La Rinitis alérgica es una inflamación de la mucosa nasal donde interviene la inmunoglobulina E (anticuerpo relacionado a alergia) como resultado de la exposición a alergenos en un paciente previamente sensibilizado.
Sus síntomas clásicos son: prurito nasal, obstrucción nasal, estornudos y rinorrea. Si presenta afectación ocular, hay lagrimeo y picazón, además de enrojecimiento de conjuntiva ocular.
Su prevalencia es paralela en niños y adultos, pudiendo ser subdiagnosticada en adultos al percibir como “normal” los síntomas nasales. Los factores ambientales, como el humo del tabaco, cambios estacionales en primavera o invierno, factores genéticos, psicosociales, y mascotas, empeoran el cuadro clínico.
Se clasifica en Intermitente o Persistente dependiendo del número de días a la semana presente los síntomas y, en leve, moderada o severa en relación a si afecta la calidad de vida, en los ámbitos de estudios, trabajo o sueño.
A su vez, cuando existe rinoconjuntivitis alérgica, pueden ser estacionales o perenne.
Existen varios tipos de rinitis como diagnóstico diferencial:
- Rinitis infecciosa
- Rinitis inducida por fármacos
- Rinitis ocupacional
- Rinitis del embarazo y la inducida por hormonas
- Rinitis vasomotora (exposición al frío)
- Rinitis autoinmune
Se han descrito patologías asociadas como asma alérgica, conjuntivitis alérgica, dermatitis atópica, hipertrofia adenoidea, pólipos nasales, rinusinusitis aguda, por lo que hoy en día se habla de vía aérea unificada, “una misma vía una sola enfermedad”.
Existen métodos diagnósticos que permiten evaluar si un paciente está sensibilizado a determinado alérgeno:
- Pruebas in vivo (Prick test o test cutáneo ) que debe ser realizado en manos expertas para evitar falsos positivos o lecturas erróneas.
- Pruebas in vitro (Medición IgE especifica a aeroalergenos o inhalantes en sangre)
Si las pruebas alérgicas son negativas en sangre, no descarta que el paciente sea alérgico, es por ello, que deben realizarse ambos estudios para poder dar una mayor orientación diagnóstica.
Los alergenos mayormente involucrados son los ácaros del polvo, pólenes y pastos, cucarachas y epitelio animal (perro, gatos), entre muchos otros.
El tratamiento de primera línea son los corticoides intranasales, seguido de los antialérgicos de segunda generación (Desloratadina, Cetirizina, Levocetirizina, Rupatadina, Fexofenadina) en conjunto con antileucotrienos (Montelukast). Los descongestionantes nasales se indican solamente por un corto tiempo, de 3 a 5 días. Finalmente, está disponible la inmunoterapia alérgeno-especifica, más conocida como “vacunas para alergias”. Éstas se preparan de manera personalizada, en base a los alergenos a los cuales el paciente está sensibilizado. Este tratamiento debe durar de 3 a 5 años, ya que es el único tratamiento efectivo para evitar y detener el curso natural de la enfermedad alérgica.
Los invito a que se acerquen y conozcan nuestro centro, donde podremos atender tus necesidades. Agenda tu cita al 55 2895583 y visita nuestras redes sociales.
Dra Liggia Rodríguez
Inmunólogo Clinico - Alergólogo
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