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Seasonal allergic rhinitis: diagnosis and treatment

Spring is a wonderful time. But not for everyone, the awakening of nature after winter promises joy. For some, spring romance may turn into a completely non-romantic state. A stuffy, swollen nose, swollen and watery eyes are the typical appearance of a person with seasonal allergic rhinitis and conjunctivitis. Sneezing and runny nose make it difficult not only to breathe, but also to communicate, and tears and itchy eyes prevent you from admiring the sun and flowering.

In the spring, it is the flowering of trees that causes allergic rhinoconjunctivitis. People suffering from this disease are not at all happy about the appearance of bright greenery on birch and alder trees. For them, this is a signal to start taking anti-allergic drugs.

Pollinosis (from English Pollen - pollen) was first called hay fever.

In 1819, the English physician John Bostock made the first official report about this disease. At that time, it was believed that the appearance of symptoms in May and June was associated with mown grass, which later becomes hay. It wasn't until 1873 that Charles Blackley proved that plant pollen was the cause of malaise. In Russia, the first official report on pollinosis belongs to Dr. L. Silich, who made it in 1889 at a meeting of the Society of Russian Physicians in St. Petersburg.

There are several periods of flowering plants. In late April and early May, pollen from birch, alder, hazel, oak, and linden trees becomes the cause of the malaise.

It is popularly believed that poplar fluff causes the development of symptoms in June. But due to its size, it cannot penetrate the respiratory tract, and besides, it is not pollen, but only a filler for poplar fruits, which carries small pollen particles and therefore poses a significant allergenic danger.

In late June and early July, cereal plants begin to bloom (rye, wheat, oats, barley, timothy, hedgehog, ryegrass, wheatgrass). The flowering period of weeds (wormwood, ragweed, quinoa) falls at the end of July - beginning of September. Therefore, it is not surprising that seasonal rhinoconjunctivitis can last until autumn or begin at the very end of summer, when, it would seem, nature is preparing to wither.

Not everyone knows the fact that during the flowering period of allergen-significant plants, a pathological reaction to certain products, the so-called cross allergy, may appear. For example, rhinoconjunctivitis in birch blossoms may be accompanied by similar symptoms when eating carrots, hazelnuts, apples, peaches. If the patient reacts to the flowering of cereals, then it is not advisable for him to eat sorrel. And those who are "not friends" with wormwood, citrus fruits, honey, and sunflower seeds will make them itch and cry.

The most characteristic symptoms of pollinosis are nasal congestion, the appearance of clear mucus, itchy nose and sneezing. My eyes also start to itch, turn red, and watery eyes get worse. With a severe allergic reaction, general malaise, a feeling of heat, and irritability may appear. Sometimes the disease does not manifest itself with all the symptoms, and the general condition does not change at all. Then the diagnosis is not entirely obvious. But if a child has a stuffy nose in the morning or acute respiratory infections become more frequent during the flowering period, parents may suspect a pathological reaction of the mucous membranes to plant pollen.

Different methods are used to diagnose pollinosis. To distinguish acute respiratory viral infections from manifestations of allergic rhinitis, nasal mucus is microscopically examined. According to the ratio of cells in the smear, it is concluded that an inflammatory or allergic process prevails.

Allergy testing is more thorough. It is possible either in the form of skin tests, when a solution containing allergens is applied to the skin after a light injection, or by assessing the presence of specific antibodies in the blood to proteins contained in pollen. These methods allow us to answer the question of which plants the patient should avoid. Those who have experienced the symptoms of hay fever for the first time will certainly need the help of a doctor. The doctor will help make the correct diagnosis and prescribe treatment, as well as recommend further medical care tactics, since it is important not only to relieve symptoms during an exacerbation, but also to prevent the occurrence of pathological reactions in the future. Fortunately, this is currently possible.

Those who have had reactions for several seasons should monitor pollen monitoring, which predicts the onset and intensity of flowering of certain plants, and also remember that some time before the start of plant pollination, medications should be taken that allow the body to withstand the onslaught of pollen storms more stoutly.

And the best part is that pollinosis can be cured! The use of microdoses of an allergen to "habituate" the body to it has become an achievement of medical science. This method is called allergen-specific immunotherapy (ASIT).

Doctors of various specialties: pediatricians, ophthalmologists, otolaryngologists, allergists - are ready to help their patients with allergic rhinoconjunctivitis make life more comfortable in the conditions of flowering. After all, nature gives us beautiful colors and smells of flowering so that we can enjoy them!

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Questions and answers

Lump in my breast
I have noted the lump in my breast periodically appeared following breastfeeding my first child (as a result of plugged duct). I did an ultrasound, but it revealed nothing, as if everything was normal. I knead my breast periodically and feel pain at those moments. Now I am pregnant, due date is on 20th. What should I
do?? When to examine my breasts, is it possible to perform the examination during pregnancy and lactation?
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The "lump" in the breast cannot occur after feeding, even if it was the plugged duct. You should not "knead" the breasts. If there is a problem or even if you think it is – the breast should be examined. Pregnancy and breastfeeding are not contraindications for this. Under normal conditions for pregnant women we
recommend a breast examination during 1 and 3 trimester (before childbirth). There are no contraindications for breast examination in your case. You are welcome at any convenient time for examination and advice on breastfeeding.
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Benign disease
I have a benign lump in one breast size of 12.0*9.9 mm. Puncture or a biopsy will be done next week. I was told by mammologist that surgery is needed. As far as I know, concerning the surgery, axillary lymph nodes are to be removed together with the tumor. I also know that in Europe lymph nodes are testes for
specific markers and only affected ones should be removed; if lymph nodes are no affected, they are not to be dissected and the surgery is minimally invasive. So what is your approach? Does it make sense to do it or you have the same methods and the same equipment?
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If histological examination of the sample reveals fibroadenoma of basic type or tissue hyperplasia without atypia, or nodular type fibrocystic condition of the breast tissue, the question of surgical treatment should not arise. If biopsy reveals giant fibroadenoma sectoral resection is indicated, i.e. mass excision
within the healthy tissues and lymph nodes will be removed. In case of non- benign histological result, i.e. carcinoma is detected, subsequent immunohistochemical examination is required as well as a clinical oncologist and surgeon consultation; and the decision on complex treatment will be taken by case management team. With regard to the diagnosis and treatment methods in our center, each case is addressed individually. Sometimes we remove a benign area (for example, the area of hyperplasia with atypia) using the vacuum-needle technique through 3-4 mm incision. As for the surgical procedure protocols for benign breast tumors, benign simple fibroadenoma is not removed in America, Europe, Israel, etc. I would like to discuss your case with you in more details and perform some additional tests if needed, so I would be glad to see you at EMC’s Breast center.
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Melanoma
My mom had a mole (suspected for melanoma) removed in November 2015. Histology revealed lentigo melanoma in situ. We checked the slides back in the Netherlands, and the diagnosis was a superficial spreading melanoma of Clark 3 Т1а Beslow 0,8 stage; re-excision with capture of 1 cm of healthy skin is recommended. Is
it possible to make re-excision and subsequent histology in your hospital? If so, how soon?
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We absolutely agree with the opinion of the European colleagues: re-excision with a wider offset is required; according to the Russian Protocol it is necessary to move 2 cm from the peripheral edge. This is for counter insurance, as lentigo-melanoma is a favorable type, and previous surgery is likely to put an end to
this story and the forecast is favorable. All the necessary manipulations for the study are possible in our Clinic; we have our own well-equipped laboratory with the possibility to ask the advice concerning the sample in Germany and Israel. You should make an appointment with the surgeon-oncologist (Marina Bissessar) in the nearest time to conduct the diagnostic re-excision. Hope to help!
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A spot on the back and chest
I have a spot on the back and chest, what could it be?
A spot on the skin is one of the most common symptoms of various skin diseases. Infectious (viral, bacterial or fungal) as well as noninfectious skin including serious diseases and nevi (moles or birthmarks) can manifest as spots on the skin. You should go to the dermatologist for accurate diagnosis. The doctor will
examine you and, if necessary, a special instrument (Dermatoscope, wood lamp) will be used. A skin scraping can also be done in the lesion for microscopy, cytology or culture. A treatment will be prescribed after diagnosis.
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Batkaeva Nadezhda
07 September 2016
Uterine cancer
My mom was diagnosed with the uterine cancer. She is 68 years of age and has an obesity of 4th grade (the growth of 166 cm, weight 135 kg) and hypertension. Admission to the radiology department was recommended. What should we do? As far as I know the surgery is the only method for cancer of the uterus to be removed.
Is it really so that this surgery is only possible for young and relatively healthy persons?
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It is not quite so. We can operate on any patient, but the issue is which complications can lead to patient’s death and which of them can just delay the recovery. From the anesthesiologist’s point of view, it is a major challenge to intubate patients with 4th degree obesity; the abdominal section is also possible,
but there is a 100% risk of suture line disruption and inflammation, let alone the postoperative pneumonia, venous thrombosis, etc. There is another option such as vaginal hysterectomy which is more acceptable and relatively safe in obese patients. It is not a «treatment standard», however, as it allows not obtaining pelvic washings, but still there is a possibility of complete cure. Anesthesia remains a problem - both general and spinal. Radiation therapy without surgery is another acceptable treatment option besides vaginal hysterectomy. A chance of complete cure is still exists, but the survival rate is on average lower than in surgical treatment
...more
Vladimir Nosov
07 September 2016

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