarel), isotonic saline solutions (Quicks, Aquamaris), vasoconstrictors (Oxymetazoline, Xylometazoline) and antiallergic drops (Vibrocil) are successfully used . Allergen-specific immunotherapy has proven itself well.

Timely, properly performed treatment can completely stop the existing acute attack, prevent the development of a new exacerbation, complications, and the transition to a chronic process.

Prevention

First of all, preventive measures should be taken in relation to children with aggravated heredity, i.e. whose closest relatives, parents suffer from allergic diseases. The probability of morbidity in children increases to 50% if one parent has allergies, and up to 80% if both have allergies.

1. Restriction in the diet of a pregnant woman of products that are highly allergenic.
2. Elimination of occupational hazards in pregnant women.
3. To give up smoking.
4. Continue breastfeeding for at least 6 months, introduce complementary foods no earlier than five months of age.
5. With an existing allergy, it is necessary to be treated with courses of antihistamines, to avoid contact with allergens.

Allergic rhinitis, whether acute or chronic, has a negative impact on the patient's social life, study and work, and reduces his performance. Examination and treatment is far from an easy task. Therefore, only close contact between the patient and the doctor, compliance with all medical prescriptions will help to achieve success.

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Allergic rhinitis: how to recognize and treat

The number of allergy sufferers is growing every year, and neither therapists nor allergists can explain the reasons for this growth. If earlier each off-season brought only 12% of new patients, now this figure has increased several times. This is only the statistics of the journal "Health". But how many more people simply do not go to hospitals with allergies just because they have never had allergies. Not everyone knows that the human body changes with age so much that a completely healthy person can become allergic.

The reaction can be caused by various factors, up to the air conditioner. Depending on the irritant and the organism, the disease can manifest itself as allergic rhinitis.

Features of the disease

Allergic rhinitis (ICB code 10 - J30) implies inflammation and swelling of the mucous membrane of the sinuses. In this case, the presence of one or all of the features of such a runny nose is mandatory:

At least one of these signs should manifest itself every hour. Otherwise, we are dealing with another kind of rhinitis, for example, with a vasomotor form. The course of allergic rhinitis has four stages:

1. Vasotonic stage: the nose is blocked by episodes, the vascular tone is changed, infrequent instillation is required; But how vasomotor rhinitis is treated, you can find out by reading this article.
2. Vasodilation: congestion is more dense and frequent, the vessels are dilated, it is difficult to breathe without medication;
3. Chronic edema: the nose is stuffy, the mucous membrane becomes blue, drops and sprays do not work; But how swelling of the nasal mucosa is treated without a runny nose, you can understand by reading the article.
4. Hyperplasia: the nose is always stuffy, polyps appear, it is fraught with secondary diseases (otitis media, infections).

Types of disease

Perennial allergic rhinitis alternates throughout the year according to the scheme: exacerbation - remission

Most often, allergic rhinitis is associated with the seasons, but this is not an axiom. The common cold is divided into several groups:

Each type differs in the severity of symptoms, the different condition of patients. With seasonal rhinitis, the disease manifests itself only in the off-season, when the flowering of plants and trees is active. Year-round chronic has a permanent form, the whole year the disease alternates according to the scheme: exacerbation - remission.

What nose drops for allergic rhinitis are best used, indicated in this article.

How rhinitis of pregnant women is treated is indicated in this article.

Acute rhinitis usually occurs after contact with a sudden irritant. For example, chronic can go into an acute phase upon contact with an aggressive allergen. The acute form is also divided into varieties:

1. traumatic, in which a runny nose begins as a protective reaction to damage;
2. infectious, with it inflammation develops from the ingestion of a bacterium or virus;
3. allergic, in which an attack by an aggressive agent occurs.

Allergic rhinitis in acute form proceeds actively, aggressively, sometimes for a long time. Even with the right treatment, it can stubbornly torment the patient and, to top it all, turn into asthma. Therefore, the acute form is considered the most dangerous to health.

Possible causes and predisposing factors

Allergy belongs to the category of hereditary diseases or predisposition. For example, there may be asthmatics in the family, which indicates the possibility of transmitting a predisposition to allergies to each relative. The development of the disease to bronchial asthma is not necessary, but the very presence of a reaction to potential allergens will manifest itself.

Often the predisposing moment becomes one of the following:

• curvature of the nasal septum;
• the presence of polyps in the nose;
• persistent colds;
• increased permeability of the shell itself;
• metabolic disorders;
• changes in liver function.

Pollen, animal dander, food - the list of allergens can be extensive.

The causes of allergies can be many factors, much depends on the individuality of the body and tolerance:

• dust, dust mites;
• flowering plants;
• animal hair;
• insect bites;
• contact with odors;
• intolerance to certain foods;
• reaction to taking drugs;
• air conditioner.

Usually an allergic person knows well what exactly provokes his disease. For example, honey, milk, eggs are highly allergenic foods, as is chocolate. As you can see, it can be difficult to find the cause, but it is still possible by elimination.

Perfumes, deodorants, a number of products can easily cause allergic rhinitis.

First signs and symptoms

Usually, allergic rhinitis is active in the morning: the patient sneezes and coughs for a long time. The first signs can sometimes be noticed immediately, but it depends on the situation. For example, if perfume was sprayed on and a person began to sneeze heavily, then this is his allergen. Others get a runny nose when they come into contact with a cat or dog. It must be said that allergic rhinitis is reactive, it does not wait long and rarely "sits in ambush". If the agent gets into the nose, the mucosa will immediately begin trying to get rid of the foreign body. Therefore, the patient begins to sneeze, his nose itches, clear mucus is released.

Allergic rhinitis may not appear alone, but bring with it a secondary disease. Most often it is otitis, less often bacteria and infections. It is difficult to treat such a ligament, since one disease complicates another.

With a clean runny nose, the discharge from the nose is transparent, easily separated.

If rhinitis is started, secondary diseases have joined, then the discharge from the nose will become yellow or green, it will be difficult to breathe, the nose itches a lot. But such a course is more typical for a chronic year-round form than for acute seasonal rhinitis.

Diagnostics

Using a special device, the doctor examines the sinuses, determining the degree of damage and swelling

Primary diagnosis is based on the complaints of the patient himself and his story: the timing of rhinitis, manifestation, course features. Then, using a special device, the doctor examines the sinuses, determining the degree of damage and swelling. If the situation is severe and requires clarification, then rhinoscopy is indicated. Rhinoscopy is an accurate type of study that allows you to examine the nasal cavities in different projections.

If we are talking about a sudden allergy in an acute form, the doctor takes a piece of skin for a sample. This allows you to identify the harmful agent and name the exact cause of allergic rhinitis.

Treatment

Medicines

The therapeutic regimen is determined only by the specific condition of the patient and the cause that caused the runny nose. Usually, with a mild form, an angistaminic drug is prescribed: Claritin, Zirtek. If necessary, and in the presence of nasal obstruction, sprays such as Otrivin are prescribed (Everything about otrivin or nazivin for children can be read here in the article.) to facilitate breathing, especially at night. Be sure to rinse the sinuses with saline to remove swelling from the mucosa and disinfect it.

More severe forms are treated individually. Acolate-type antagonists may be prescribed in combination with antihistamines. For some, special diets are recommended, such as the complete elimination of food allergens. Depending on what type of pollen you have allergic rhinitis, you may be banned from eating foods such as nuts or apples.

If the treatment is not effective, then a special therapy may be indicated to develop immunity to a particular allergen. But this long-term treatment takes up to five years.

The drugs of the new generation, more powerful and effective, include such as Lordestin, Zodak Express, Desloratadine-Teva. These drugs have reduced side effects such as drowsiness. At the same time, the effect comes much faster, for example, when taking Zodak Express, the first relief is felt after 15 minutes. But a caveat must be made: the new generation of drugs has different chemical lines of compounds, so intolerance is possible.

Folk remedies

For the patient, it is necessary to provide strict conditions:

• cleanliness and wet cleaning;
• exclude communication with any animal;
• do not use perfumes, fresheners;
• constantly ventilate the room.

Recipes for a runny nose at home will help well, for example, a decoction of a collection of herbs: elecampane, centaury, St. John's wort and wild rose. Grind the last one separately. Mix all herbs in equal proportions, you can add 2 tablespoons of dandelion. Pour 400 g of hot water and put for one day. After a day, take out, boil and immediately remove. Wrap tightly for 4 hours and leave. Drink 1/3 cup twice a day, course for six months.

It will be useful to brew coltsfoot with chamomile. Also, mix in equal portions, boil, let it boil for a few minutes and remove. When cool, strain and let cool. Drink 1/2 cup twice. The same composition can be used for inhalation. Only chamomile should be a little more: 200 g of coltsfoot and 250 g of chamomile. It is necessary to let it boil, remove from heat, cover with a thick towel and actively breathe in the released steam. very effective if the patient often complains of congestion.

Alternatively, nebulizers can be used. You can pour any composition into the device and breathe calmly into the mask, which is much more convenient. If there is not a single herb at hand, then you can make an inhalation from a simple validol. Put crushed 3-5 tablets into boiling water and start the procedure.

The simplest inhalation is the inhalation of steam from boiled potatoes. The old way is often the most effective in treating any cold.

However, it should be remembered that folk recipes alone will not quickly cure a runny nose in an adult.

Prevention

The best remedy to avoid an allergic rhinitis problem is to stay away from the aggressive agent. There is simply no other way to save yourself. As an additional option - a thorough rinsing of the nose with salt in case of probable contact with the allergen.

Consequences and complications

Sinusitis, asthma, allergic cough are just a few of the complications of allergic rhinitis

Untreated allergic rhinitis inevitably leads to the appearance of secondary diseases:

A runny nose can become chronic, and the treatment of chronic allergic rhinitis is a very long and laborious process.

Video

Learn more about diagnosing allergic rhinitis:

Allergic rhinitis is painful, interferes with living a normal life. But timely treatment, adequacy of measures and determination of the type of agent will reduce the aggressiveness of attacks. And sometimes it is possible to completely eliminate the problem if everything is done correctly and in due time.

Rhinitis

In medical practice, doctors should take into account that according to ICD 10, the code for allergic rhinitis, vasomotor and infectious inflammatory processes differ. The division is due to the fact that each type of damage to the nasal mucosa occurs under certain conditions and requires specific treatment.

In addition, bronchial asthma with rhinitis (J45.0) is highlighted in a separate code, since it is not the phenomena of nasal congestion that come to the fore here.

allergic rhinitis

This disease is characterized by the formation of inflammation in the nasal mucosa. Symptoms occur when a person comes into contact with an irritant, most often plant pollen. However, there can be many allergens. The clinical picture is characterized by the following symptoms:

• swelling of the mucosa;
• difficulty breathing;
• sneezing
• lacrimation;
• secretions from the nose of a serous nature;
• itching in the nose.

In ICD 10, allergic rhinitis is placed in the class of diseases of the respiratory system. Further, the classification branches into sections, and rhinitis is found in other pathologies of the upper respiratory tract.

Under the code J30 are vasomotor and allergic inflammatory processes.

In this case, the disease, proceeding according to the type of allergy, is divided into several more points. A disease that is caused specifically by plant pollen is recorded separately. It is under the code J30.1 and includes hay fever, pollinosis, and so on. Item J30.2 includes seasonal allergic reactions not covered in the previous code.

Other allergic rhinitis includes inflammation that is not tied to the season. Here the code is represented by the following characters: J30.3. The last item is an unspecified allergic reaction, which implies the absence of an accurately identified allergen, J30.4 is recorded.

Vasomotor rhinitis

As with allergies, the ICD 10 code for vasomotor rhinitis is represented by a class of diseases of the respiratory system and a section of other pathologies of the upper respiratory tract. The full encoding looks like this: J30.0. The disease has no subparagraphs, as well as clarifications.

Vasomotor inflammation is a pathological process that is characterized by impaired vascular tone and loss of control over the amount of incoming air.

Vessels regulate the volume based on data on the temperature and humidity of the environment. Unlike an allergic reaction, here the main symptom may not be the appearance of secretions, but, on the contrary, a pronounced dryness of the mucous membrane. In addition, there is nasal congestion, its swelling, pain syndrome joins. This pathology is also characterized by violations of the general condition:

Viruses can cause the disease, but sometimes it is associated with the failure of the nervous system. Also among the causes of the pathology are: stressful situations, hormonal disruptions, sudden changes in temperature and humidity. In the classification, rhinitis of this nature is in the allergic section, since it can also be caused by a contact irritant. There is a chronic course of pathology, but it is quite rare.

Infectious rhinitis

Rhinitis of an infectious nature, in particular, caused by bacterial flora, is encoded quite separately according to the ICD. Infectious rhinitis is in the class of respiratory diseases, but belongs to the section of acute respiratory infections of the upper respiratory tract. Nosology is coded as follows: J00. An infectious lesion is called acute nasopharyngitis, that is, a runny nose.

The disease is caused by bacteria streptococcal and staphylococcal flora. Most often, the pathology is combined with other lesions of the respiratory tract. The patient has a violation of general well-being, the temperature may rise, weakness increases. Discharge from the nose is purulent, which confirms the bacterial origin of the infection. The process is acute and subsides within a week, with a prolonged course, recovery may take 14 days.

chronic course

A separate nosology is also chronic rhinitis. It is in the section of other respiratory diseases, however, it is under the code J31, which includes chronic inflammation of the nose and pharynx. Specifically, rhinitis is written with the following symbols: J31.0. These include ulcerative inflammation, granulomatous, atrophic and hypertrophic processes, as well as purulent and obstructive rhinitis.

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Allergic rhinitis (ICD-10:J30) is an inflammatory disease that manifests itself as a set of symptoms in the form of a runny nose with nasal congestion, sneezing, itching, rhinorrhea, swelling of the nasal mucosa.
Epidemiology

Allergic rhinitis is a widespread disease. The frequency of symptoms of allergic rhinitis in Russia is 18-38%. In the US, allergic rhinitis affects 20-40 million people, the prevalence of the disease among children reaches 40%. Boys get sick more often. In the age group under 5 years, the prevalence of allergic rhinitis is the lowest, the rise in incidence is noted at early school age.

Prevention
Primary prevention carried out primarily in children at risk (with aggravated heredity for atopic diseases). Primary prevention includes the following activities.

1. Compliance with a pregnant rational diet. If she has allergic reactions, highly allergenic foods are excluded from the diet.
2. Elimination of occupational hazards from the 1st month of pregnancy.
3. Reception of drugs only on strict indications.
4. Cessation of active and passive smoking as a factor contributing to the early sensitization of the child.
5. Natural feeding is the most important direction in the prevention of the implementation of atopic predisposition, which must be maintained at least until the 4-6th month of life. It is advisable to exclude whole cow's milk from the child's diet. We do not recommend the introduction of complementary foods up to 4 months.
6. Elimination procedures (see "Treatment" section below).

Secondary prevention is aimed at preventing the manifestation of allergic rhinitis in sensitized children and includes the following activities.

1. Monitoring the state of the environment.
2. Preventive therapy with antihistamines.
3. Allergen specific immunotherapy.
4. Prevention of respiratory infections as allergy triggers.
5. Educational programs.

The main goal of tertiary prevention is to prevent the severe course of allergic rhinitis. Reducing the frequency and duration of exacerbations is achieved with the help of the most effective and safe drugs, as well as the elimination of allergens.

Screening. Screening is not routinely performed.

Classification
There are acute episodic, seasonal and persistent allergic rhinitis.

1. Episodic exposure to inhaled allergens (eg, cat saliva protein, rat urine protein, house dust mite waste products) can provoke acute allergic symptoms, which are regarded as acute episodic allergic rhinitis.
2. Seasonal allergic rhinitis: symptoms occur during the flowering of plants (trees and herbs) that secrete causative allergens.
3. In persistent allergic rhinitis, symptoms occur for more than 2 hours a day or at least 9 months a year. Persistent allergic rhinitis usually develops with sensitization to household allergens (house dust mites, cockroaches, animal dander).

Diagnostics
The diagnosis of allergic rhinitis is established on the basis of anamnesis data, characteristic clinical symptoms and the detection of allergen-specific IgE antibodies.

History and physical examination. When collecting an anamnesis, it is necessary to clarify the presence of allergic diseases in relatives, the nature, frequency, duration, severity of symptoms, the presence / absence of seasonality, response to therapy, the presence of other allergic diseases in the patient, provoking factors. It is necessary to carry out rhinoscopy (examination of the nasal passages, the mucous membrane of the nasal cavity, secretions, turbinates and septum). In patients with allergic rhinitis, the mucous membrane is usually pale, cyanotic gray, and edematous. The nature of the secret is slimy and watery. In chronic or severe acute allergic rhinitis, a transverse fold is found on the back of the nose, which is formed in children as a result of "allergic salute" (rubbing the tip of the nose). Chronic nasal obstruction leads to the formation of a characteristic "allergic face" (dark circles under the eyes, impaired development of the facial skull, including malocclusion, arched palate, flattening of the molars). Laboratory and instrumental research. Skin testing and radioallergosorbent test are used for differential diagnosis
allergic and non-allergic rhinitis; these methods also allow to determine the presence of causally significant allergens.

Skin testing. Properly performed skin testing allows assessment of the presence of IgE-AT in vivo; the study is indicated for the following groups of patients:

1. With poorly controlled symptoms (persistent nasal symptoms and/or inadequate clinical response to intranasal glucocorticoids).
2. With an unspecified diagnosis based on history and physical examination.
3. With concomitant persistent bronchial asthma (BA) and / or recurrent sinusitis or otitis media.

Skin testing is a fast, safe and inexpensive test to confirm the presence of IgE-AT. When setting skin tests with household, pollen and epidermal allergens, the reaction is evaluated after 20 minutes by the size of the papule and hyperemia. Antihistamines should be discontinued 7-10 days prior to skin testing. Skin testing should be performed by specially trained medical personnel. The specific set of allergens to be tested varies depending on the perceived allergen sensitivity and geographic area.

Radioallergosorbent test. The radioallergosorbent test is a less sensitive and more expensive (compared to skin tests) method for detecting specific IgE-ATs in blood serum. In 25% of patients with positive skin tests, the results of the radioallergosorbent test are negative. Given this, this method is of limited use in the diagnosis of allergic rhinitis. It is not necessary to cancel antihistamines before the study.

Other research methods. Cytological examination of smears from the nasal cavity is an affordable and inexpensive method designed to detect eosinophils0 (performed during an exacerbation of the disease). The practical application of the method is limited, since the appearance of eosinophils in the nasal secretion is possible in other diseases (BA, nasal polyps in combination with asthma or without it, non-allergic rhinitis with eosinophilic syndrome).

1. Determination of the content of eosinophils and the concentration of IgE in the blood has a low diagnostic value0.
2. Provocative tests with allergens in clinical practice are of limited use.
3. X-rays of the paranasal sinuses are performed if sinusitis is suspected.

Table 1.

Differential diagnosis of allergic and vasomotor rhinitis

Differential Diagnosis

• Acute infectious rhinitis in ARI it is manifested by nasal congestion, rhinorrhea, sneezing. Nasal symptoms predominate on the 2-3rd day and subside by the 5th day of illness. Symptoms persisting for more than 2 weeks may indicate the presence of allergic rhinitis.
• Vasomotor (idiopathic) rhinitis- one of the most common forms of non-allergic rhinitis.
  Characterized by constant nasal congestion, aggravated by changes in temperature, humidity and strong odors. There is a hypersecretory variant with persistent rhinorrhea, which is characterized by slight nasal itching, sneezing, headaches, anosmia, and sinusitis. Heredity for allergic diseases is not burdened, and sensitization to allergens is also not typical. With rhinoscopy, in contrast to allergic rhinitis, which is characterized by cyanosis, pallor, edema of the mucous membrane, its hyperemia and viscous secretion are revealed (see Table 1).
• Medicated rhinitis- the result of long-term use of vasoconstrictor nasal drugs, as well as inhalation of cocaine. Persistent nasal obstruction is noted, with rhinoscopy the mucous membrane is bright red. A positive response to therapy with intranasal GCs is characteristic, which are necessary for the successful withdrawal of drugs that cause this disease.
• Nonallergic rhinitis with eosinophilic syndrome characterized by the presence of severe nasal eosinophilia, the absence of a positive allergic history, and negative results of skin testing. Persistent symptoms, mild sneezing and itching, a tendency to form nasal polyps, lack of an adequate response to antihistamine therapy, and a good effect with intranasal GCA are noted.
• Unilateral rhinitis suggests the presence of nasal obstruction due to a foreign body, tumor, nasal polyps, which are possible with non-allergic rhinitis with eosinophilic syndrome, chronic bacterial sinusitis, allergic fungal sinusitis, aspirin-induced asthma, cystic fibrosis, and respiratory epithelial immobility cilia syndrome. Unilateral lesion or nasal polyps are not typical for uncomplicated allergic rhinitis.
• Nasal symptoms are characteristic of some systemic diseases, in particular for Wegener's granulomatosis, which is manifested by persistent rhinorrhea, the presence of purulent / hemorrhagic discharge, ulcers in the mouth and / or nose, polyarthralgia, myalgia, pain in the additional sinuses of the nasal cavity.

Treatment
Main goal of therapy- relief of the symptoms of the disease. The complex of therapeutic measures includes the elimination of allergens, drug therapy and specific immunotherapy.

Indications for hospitalization. Allergic rhinitis is treated on an outpatient basis.

Elimination of allergens. Treatment of allergic rhinitis begins with the identification of possible causal allergens, after the elimination of which, in most cases, the symptoms of rhinitis decrease.

There are the following main groups of allergens that cause allergic rhinitis.

• A group of pollen allergens (pollen from trees, cereals and weeds). During the flowering season, to eliminate allergens, it is recommended to keep windows and doors closed indoors and in the car, use indoor air conditioning systems, and limit time spent outdoors. After a walk, it is advisable to take a shower or bath to remove pollen from the body and prevent soiling of linen.
• Mold spores. If you are allergic to mold spores, it is recommended to frequently clean rooms in which mold growth is possible, thoroughly clean humidifiers, hoods to remove steam, apply fungicides, and maintain relative humidity in the room below 50%.
• House dust mites, insects (cockroaches, moths and fleas). The highest concentration of house dust mite allergens is found in carpets, mattresses, pillows, upholstered furniture, clothes (mainly for children), soft toys. Mite excrement is the main allergen in house dust.
• animal allergens.
• Food allergens can cause rhinorrhea in young children

Drug therapy. If the elimination of allergens does not lead to a decrease in the severity of symptoms, drug therapy is started (see Table 2).

intranasal glucocorticoids. Local (intranasal) GCs are the drugs of choice in the treatment of allergic rhinitis; they effectively reduce the severity of symptoms such as itching, sneezing, rhinorrhea, nasal congestion. The onset of action of intranasal GCs falls on the 2nd-3rd day of treatment, the maximum effect develops by the 2nd-3rd week. To achieve control over the disease, their regular use is recommended. Intranasal GCs are generally well tolerated. The advantages of this group of drugs include the possibility of their use once a day and minimal systemic absorption. Side effects occur in 5-10% of cases, among the local effects the most common are sneezing, burning, irritation of the nasal mucosa, which are usually minimally expressed and do not require discontinuation of the drug. In rare cases, nasal septal perforation may occur if intranasal GCs are used incorrectly.

Numerous studies in children have shown that the use of intranasal GCs at therapeutic doses does not affect growth and the hypothalamic-pituitary-adrenal system*. However, intranasal GCs should be given at the lowest daily doses and the child's growth should be monitored. The use of aqueous solutions is preferable, as they cause less irritation of the mucosa. Mometasone, fluticasone, beclomethasone, and budesonide adequately control allergic rhinitis symptoms and are well tolerated.

Due to the pronounced anti-inflammatory effect, intranasal GCs are more effective than intranasal cromones and systemic antihistamines*. In most patients, the additional prescription of antihistamines (including in combination with decongestants) does not improve clinical efficacy. To increase the effectiveness of intranasal GCs, it is recommended to clear the nasal cavity of mucus before the administration of drugs, as well as the use of moisturizers.

1. Mometasone is used in children from 2 years of age, appoint 1 inhalation (50 mcg) in each nasal passage 1 time per day.
2. Fluticasone is approved for use in children from 4 years old, prescribed 1 dose (50 mcg) in each nasal passage 1 time per day, the maximum daily dose is 200 mcg.
3. Beclomethasone is used in children from 6 years old, prescribed 1-2 inhalations (50-100mcg) 2-4 times a day, depending on age.
4. Budesonide is approved for use in children from 6 years old, prescribed 1 dose (50 mcg) in each nasal passage 1 time per day, the maximum daily dose is 200 mcg.

Systemic GCs (oral or parenteral) reduce the symptoms of allergic rhinitis, but given the possibility of systemic side effects, their use in the treatment of allergic rhinitis in children is very limited.

Table 2.

The effect of different groups of drugs on individual symptoms of allergic rhinitis

* - except for desloratadine - ++

Antihistamines. Systemic antihistamines prevent and relieve symptoms such as itching, sneezing, and runny nose, but are less effective for nasal obstruction. The possibility of developing tachyphylaxis when taking antihistamines has not been confirmed.
First-generation antihistamines are rarely used in the treatment of allergic rhinitis due to the presence of sedative and anticholinergic side effects.

Second-generation antihistamines (cetirizine, loratadine) do not cross the blood-brain barrier and have less of a sedative effect.

1. Cetirizine for children from 1 to 6 years old is prescribed 2.5 mg 2 times a day or 5 mg once a day in the form of drops, over 6 years old - 10 mg once or 5 mg 2 times a day.
2. Loratadine is used in children older than 2 years. For children weighing less than 30 kg, the drug is prescribed 5 mg 1 time per day, more than 30 kg - 10 mg 1 time per day.

Of the third-generation antihistamines, fexofenadine and desloratadine are used to treat allergic rhinitis.

1. Fexofenadine is used in children from 6 years of age, 30 mg 1-2 times a day, over 12 years old - 120 mg 1 time per day.
2. Desloratadine is used in children from 2 to 12 years old, 2.5 mg 1 time per day in the form of a syrup, over 12 years old - 5 mg 1 time per day.

In terms of reducing the symptoms of allergic rhinitis, antihistamines are less effective than intranasal GCs and are comparable to or even superior to cromones. The most effective prophylactic use of antihistamines (before contact with the allergen). The addition of antihistamines to therapy with intranasal GCs is justified in severe allergic rhinitis, concomitant allergic conjunctivitis and atopic dermatitis.

Intranasal antihistamines (azelastine) are effective in the treatment of seasonal and perennial allergic rhinitis. With their use, a burning sensation in the nose, a bitter and metallic taste in the mouth are possible. Azelastine is used in children over 5 years of age in the form of a nasal spray, 1 insufflation 2 times a day.

Cromons. Cromoglycic acid is less effective than intranasal HA but more effective than placebo in the treatment of allergic rhinitis. The drug is used in children with mild allergic rhinitis in the form of nasal sprays, 1-2 insufflations in each nasal passage 4 times a day. Cromoglycic acid is the drug of first choice in children under 3 years of age, the second choice in children over 3 years of age. The most effective prophylactic use of the drug (before contact with allergens). Side effects are minimal.

Combined therapy. For patients with moderate to severe disease or when initial therapy has failed, combination therapy may be considered, which may include intranasal GCs or cromoglycic acid in combination with second-generation antihistamines. When a positive effect is achieved, one of the components of therapy should be discontinued.

Decongestants. Intranasal vasoconstrictor drugs (naphazoline, oxymetazoline) are not recommended for the treatment of allergic rhinitis, since after 3-7 days of their use tachyphylaxis develops, which is manifested by rebound swelling of the nasal mucosa. With prolonged use of drugs in this group, drug-induced rhinitis develops. It is acceptable to use vasoconstrictor drugs in patients with severe nasal congestion before prescribing intranasal GCs for no more than 1 week.

Moisturizers. This group of drugs helps to moisturize and cleanse the nasal mucosa.

Allergen specific immunotherapy. This method of treatment consists in the introduction of increasing doses of the allergen, to which the patient has an increased sensitivity. It is used to treat allergic rhinitis associated with hypersensitivity to plant pollen and house dust mites A, as well as, but with less effect, with sensitization to animal allergens and molds. Allergen-specific immunotherapy is carried out with the ineffectiveness of elimination measures and drug therapy or in the presence of undesirable side effects from the drugs used. Used in children over 5 years of age. The duration of treatment is from 3 to 5 years. Allergen-specific immunotherapy is carried out according to an individually designed scheme, under the supervision of an allergist. Patients receiving the allergen parenterally should be under medical supervision for 30-60 minutes after injection (possible time for the development of adverse reactions).

Surgery. Indications:

1. irreversible forms of turbinate hypertrophy, which developed against the background of allergic rhinitis;
2. true hyperplasia of the pharyngeal tonsil, which significantly impairs nasal breathing;
3. anomalies of intranasal anatomy;
4. pathology of the paranasal sinuses, which cannot be eliminated in any other way.

Patient education

1. Providing detailed information about elimination activities.
2. Acquaintance with modern methods of therapy and possible side effects.
3. Familiarization with various measures to prevent exacerbations of allergic rhinitis (pre-season prophylaxis, before the alleged contact with the allergen).
4. Conducting allergy schools, providing methodological materials and manuals.

Indications for consulting other specialists
The patient should be referred to a specialist (allergist, ENT) in the following cases.

1. Failure of oral/nasal drug therapy.
2. Moderate to severe persistent symptoms.
3. The need for skin testing / radioallergosorbent test to identify causally significant allergens in order to carry out elimination measures and resolve the issue of conducting allergen-specific immunotherapy.
4. Presence of comorbidities such as atopic dermatitis, asthma, chronic/recurrent rhinosinusitis.
5. Any severe allergic reactions that cause concern to the child and parents.

Further management
The frequency of observation of a patient with allergic rhinitis:

1. pediatrician: in case of exacerbation according to clinical indications, mainly 1 time in 5-7 days; without exacerbation - 1 time in 6 months;
2. allergist: without exacerbation - 1 time in 3-6 months.

Forecast
Timely and correctly conducted complex therapy, including the elimination of allergens, allergen-specific immunotherapy and pharmacotherapy, can eliminate all the symptoms of allergic rhinitis and prevent the development of complications.

Alexander BARANOV,
Director of the Science Center
children's health RAMS,
academician of RAMS.
Leila NAMAZOVA, professor.
Ludmila OGORODOVA,
corresponding member of RAMS.
Irina SIDORENKO,
chief allergist-pulmonologist
Moscow Health Department,
docent

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2013

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general information

Short description

allergic rhinitis- an inflammatory disease of the nasal mucosa characterized by IgE-mediated inflammation of the mucous membranes of the nasal cavity and the presence of at least two of the following symptoms daily for an hour or more: nasal congestion (obstruction), discharge (rhinorrhea) from the nose, sneezing, itching in the nose ( International Consensus EAACI, 2000)

Protocol name: allergic rhinitis

Protocol code:

Code (codes) according to ICD-10:
J30. Vasomotor and allergic rhinitis.
J30.1 Allergic rhinitis due to plant pollen
J30.2 Other seasonal allergic rhinitis
J30.3 - Other allergic rhinitis
J30.4 Allergic rhinitis, unspecified

Abbreviations used in the protocol:
AR - allergic rhinitis
GCS - glucocorticosteroids
BA - bronchial asthma
IgE - immunoglobulin E
AC-IgE - allergen-specific immunoglobulin E
SBP - specific allergodiagnostics
ASIT - allergen-specific immunotherapy
WHO - World Health Organization (WHO)
EAACI - European Academy of Allergology and Clinical Immunology
RNPAC - Republican Scientific and Practical Allergological Center

Protocol development date: April 2013

Protocol Users: healthcare professionals involved in providing medical care to patients with allergic rhinitis.

Indication of no conflict of interest: missing.

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Classification

WHO classification (ARIA, 2007):
with the flow:
1. Intermittent (less than 4 days a week or less than 4 weeks).
2. Persistent (more than 4 days a week or more than 4 weeks).

by gravity:
1. Light (all of the following: normal sleep, no disruption of life, sports and work regimen).
2. Moderate and severe (one or more of the following: disruption of sleep, activity, sports and work, debilitating symptoms).

Diagnostics

PeReven morenl diagnostic measures:

Main:
1. Complete blood count.
2. Determination of the content of total IgE in serum or plasma.
3. Cytological analysis of a swab (wash, scraping) from the nose.

Additional:
1. Specific allergy diagnostics in vitro and/or in vivo.
2. Peakflowmetry, rhinomanometry (according to indications).
3. Spirometry (according to indications).
4. X-ray of the sinuses (according to indications).
5. Consultation of an ENT doctor (according to indications).

Diagnostic criteria:

Complaints and anamnesis:
Nasal congestion (obstruction) - complete, partial or alternate, at different times of the day, depending on the etiology and regimen.
Nasal discharge (rhinorrhea) is usually watery or mucous.
Itching in the nose, burning sensation, pressure in the nose.
Sneezing - paroxysmal, not bringing relief.
There may be additional complaints - headache, weakness, irritability, watery eyes (due to sneezing), sore throat, dry cough (due to irritation of the lower respiratory tract, sputum), feeling short of breath, etc.
In the allergological history, it is necessary to pay attention to the prescription of the disease, seasonality, daily cyclicity, connection with specific and non-specific (heat, cold, pungent odors, stuffiness, etc.) provoking factors, occupational hazards, the effect of medications (local and systemic).

Physical examination:
During a general examination, redness and irritation of the skin of the nose and nasolabial triangle (due to rhinorrhea), dark circles under the eyes (due to venous stasis and poor sleep quality), the so-called. “allergic salute” (rubbing the tip of the nose with the palm of your hand), complete or partial absence of nasal breathing, changes in the timbre of the voice, “adenoid face” (with the development of year-round rhinitis from childhood - a sleepy facial expression with puffiness and an open mouth).
With rhinoscopy, edematous pale pink or stagnant nasal turbinates, mucous discharge are visible.

Laboratory research:
Complete blood count - the content of eosinophils is not a reliable diagnostically significant indicator.
Cytological examination of discharge from the nose with Wright or Hansel stain (smear, wash or scraping) - eosinophilia (more than 10%).
Determination of total IgE in serum - increase (more than 100 IU / ml).
Specific allergodiagnosis in vitro with the main groups of allergens (household, epidermal, pollen, infectious, food, medicinal) - the establishment of etiological moments allows you to make a complete diagnosis, increase the effectiveness of preventive and therapeutic measures, make a prognosis, determine the possibility of allergen-specific immunotherapy (ASIT).

YingfromTRmental research:
Rhinomanometry - partial or complete patency of the nasal passages, a sharp increase in the resistance of the nasal passages (symmetrical or with a predominance of one side).
Radiography - no signs of organic lesions of the nose and paranasal sinuses, swelling of the nasal mucosa.
Specific allergodiagnosis in vivo - skin tests, provocative tests with allergen extracts (performed in specialized treatment rooms only during the period of complete remission of the disease under the supervision of a doctor and nurse) - allow you to verify in vitro tests, determine the etiology of the disease, determine the sensitivity threshold and starting concentrations allergens in ASIT.

Indications for expert advice:
Otorhinolaryngologist - in case of purulent discharge, a history of nasal injuries and chronic infectious diseases of the nose and paranasal sinuses in history, polyposis of the nasal mucosa and sinuses; in the absence of a visible connection with provoking factors in the long course of the disease; in case of suspected occupational genesis.

Vasomotor and allergic rhinitis (J30)

Includes: spasmodic coryza

In Russia International Classification of Diseases 10th revision ( ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to apply to medical institutions of all departments, and causes of death.

ICD-10 introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

Classification of allergic reactions according to ICD 10

Allergy is included in the database of the international classifier of diseases - a document that acts as the basic statistical and classification basis for healthcare in different countries. The system developed by physicians makes it possible to convert the verbal formulation of the diagnosis into an alphanumeric code, which ensures the convenience of storing and using data. So an allergic reaction according to the ICD is coded with the number 10. The code includes one Latin letter and three numbers (from A00.0 to Z99.9), which allows you to encode another 100 three-digit categories in each group. Group U is reserved for special purposes (detection of new diseases that cannot be attributed to an already existing classification system).

Types of allergic reactions and their ICD-10 codes

In 10 classifications, diseases caused by the response of the immune system are divided into different groups depending on the symptoms and characteristics of the course:

• contact dermatitis (L23);
• urticaria (L50);
• rhinitis (J30);
• dysbacteriosis (K92.8);
• allergy, unspecified (T78).

Important! It is possible to talk about the presence of an allergy only when the results of tests and other examination methods exclude diseases that provoke the occurrence of similar symptoms.

A correct diagnosis is the key to a successful fight against the disease, because different types of allergies often require different approaches to treatment and adherence to a number of rules to minimize unpleasant manifestations and improve the quality of life.

Allergic contact dermatitis (L23)

Unlike most "classic" allergic reactions triggered by humoral immunity, contact dermatitis is a cellular immune response. From the moment of skin contact with the allergen to obvious skin manifestations, an example of which can be seen in the photo, an average of 14 days passes, since the process is triggered by a delayed-type hypersensitivity mechanism.

To date, more than 3,000 allergens are known:

• elements of plant origin;
• metals and alloys;
• chemical compounds that make up rubber;
• preservatives and flavorings;
• medications;
• other substances found in dyes, cosmetic products, adhesives, insecticides, etc.

Contact dermatitis is manifested by reddening of the skin, local rash, swelling, blistering and intense itching. As you can see in the photo, skin inflammation has a local character. The severity of manifestations depends on the duration of contact with the allergen.

There are acute and chronic dermatitis. The acute form is more often observed with a single contact, while the chronic form can develop over time if a person is constantly in contact with an element dangerous to the body. The picture of chronic dermatitis is typical for people whose professional activities involve frequent contact with aggressive compounds.

Allergic urticaria ICD-10 (L 50)

WHO statistics show that 90% of people have experienced this problem at least once in their lives. The photo shows what allergic urticaria looks like microbial 10, resulting from contact with allergens.

According to the classification, this type of allergy is assigned to group L50 "Diseases of the skin and subcutaneous tissue." The alphanumeric code for urticaria caused by a reaction to an allergen is L50.0.

Most often, hives, caused by the response of the immune system to a specific stimulus, occurs suddenly, causing symptoms such as:

• blisters that can form both on the skin and on the mucous membranes and reach a diameter of 10-15 cm;
• itching and burning;
• chills or fever;
• abdominal pain and nausea (possible vomiting);
• deterioration in general condition.

Acute urticaria, subject to the appointment of appropriate treatment, disappears in 6 weeks (in some cases much faster). If the manifestations persist longer, they talk about the transition of the disease to a chronic form, which can significantly worsen the quality of life. Chronic urticaria is characterized not only by skin problems, but also by sleep disturbance, changes in the emotional background, and the development of a number of psychological problems that often lead to social isolation of a person.

Allergic rhinitis (J30)

Rhinitis often occurs when the mucosa comes into contact with a certain type of allergen. Group J30 lists the following diagnoses:

• J30.2 - Vasomotor rhinitis, which may occur against the background of autonomic neurosis or under the influence of any allergen.
• J30.1 Pollinosis (hay fever) It is caused by pollen, which is present in large quantities in the air during the flowering of plants.
• J30.2 - Other seasonal rhinitis occurring in pregnant women and in people allergic to flowering trees in the spring.
• J30.3- Other allergic rhinitis, arising as a response to contact with vapors of various chemicals, medicines, perfumes or insect bites.
• J30.4 Allergic rhinitis, unspecified This code is used if all tests indicate the presence of an allergy manifested in the form of rhinitis, but there is no clear response to the tests.

The disease is accompanied by inflammation of the nasal mucosa, which provokes sneezing, runny nose, swelling and shortness of breath. Over time, these symptoms can be joined by a cough, which, if left untreated, threatens to develop asthma.

General and local preparations help to improve the condition, the complex of which is selected by the allergist, taking into account the severity of symptoms, the age of the patient and other diseases in the anamnesis.

Dysbacteriosis of allergic nature (K92.8)

Dysbacteriosis is a set of symptoms caused by clinical disorders of the gastrointestinal tract that occur against the background of changes in the properties and composition of the intestinal microflora or under the influence of substances released during the life of helminths.

Doctors and scientists note that the relationship between allergies and dysbacteriosis is very strong. Just as disorders of the gastrointestinal tract provoke the development of a reaction to individual food allergens, an allergy already present in a person can cause an imbalance in the intestinal microflora.

Symptoms of allergic dysbacteriosis include:

• diarrhea;
• constipation;
• flatulence;
• pain in the stomach;
• common skin manifestations characteristic of food allergies;
• lack of appetite;
• headache;
• general weakness.

Important! Since such symptoms are characteristic of many ailments, including acute poisoning and infectious diseases, it is important to seek help from specialists as soon as possible to identify the cause that caused the symptoms described above.

Diarrhea is especially dangerous for children, since dehydration in combination with the accumulation of toxic substances can have serious consequences, even death.

Adverse effects not elsewhere classified (T78)

The T78 group included adverse effects that occur when the body is exposed to various allergens. In the 10th edition of the ICD are classified:

• 0 - Anaphylactic shock due to food allergy.
• 1 - Other pathological reactions that occur after eating.
• 2 - Anaphylactic shock, unspecified. The diagnosis is made if the allergen that caused such a strong immune response is not identified.
• 3 - Angioedema (Quincke's edema).
• 4 - Allergy, unspecified. As a rule, this formulation is used until the necessary tests have been carried out and the allergen has not been identified.
• 8 - Other adverse conditions of an allergic nature not classified in the ICD.
• 9 - Adverse reactions, unspecified.

The conditions listed in this group are especially dangerous because they can be life-threatening.

Classification of allergic rhinitis

A third of the world's population at least once experienced manifestations of allergic reactions. Runny nose with allergies is one of the problems of many people, which occurs acutely during periods of flowering herbs and flowers. But what is allergic rhinitis from the point of view of science, its classification and how to recognize allergic rhinitis, distinguish it from other dangerous diseases?

Description of the problem

Allergic rhinitis (ICD code 10 J 30: vasomotor and allergic rhinitis) is an inflammatory disease of the nasal mucosa, which is characterized by sneezing, secretions in the form of clear mucus, itching, and impaired respiratory function (nasal congestion).

Like any other allergy, allergic rhinitis occurs when an irritant enters the human body.

In some cases, there is a substitution of concepts when allergic rhinitis is equated with vasomotor. This is not entirely correct, since the concept of "vasomotor" implies the contraction and relaxation of blood vessels under the influence of any factors, not just allergens. In other words, this is a broader concept, since vasomotor rhinitis has both an allergic form and a neurovegetative one.

Allergic vasomotor rhinitis occurs when the mucous membranes of the nose come into contact with an irritant, but it is not the irritant itself that causes the symptoms, but the hypersensitivity of the vessels.

If we consider the allergic rhinitis as an independent disease, then we can say that the main culprit for the occurrence of the inflammatory process is an irritant of any origin: animal, vegetable, chemical, physical.

Causes of allergic rhinitis:

• Pollen from plants (both seasonal and domestic);
• Food products with a high degree of allergenicity, especially those with a pungent odor;
• Household chemicals (washing powders, cleaning products);
• Household and construction dust;
• Spores of fungi and mold;
• Pets (their hair, excrement, dander, saliva);
• Insects, their chitinous particles, saliva, waste products;
• Tobacco smoke.

This is not the whole list. For example, when talking about vasomotor and allergic rhinitis, the manifestations of the disease can occur when the ambient temperature changes, when the humidity changes, at the time of severe overstrain or excitement.

Classification

Since this type of disease is widespread throughout the globe and the problem is international in nature, there is no single approved classification of the disease, it is constantly being supplemented and changed. ICD 10 proposes to consider vasomotor and allergic rhinitis in one block.

For convenience, the following classification of allergic rhinitis is currently used:

• Acute allergic rhinitis;
• Chronic rhinitis.

The first form is characterized by the rapid development of symptoms, for example, immediately after going outside or when inhaling the aroma of flowers. The main danger is the possibility of the transition of an acute form into a chronic one, when the mucous membrane thickens and changes due to frequent inflammation. In this case, there is always a complete or partial nasal congestion.

In addition, depending on the cyclicity of the occurrence of reactions, there are:

• Intermittent allergic rhinitis;
• Persistent allergic rhinitis;
• Occupational allergic rhinitis.

The professional form of the disease was identified relatively recently. This group includes patients whose working conditions and duties are associated with constant exposure to the respiratory organs of various substances of predominantly chemical origin.

The remaining forms of the common cold are seasonal and year-round allergic rhinitis, respectively. Seasonal runny nose can be determined during the flowering periods of various plants. More than half of seasonal allergic reactions are caused by ragweed. This type of plants began to spread actively in the last two decades in our latitudes. At the same time, one plant releases about a million dust particles per day (mainly in the morning hours), each of which, penetrating into the body when inhaled, can cause severe allergic reactions.

The reason for such reactions is that ragweed pollen contains a complex protein that never entered the body of our ancestors 40-50 years ago, so the immunity of a modern person does not respond adequately to these particles.

However, this does not exclude allergic rhinitis (seasonal) to other plants: the color of birch, wormwood, tulips, dandelions, sunflowers, as well as any other herbs and cultivated plants.

Allergic perennial rhinitis is diagnosed as a result of exposure to irritants, regardless of the time of year. Most often, these allergens are inside the apartment. These include: dust mites, dust, fungal spores and molds that can develop on walls, wallpaper, carpets, potted plants, etc. In addition, pets are a potential threat for an allergic person, and allergies can occur on wool, feces, dander, saliva or pet food.

Another culprit of the year-round runny nose is domestic insects (mites, cockroaches). The fact is that the products of their vital activity contain protein, thanks to which insects digest food. Once in the human body, this protein is perceived by the immune system as a threat that should be eliminated by any means. The same reaction can occur when microscopic chitinous particles of an insect enter the respiratory tract.

Symptoms and Diagnosis

Recognizing an allergic rhinitis is the responsibility of a specialist. The fact is that some incompetent doctors write in the case histories "vasomotor" or "vasomotor runny nose" and send the patient for treatment to a surgeon. But surgery is the last stage of help. It is important to exclude the allergic component of the disease.

To confirm the diagnosis, a venous blood test is required to determine specific antibodies. Then do skin tests to accurately determine the type of irritant.

In favor of allergy is a sharp exacerbation of symptoms after contact with the alleged allergen. If there is a suspicion that the irritant is in the apartment, then the aggravation should occur in rooms with upholstered furniture or carpets, near places where pets sleep, near bookshelves, etc. With an allergy to dust mites, the condition worsens at night.

• Strong and prolonged sneezing;
• Itching and burning in the nose;
• Liquid and clear discharge from the nose;
• Redness of the conjunctiva;
• lacrimation;
• Nasal congestion (both one and two sinuses at once).

Sometimes there may be a dry cough. But in this case, we can talk about a complication in the form of asthma, since allergic rhinitis and bronchial asthma often complement each other, and untreated allergies turn into asthma with all the ensuing consequences.

In addition, a constant inflammatory process in the nose turns into otitis, pharyngitis, sinusitis, since the organs of smell, hearing and throat are closely connected. A constantly stuffy nose contributes to sleep disturbance, a person becomes irritable, nervous, apathetic, he is haunted by a feeling of fatigue, sometimes headaches are observed.

Separately, it should be noted that allergic rhinitis during pregnancy or lactation is aggravated in the supine position or during short-term physical exertion.

Variant of the norm and other diseases

Of course, when an irritant enters the respiratory tract, the body reacts with a sneeze and secretion of mucus in order to get rid of the foreign component. This may be a variant of the norm if such manifestations are short-term and do not interfere with human life.

One of the causes of rhinitis in general can be anatomical abnormalities in the very structure of the sinuses. But this fact does not mean at all that the disease cannot be aggravated by an allergic syndrome. Insufficient or unqualified diagnostics will lead to the fact that long-term treatment of only allergies, or surgical correction of only physical anomalies, will not bring positive results.

In addition, it is important to exclude infection, since allergies can be easily confused with SARS, acute respiratory infections or other serious bacterial diseases. Therefore, you should listen to the general condition of the body. With allergies, body temperature practically does not rise, there is no acute pain when swallowing, the mucous membrane of the throat does not change color to bright red, the tonsils do not increase in size. There is also no dizziness, sweating and weakness. If you have, along with a runny nose, such symptoms, you should immediately consult a doctor.

Treatment

Like any other manifestation of allergy, such rhinitis is treated with antihistamines, both systemic and local.

In the form of tablets, Loratadin, Edem, Tavegil, Zodak are used. Antihistamines in the form of sprays: Kromoglin, Lekrolin, Kromopharm.

But such drugs have a wide range of contraindications, so allergic rhinitis in pregnant women and children under three years of age cannot be treated with these drugs. In this case, special preparations are used that create a film - a barrier that prevents the penetration of allergens into the body through the nose. Such means include Nazaval.

Inhalations for allergic rhinitis are done using a nebulizer with the addition of special glucocorticosteroids. But such procedures can be done only in severe forms of allergies and only as directed by a doctor.

Vasoconstrictor drops are more of a one-time help; they cannot be used with such rhinitis, since they themselves can cause allergies and swelling of the nasal mucosa.

Homeopathy for allergic rhinitis does not bring positive results, because the most important method of treatment is the exclusion of the allergen. In the case when this is not possible, it is possible to overcome the symptoms only with the help of antihistamines or hormonal agents in different dosages.

Classification of rhinitis (allergic, acute, chronic, etc.) and their codes according to ICD-10

Allergic rhinitis ICD 10 is characterized as a pathology caused by plant pollen. A large number of people on the planet suffer from various autoimmune diseases, but the figure of the population with such an ailment is not only impressive, it is also prone to constant annual growth. According to world statistics, about 25% of people in the world suffer from allergic rhinitis. And this is a fairly high figure. Acute rhinitis, in turn, causes a lot of inconvenience.

What are allergies and hypersensitivity?

Allergy is an increased sensitivity of the body to the effects of molecules that specifically bind to antibodies that affect humoral immunity, which often causes acute rhinitis. Pathological reactions are usually referred to as autoimmune diseases. With these ailments, the body launches specific mechanisms for the production of antibodies against its own cells, that is, it identifies healthy elements as foreign and dangerous.

Allergy is the scourge of our time. Everyone should know some characteristic symptoms in order not to miss them, recognize them in time and start timely treatment, so as not to turn acute rhinitis into a chronic form, which will develop progressively with rare periods of remission.

Signs of nonspecific reactions can manifest themselves as follows:

• sore throat;
• subfebrile temperature;
• rhinitis;
• shortness of breath;
• apnea;
• lethargy;
• itching of the facial skin;
• rash on different parts of the body;
• profuse salivation;
• dryness in the mouth;
• cough;
• sudden attacks of suffocation;
• wheezing in the lungs;
• peeling;
• swelling of the mucous membranes;
• blisters;
• burning in the eyes;
• increased tearing;
• intestinal colic;
• nausea;
• angioedema;
• diarrhea;
• rheumatoid pains.

Most people blithely perceive the onset of allergic reactions in their body, but when the disease is gaining momentum and chronic rhinitis appears, the person seeks help already out of time, having more serious health problems.

Allergic rhinitis and its ICD-10 code

The ICD-10 code is an international classification of diseases of the tenth revision, conducted and approved in 2007 by the World Health Organization. Today it is generally recognized for naming medical diagnoses. Contains 21 items with various diseases and conditions. The ICD-10 code in J00-J99 includes diseases of the respiratory system, and subsections are represented by infections of the upper respiratory tract. J30-J39 contains diseases such as vasomotor and allergic rhinitis.

The ICD-10 code J30-J39 is defined as an inflammatory process of the nasal mucosa, manifested in episodic respiratory disorders caused by profuse secretions provoked by immediate allergic reactions.

The disease is nonspecific, in most people it has a classic course, due to typical symptoms of acute rhinitis, such as:

• sneezing
• swelling of the nasopharynx;
• copious secretion of mucus in the cavity of the sinuses;
• subfebrile temperature;
• in some cases, fever;
• asthma attacks;
• irritation of the facial skin;
• nasal congestion.

The symptoms are so non-specific that the patient is not immediately able to understand what caused the runny nose. Since allergic rhinitis can be characterized as a seasonal phenomenon, when temperature changes occur, they can manifest themselves in the same way as classic colds. Therefore, in order not to start the process, it is necessary to consult a doctor who will determine its etiology.

There are a lot of allergens that cause acute rhinitis. People can only feel over the years how the body begins to react to something new, to which there was no sensitivity before. The most classic allergens:

• pollen of flowering plants;
• road and book dust;
• fungal spores;
• medications;
• waste products of insects;
• various food.

If chronic rhinitis does not let go of the body for years, then you should try to protect yourself as much as possible from contact with the sources of the disease. This is not easy, but in order not to aggravate the condition, sometimes it is worth refusing to travel to a summer cottage or walk in a forest belt with massive flowering of plants and trees, to exclude foods that cause acute conditions from the diet.

Vasomotor rhinitis

Vasomotor rhinitis in medical practice is called a false cold by otolaryngologists. Which classifies it as a disease of a neurotic nature. Vasomotor rhinitis can occur in two types: vasoconstrictor and vasodilator. One of the subspecies is an allergic condition caused by the action of a substance.

Vasomotor rhinitis is studied by two branches of medicine. It is immunology and allergology that explain the etiology of such conditions. Scientists recognize that vasomotor and allergic rhinitis are one pathological process. In addition, this type of ailment is divided into several subtypes depending on the occurrence.

Vasomotor rhinitis is seasonal and permanent, when a runny nose torments the patient all year round, turning into chronic. Nasal congestion in this case is felt constantly.

Symptoms of vasomotor rhinitis are classic, as in acute rhinitis, but they can also be monitored during periods of flowering plants and increased exposure to natural allergens to understand the etiology of the common cold.

Acute nasopharyngitis

Acute nasopharyngitis is characterized by inflammation of the mucous membrane of the nasopharynx. Combines pharyngitis and runny nose. In addition to the classic inflammatory disease caused by infection, acute nasopharyngitis of an allergic nature is isolated. The principle of the onset and course of the disease when causative substances enter is similar to the classical course of SARS. The disease can affect not only the nasopharyngeal part, but also the middle ear, causing severe otitis media and inflammation of the trigeminal nerve.

To find out the etiology of the disease and not to translate it into a chronic condition, you should consult a doctor in a timely manner.

Methods and methods of therapy

Treatment of chronic rhinitis involves medication and folk methods. With a runny nose of any etiology, inhalations with the addition of essential oils that inhibit the pathogenic microflora of the mucosa, washing with various decoctions of herbs and saline solutions will be effective. Chlorophyllipt will help well for gargling and instillation into the nasal passages in chronic rhinitis.

When a doctor determines an allergic runny nose, antihistamines (Cetrin, Claritin, Ketatifen, Telfast), as well as local anti-inflammatory drugs that relieve swelling, reduce mucus secretion, lower temperature, microelements and vitamin complexes are recommended for prescription.

Do not prescribe vasoconstrictor drops to the patient. Frequent use of them leads to chronic rhinitis.

Of course, it must be understood that the patient's condition will last in the acute phase until the allergen stops. Medicines will only relieve symptoms, but will not cure chronic rhinitis.

Preventive actions

Preventive measures for allergy sufferers should include many activities, including medication prescriptions, physiotherapy exercises, blood cleansing procedures, body improvement, hardening, changing the microclimate of the home, getting rid of bad habits, adjusting the diet, diets, eliminating stressful situations.

The ecological situation on the planet is rapidly deteriorating. Every year indicators of the quality of drinking water and air are declining. Precipitation is often deadly to humans, foods cause food allergies, contain GMOs. The production of even baby food without preservatives and dyes is practically not carried out anymore.

If a patient with allergic rhinitis appears in the family, it is necessary to protect him as much as possible from exposure to harmful substances by removing carpets and heavy fabric curtains from his room, replacing them with plastic or rubber coverings and blinds. Up to three times a week it is necessary to carry out wet cleaning of the premises with the use of acarcidal agents.