alergiuli riniti da misi gavlena

asTmaze

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 alergiuli riniti jandacvis globaluri problemaa

• alergiuli rinitiT avadoba meryeobs 5-dan 50%-de sxvadasxva

populaciaSi

• rinitis prevalentoba mudmivad izrdeba ukanasknel sam

dekadaSi

• msoflioSi 600 ml.-ze meti adamiania Sepyrobili alergiuli rinitiT,

250 mil-CineTSi

ARIA, WHO, 2001-2007-2008, Clinical and Experimental Allergy, 2008

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 alergia & asTma:
janmrTelobis mTavari sazrunavi

• evropaSi 130 milionze met adamians aReniS neba

sasunTqi gzebis alergiuli daavadebebi

• msoflioSi daaxloebiT 300 mln Sepyrobi lia asTmiT

• 2016 wlisaTvis, SesaZlebelia, rom 3-dan 1 evropeli

alergiis erT-erTi formiT iyos daavadebuli

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 alergiuli rinitis gavrceleba
evrokavSiris qveynebSi

28.5%
26.0%
24.5%
21.5% 20.6%
16.9%

belgia didi safrangeTi espaneTi germania italia

britaneTi

Base: Total sample, Belgium (n=1602), UK (n=1625), France (n=1606), Germany (n=1613), Italy (n=1600), Spain (n=1600)
Bauchau and Durham. Eur Respir J. 2004;24:758. 4
 alergiuli rinitis formebis gavrceleba

• persistiuli alergiuli rinitis gavrceleba evrokavSiris

qveynebSi – 29%
persistiuli
intermisiuli

29%

71%

Bauchau and Durham. Eur Respir J. 2004;24:758. 5

 alergiuli riniti sasunTqi gzebis seriozuli qronikuli daavadebaa,
rasac ganapirobebs:

 maRali prevalentoba

 cxovrebis xarisxze gavlena

 swavlasa da profesiul saqmianobaze gavlena

 ekonomikuri danaxarjebi

 asTmis ganviTarebaze gavlena

 sinusitTan da sxva Tanmxleb daavadebTan iseTi, rogoricaa koniunqtiviti

urTierTkavSiri

ARIA, WHO, 2001-2007-2008 6

 Aalergiuli rinitis definicia

• alergiuli riniti warmoadgens IgE-ganpirobebul cxviris

lorwovanis anTebas

• alergiuli riniti erT-erTi yvelaze xSiri qronikuli procesia

18 wlamde asakis pacientebSi

• pacientTa 40% - bavSvia

IgE = immunoglobulin E.
Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147; Bauchau and Durham. Eur Respir J. 2004;24:758; Linneberg.
BMJ. 2005:331.352; Wjst et al. PLoS Med. 2005;2:e294; Jarvis et al. J Allergy Clin Immunol. 2005;116:675. 7
 alergiuli rinitis klasifikacia

• simptomebis simZimis da sixSiris mixedviT; maT

safuZvelze warmoebs daavadebis marTva (janmo da
ARIA)

• klinikuri klasifikacia – sezonuri, wliuri da okupaciuri

riniti (EAACI, BSACI)

Clinical and Experimental Allergy, 2008

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 ARIA saxelmZRvanelo:
alergiuli rinitis klasifikacia

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

msubuqi saSualo/mZime
• normaluri Zili • darRveuli Zilis riTmi
• profesiuli aqtioba • yoveldRiuri aqtivobisa
• normaluri yoveldRiuri aqtivoba, daSromisunarianobis daqveiTeba
sporti, dasveneba • simptomebi mkveTradaa
• simptomebi ar awuxebs pacients gamoxatuli, awuxebs pacients

ARIA = Allergic Rhinitis and its Impact on Asthma.

Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147.
Bousquet et al. Allergy. 2002;57:841. 9
alergiuli rinitis mizezebi

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 alergiuli rinitis trigerebi

alergenebi
 aeroalergenebi-ar formirebis yvelaze xSiri faqtorebia
• karSida alergenebis raodenobis zrda nawilobriv ganapirobebs rinitis, asTmis
da alergiis prevalentobas
• karSida ZiriTadi alergenebia: oTaxis mtvris tkipa, cxovelis nerwyvi da
bewvi, mwerebi an mcenareuli warmoSobis alergenebi da sxva
• kargareTa ZiriTadi alergenebia: mcenaris mtveri da obis soko.
 profesiuli alergiuli riniti naklebad aris Seswavlili
 lateqs alergia samedicino personalisa da pacientebis sul ufro mzard
yuradRebas imsaxurebs

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 alergiuli rinitis trigerebi

garemos damabinZureblebi
Sida da gare dambinZureblebi
• gare dabinZurebis ZiriTadi wyaro avtomanqanis
gamonabolqvia, ZiriTadi polutantebi ki _ozoni, azotis
oqsidi da gogirdis orJangi

• mniSvnelovania karSida garemos damabinZureblebi,

sadac industriuli qveynebis mosaxleoba drois 80%-ze
mets atarebs. miekuTvneba-binis alergenebi da airebi,
Tambaqos kvamli

 a s p i r i n i da asass xSirad iwveven rinitsa da asTmas

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 diagnostika

• tipiuri alergiuli simptomebi anamnezSi

• damaxasiaTebeli klinikuri simptomebi
• rinoskopia
• cxviriT sunTqvis pikuri nakadi Peak nasal inspiratory flow (cxviris floumetri)
• saerTo IgE da alergen specifikuri IgE
• kanis prik-testebi
• nazalur CamonarecxSi eozinofilebis Seswavla
• cxviris endoskopia
• nazaluri provokaciuli testi

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 Aalergiuli rinitis simptomatika

• cemineba
• rinorea (gare, Sida)
• nazaluri obstruqcia
• cxviris qavili
• koniunqtiviti
es simtomebi ganicdian ukuganviTarebas an spontanurad,
an mkurnalobis fonze

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 alergiuli rinitis simptomatika

cxvircemineba
gare rinorea
cxviris qavili

Sida rinorea
cxviris gaWedva

• pacients SeiZleba ar awuxebdes yvela simptomi erTad

• pacientTa umetesoba aRniSnavs simptomTa mkveTr gamwvavebas dilis
saaTebSi

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klinikuri niSnebi

• alergiuli
misalmeba
”saluti”
• pirRia-sunTqva –
adenoiduri saxe
• alergiuli
naTeba
- saTvale

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 alergiuli rinitis marTva

 alergenTan kontaqtis acileba

 farmakoTerapia

 specifiuri imunoTerapia

 ganaTleba

 qirurgiuli mkurnaloba SeiZleba gamoyenebuli iyos, rogorc

damatebiTi RonisZieba calkeuli kategoriis pacientisaTvis

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 alergiuli rinitis menejmenti

alergenTan kontaqtis gamoricxva

(SesaZleblobis mixedviT)

farmakoTerapia imunoTerapia
usafrTxoeba efeqturoba
efeqturoba iniSneba specialis tis mier
advilad marTvadoba SeiZleba Secvalos
daavade bis bunebrivi
mimdinareoba

pacientis ganaTleba
naCvenebia yovelTvis

Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147. 18

 alergiuli rinitis farmakoTerapia

 Н -blokerebi
1

 kromonebi
 nazaluri da sistemuri glukokortikos teroidebi

 adgilobrivi da sistemuri moqmedebis dekongestantebi

 antiqolinerguli saSualebebi
 antileikotrienuli preparatebi
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 farmakoTerapiis efeqturoba
(rinitis simptomebze dayrdnobiT)
simptomebi

qavili rinorea cxviris cxviris qavili Tvalis

gaWedva simptomebi

antihistamini (OR) ++ ++ + +++ ++

antihistamini (NS) ++ ++ + ++ 0
antihistamini (OC) 0 0 0 0 +++
steroidi (NS) +++ +++ +++ ++ ++
kromoni (NS) + + + + 0
kromoni (OC) 0 0 0 0 ++
dekongestanti (OR) 0 0 + 0 0
dekongestanti (NS) 0 0 ++++ 0 0
antiqolinerguli 0 ++ 0 0 0
antileikotrieni 0 + ++ 0 ++

Bousquet and Van Cauwenberge; Annals of Internal Medicine;

Consensus statement on the treatment of Al. Rhinitis Feb 04 20
 ARIA: alergiuli rinitis marTvis rekomendaciebi

saSualo/mZime
msubuqi persistiuli persistiuli
saSualo/mZime
intermisiuli

msubuqi intranazaluri steroidebi

intermisiuli
lokaluri kromonebi
antileikotrienebi
meore Taobis arasedatiuri H1 -antihistaminurebi
intranazaluri dekongestanti (10 dReze) an oraluri dekongestanti
alergenebisa da iritantebis Tavidan acileba
imunoTerapia
ARIA = Allergic Rhinitis and its Impact on Asthma.
Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147. 21
 alergiuli rinitis Terapiis efeqturoba mtkicebulebaTa
doneebis mixedviT

ARIA 2007
Careva SAR PAR PER
mozrd bavSvebi mozrd bavSvebi
oraluri H1– blokatorebi
A A A A A

intranazaluri H1–
A A A A A**
blokatorebi
intraokularuli
A A B B
H1– blokatorebi

intranazaluri
A A A B
kromonebi
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 alergiuli rinitis Terapiis efeqturoba mtkicebulebaTa
doneebis mixedviT

ARIA 2007
Careva SAR PAR PER
mozrd bavSvebi mozrd bavSvebi
intraokularuli
A A B B
kromonebi

intranazaluri ks
A A A A A**
oraluri ks
A B B B B**
intramuskularuli
A B B B
ks
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 alergiuli rinitis Terapiis efeqturoba mtkicebulebaTa
doneebis mixedviT

ARIA 2007
Careva SAR PAR PER
mozrd bavSvebi mozrd bavSvebi
intranazaluri
C C C C C**
dekongestanti

oraluri dekongestanti
A

oraluri+ H1– blokatorebi

A B B B B**
antiqolinergu
A A
lebi
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 alergiuli rinitis Terapiis efeqturoba mtkicebulebaTa
doneebis mixedviT

ARIA 2007
Careva SAR PAR PER
mozrd bavSvebi mozrd bavSvebi
homeopaTia
D D D D D**

akupunqtura
D D D D D**
fitoTerapia
B D D D D**
alergenis Tavidan
acileba(tkipa da sxv.
D D A* B* D**
karSida al) 25
 alergiuli rinitis Terapiis efeqturoba mtkicebulebaTa
doneebis mixedviT (gagrZeleba)
leikotrienebis A A A A**
antagonistebi

kanqveSa specifiu ri
imunoTerapia
A A A A A**

sublingaluri specifiuri
imunoTerapia
A A A B A**

nazaluri imunoTerapia A

SAR- sezonuri alergiuli riniti *ar aris efeqturi saerTo pop.

PAR- wliuri alergiuli riniti ** SAR/PAR- eqstrapolireba
PER- persisitiuli alergiuli riniti
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 alergiuli riniti da asTma (epidemiologiuri aspeqtebi)

• alergiuli rinitiT daavadebulTa 38-40%-s aqvs

asTmis simptomebi

• alergiuli riniti 32 – 49%-Si warmoadgens

asTmis ganviTarebis winapirobas da risk-
faqtors

• asTmiT daavadebulTa 80-90%-s awuxebs

alergiuli riniti
(Leynaert et al, 2000) 27
asTmisa da rinitis Tanamedrove koncefcia

alergiuli riniti da asTma xSirad

Serwymulia, rac daedo safuZvlad
koncefcias _ "erTiani sasunTqi
sistema, erTiani daavadeba"

ARIA, WHO, 2001-2007-2008, Clinical and Experimental Allergy, 2008

28
 asTmisa da rinitis Tanamedrove koncefcia

asTma da riniti sasunTqi

gzebis erTian daavadebas
warmoadgens

(“united airways disease”, “one

airway, one disease”, “allergic
rinobronchitis”)

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 ARIA 2008 alergiuli rinitis diagnozi asTmis Semowmeba gansakuTrebiT
mZime da/an persistiuli rinitis mqone pacientebSi


 intermisiuli
intermisiulisimptomebi
simptomebi persistiuli
persistiulisimptomebi
simptomebi

saSualo/mZime msubuqi saSualo- mZime

araupiratesi araupiratesi
TanmimdevrobiT TanmimdevrobiT upiratesi TanmimdevrobiT
peroraluri H1-
blokatori, an intranazaluri CS
peroraluri H1-
intranazaluri H1- blokatori an LTRA
blokatori, an
H1-blokatori,
intranazaluri pacientis konsultacia 2-4
da/an dekonges
H1- blokatori, kviris Semdeg
tanti, an LTRA da/an dekonges
tanti, an intranazalu
ri CS, an LTRA gaumjobeseba
uefeqtoba
(an kromoni)
safexuri diagnozis gadasinjva,
persistiuli rinitis
dabla da mk gagr med sworad miRebis Semowmeba,inf da
dros pacientis konsul Zeleba >1 Tveze sxva mizezebis dadgena
tacia 2-4 kviris Semdeg

uefeqtobis dros
safexuri daamateT mk an rinorea+iprat obstruqcia+dekongestan
CS dozis gazrda ropiumi Ti an oraluri CS
maRla, gaumjobesebisas
gagrZeldes 1Tve uefeqtobis SemTxvevaSi mimarTeT 30
specialists
alergiuli rinitis diagnozi asTmis Semowmeba gansakuTrebiT mZime da/an
persistiuli rinitis mqone pacientebSi

marTebulia alergenisa da gamRizianeblis Tavidan acileba

koniunqtivitis dros
daematos peroraluri, intraokularuli H1blokatori
intraokularuli kromoni (fiziologiuri xsnari)

specifiuri imunoTerapiis sakiTxis ganxilva

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