알레르기 비염 환경 컨트롤 치료, 항원 피하기 치료, 약물 치료, Enviromental control treatments, antigens avoid treatments, drug treatments for allergic rhinitis

posted in: Uncategorized | 0

알레르기 비염 환경 컨트롤 치료, 항원 피하기 치료, 약물 치료, Enviromental control treatments, antigens avoid treatments, drug treatments for allergic rhinitis

 

알레르기 비염 환경 콘트롤 치료와 항원 피하기 치료

antigens-1.jpg

그림 27. 다행히 누구에게나 알레르기 질환이 생기지 않고 일부에게만 알레르기 질환이 생긴다. 평소에 세심히 살펴서 대처해야 한다. 알레르기 질환의 예방과 치료는 항원을 피하고 제거하는 것이다.

Copyright ⓒ 2011 John Sangwon Lee, M.D. FAAP

Screen Shot 2013-06-27 at 2.47.40 PM.png

알레르기 비염의 약물 치료

allergymedication.jpg

그림 119. 알레르기 비염 약물치료와 각 종류의 알레르기 비염 치료에 쓰는 약리 작용과 비만 세포와 히스타민 분비 관계.

참조문헌-FISONS Pharmaceuticals

알레르기 비염을 경구용 1세대나 2세대 항 히스타민제로 치료한다.

nasalcrome_nasal_spray_s.jpg

사진 121. 반세나제, 베클로메타손(Beclomethasone), 부데소나이드(Budesonide),또는 플우티카손(Fluticasone) 등 비강 점막층에 뿌리는  코르티코스테로이드 비강 분무제(코 분무제)로 알레르기 비염을 치료할 수 있다.

Used with permission from Schering Corporation Kenilworth, NJ 07033, USA과 소아가정의학백과 

steroid_nasal_spray_1s.jpg

사진 120. 베클로메타손(Beclomethasone), 부데소나이드(Budesonide), 또는 플우티카손(Fluticasone) 등 코르티코스테로이드제  비강 분무제(코 분무제)로 알레르기 비염을 치료할 수 있다.  Used with permission from Schering Corporation Kenilworth, NJ 07033, USA과 소아가정의학백과

drug_tablets_2s.jpg

사진 122. 애스테미졸(Astemizole), 세티리진( Cetirizine), 펙소페나딘(Fexofenadine) , 또는 로라타딘(Loratadine) 등 2세대 항히스타민제의 정이나 시럽으로 알레르기 비염을 치료할 수 있다.

Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

drugs_syrup_1s.jpg

사진 123. 애스테미졸(Astemizole), 세티리진( Cetirizine), 펰소페나딘(Fexofenadine), 또는 로라타딘(Loratadine) 등 2세대 항히스타민제의 정이나 시럽으로 알레르기 비염 을 치료할 수 있다. Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

다음과 같은 2세대 항 히스타민제로 알레르기 비염을 치료할 수 있다. 

  1. 클라리틴(Claritin/Loratadine),
  2. 클라리틴-디(Claritin-D),
  3. 지르텍(저텍, 지르텍정, 자이택, Zyrtec/Cetirizine),
  4. 알레그라(Allegra, Fexofenadine),
  5. 데스로라타딘(Desloratadine/clarinex)
  6. 씨잘(XYZAL) 경구용 액
  7. 그 외 2세대 항히스타민제

알파 아드레날린 작동제로 알레르기 비염을 치료할 수 있다.

1세대 항히스타민제와 알파 아드레날린 작동제를 혼합제로 치료할 수 있다

예를 들면

비강 점막층 충혈 완화를 시킬 수 있는 코 점적약제나 코 분무제로 알레르기 비염을 치료할 수 있다.

intal-action-1s.jpg

그림 124. 소듐 크로몰린(Sodium Cromolyn)약리 작용.

 나살크롬(Nasalcrom)은 소듐 크로몰린의 상품명이다.

소듐 크로몰린의 성분은 Cromolyn sodium이다.

a-레그위드, 집 먼지 진드기(집 먼지 좀 진드기), 음식물 알러젠(항원),

b-알러젠이 히스타민이 들어 있는 마스트 세포(비만 세포)를 자극한다, c-나살크롬은 마스트 세포내 히스타민 과립체가 마스트 세포에서 분비되지 못하게 한다. d-약으로 치료하지 않을 때는 히스타민 과립체가 마스트 세포 내에서 분비될 때 알레르기 비염이 유발될 수 있다. e-항히스타민제로 이 과정이 차단된다. f -코르티코스테로이드제는 이 과정이 다 진행된 후 비강 점막층에 생긴 알레르기 비염을 치료한다. 참조문헌-FISONS Pharmaceuticals

비만 세포 안정제, 크로몰린으로 알레르기 비염을 치료할 수 있다.

코르티코스테로이드 코 분무제로 알레르기 비염을 치료할 수 있다.

극심한 알레르기 비염이 약물로 치료되지 않을 때 며칠 동안 경구용 코르티코스테로이드제나 근육 주사용 데포트-코르티코스테로이드제(Depot-corticosteroid)로 치료할 수 있다.

류코트리엔 수용체 길항제(Leukotriene-receptor antagonists)로 치료할 수 있다.

항콜린 작용제(Anticholinergics)로 알레르기 비염을 치료할 수 있다

H₁ 수용체 길항제(H₁ receptor antagonist) 판타나 코 분무(Pantanase nasal spray/Olopatadine)로 12세나 12세 이상 아이들의 계절적 알레르기 비염을 치료할 수 있다.

항 히스타민제와 코르티코스테로이드제를 동시 써서 알레르기 비염을 치료할 수 있다.

항원 면역 요법으로 알레르기 비염을 치료할 수 있다.

nasalcrome_nasal_spray_s.jpg

사진 125. 비강 내 뿌리는 크로몰린 코 분무제로 알레르기 비염을 예방할 수 있다.

Copyright ⓒ 2011 John Sangwon Lee, MD.,FAAP

미국에서 흔히 쓰는 알레르기 비염 치료 약물

총칭 약명(상품 약명) 성인 용량 소아 용량 부작용 참고사항
비강 내 코티코스테로이드 분무제 Intranasal corticosteroids
Beclomethasone dipropionate (Beconase, Vancenase) 42 ㎍을 양쪽 비강 속에 1일 2~4회 42 ㎍을 양쪽 비강 속에 1일 2회 국부적 비출혈, 비강자극 단기간 성장 지연이 생길 수 있음
Budesonide (Rhinocort Aqua) 64 ㎍을 양쪽 비강 속에 1일 2회, 또는 128 ㎍ 1일 1회 64 ㎍을 1일 1회 국부적 비출혈, 비강자극 치료 초기에는 적은 용량으로 시작해서 용량을 점점 증가함
Flunisolide (Nasalide, Nasarel) 50 ㎍을 양쪽 비강 속에 1일 2회 또는 3회 25 ㎍을 양쪽 비강 속에 1일 3회 국부적 비출혈, 비강자극
Fluticasone propionate (Flonase) 100 ㎍을 1일 1회 양쪽 비강 속에 100 ㎍을 1일 1회 양쪽 비강 속에 국부적 비출혈, 비강자극 성인에게 1일 1회 50 ㎍을 양쪽 비강 속에 뿌려 치료할 수 있다. 치료효과가 좋으면 필요할 때마다 사용하고 소아치료에서 성장에 영향을 주지 않음
Mometasone furoate monohydrate (Nasonex) 100 ㎍을 1일 1회 양쪽 비강 속에 50 ㎍을 1일 1회 양쪽 비강 속에 국부적 비출혈, 비강자극 소아치료에서 성장에 영향을 주지 않음
Triamcinolone acetonide ( Nasacort AQ) 110 ㎍을 양쪽 비강 속에 1일 2회 110 ㎍을 양쪽 비강 속에 1일 1회 국부적 비출혈, 비강자극 냄새가 없음
Dexamethasone(Dexacort phospate in turbinaire) 성인은 1일 2회, 비강 속에 6-12세 1일 1-2회, 비강 속에 국부적 비출혈, 비강자극
경구용 코티코스테로이드제 Oral corticosteroids
Prednisone (Deltasone, Orasone, Meticorten) 20mg씩 1일 1회 5일간 체중 매 kg당 1mg 을 1회 용량으로 1일 1회 감정 변화 등 심한 알레르기성 비염 치료에만 사용
항 히스타민제 Antihistamines
Cetirizine HCl (Zyrtec) 1일 5~10mg 1일 5~10mg 경미한 진정 수면 작용 시럽형태. 알레르기성 비염의 증상이 시작하기 전 또는 후에 쓸수 있음.
Desloratadine (Clarinex) 1일 5mg 12세나 12세 이상된 소아의 1일 용량 5mg -진정 수면 작용이 거의 없음 알레르성 비염의 증상이 생기 전 또는 후에 치료함. 치료 용량은 약회사의 용법에 따라 함과
Fexofenadine HCl (Allegra) 1일 180mg 또는 60mg 1일 2회 30mg 1일 2회 또는 60mg을 1일 1회 진정 수면 작용이 거의 없음 알레르성 비염의 증상이 생기 전 또는 후에 치료함. 치료 용량은 약회사의 용법에 따라 함과
Loratadine (Claritine) 10mg을 1일 1회 5mg을 1일 1회 진정 수면 작용이 거의 없음 시럽, 처방 없이 살 수 있음
비점막 충혈 완화제 Decongestants
Pseudoephedrine(sudafed) 제약회사의 지시에 따라 15mg을 1일 4회 신경질, 불면증 등 슈도에페드린과 항히스타민제를 종합한 알레르기성 비염약이 여러 종류있다.
류코트라이인 수용체 길항제 Leukoriene-receptor antagonists
Montelukast sodium (Singulair) 10mg을 1일 1회 복용 2~5세 4mg을 1일 1회, 6~14세 5mg을 1일 1회 복용 거의 없음, 천식이 있는 환자는 저녁에 복용함
항 콜린 작동제 Anticholinergics
Ipratropium bromide ( Nasal Atrovent 0.03%) 42 ㎍을 양쪽 비강 속에 1일 3회 21 ㎍을 양쪽 비강 속에 1일 3회 건조감, 비강출혈 맑은 콧물이 많이 날 때 주로 치료함
비 스테로이드 비강 분무제
Cromolyn sodium (Nasal cromolyn) 10.4mg 을 양쪽 비강 속에 1일 3~6회 6세나 그 이상 10.4mg 을 양쪽 비강 속에 1일 3~6회 안전 의사의 처방 없이 살 수 있음, 적어도 2주 정도 치료해야 치료효과가 나타나기 시작함
비강 분무용 항히스민제와 충혈 완화제Antihistamine/ Decongestant Nasal sprays
azelastine(Astelin) 제약회사에서 제공하는 용법에 다라 치료함 제약회사에서 제공하는 용법에 다라 치료함 의사의 처방에 따라 사용, 증상이 있을 때만 사용함
phenylephrine(비강점막층 충혈 완화제)(Neo-Synephrine) 제약회사에서 제공하는 용법에 다라 치료함 제약회사에서 제공하는 용법에 다라 치료함 3일 이상 계속 치료해서는 안됨 의사의 처방이 없이 사서 쓸 수 있음, 매 4시간 마다 치료할 수 있음
oxymetazoline( 비강점막층 충혈 완화제)(Afrin) 제약회사에서 제공하는 용법에 다라 치료함 제약회사에서 제공하는 용법에 다라 치료함 3일 이상 계속 치료해서는 안됨 의사의 처방이 없이 사서 쓸 수 있음, 매 4시간 마다 치료할 수 있음
경구용 항히스타민제와 비강 점막층 충혈 완화제 Antihistamine/Decongestant, oral medications
triprolidine/pseudoephedrine (Actifed) 제약회사에서 제공하는 용법에 다라 치료함 제약회사에서 제공하는 용법에 다라 치료함 잠이 오거나 불면증이 올 수 있음 의사의 처방이 없이 사서 쓸 수 있음
chlorpheniramine/phenylpropanolamine (Contact) 제약회사에서 제공하는 용법에 다라 치료함 제약회사에서 제공하는 용법에 다라 치료함 증상이 생기기 전이나 생긴 후 복용함 잠이 오거나 불면증이 생길 수 있음, 의사의 처방이 없이 사서 쓸 수 있음
brompheniramine/phenylpropanolamine(Dristan) 제약회사에서 제공하는 용법에 다라 치료함 제약회사에서 제공하는 용법에 다라 치료함 증상이 생기기 전이나 생긴 후 복용함 잠이 오거나 불면증이 생길 수 있음, 의사의 처방이 없이 사서 쓸 수 있음
chlorpheniramine/pseudoephedrine(Sudafed-Plus) 제약회사에서 제공하는 용법에 다라 치료함 제약회사에서 제공하는 용법에 다라 치료함 증상이 생기기 전이나 생긴 후 복용함 잠이 오거나 불면증이 생길 수 있음, 의사의 처방이 없이 사서 쓸 수 있음
loratadine/pseudoephedrine(Claritin-D) 제약회사에서 제공하는 용법에 다라 치료함 제약회사에서 제공하는 용법에 다라 치료함 증상이 생기기 전이나 생긴 후 복용함 잠이 오거나 불면증이 생길 수 있음, 의사의 처방이 있어야 함
경구용 항히스타민제 Antihistamine, oral medications
clemastine fumerate(Tavista) 제약회사에서 제공하는 용법에 따라 치료함 제약회사에서 제공하는 용법에 따라 치료함 증상이 생기기 전이나 생긴 후 복용함 진정 수면효과 많이 생김, 의사의 처방이 있어야 사서 쓸 수 있음
diphenhydramine(Benadryl) 제약회사에서 제공하는 용법에 따라 치료함 제약회사에서 제공하는 용법에 따라 치료함 증상이 생기기 전이나 생긴 후 복용함 진정 수면효과가 많이 생김, 의사의 처방없이 사서 쓸 수 있음
chlorpheniramine(Allerest) 제약회사에서 제공하는 용법에 따라 치료함 제약회사에서 제공하는 용법에 따라 치료함 증상이 생기기 전이나 생긴 후 복용함 진정 수면효과가 많이 생김, 의사의 처방없이 사서 쓸 수 있음
dexbrompheniramine(Drixoral) 제약회사에서 제공하는 용법에 따라 치료함 제약회사에서 제공하는 용법에 따라 치료함 증상이 생기기 전이나 생긴 후 복용함 진정 수면효과가 많이 생김, 의사의 처방없이 사서 쓸 수 있음

출처 및 참조문헌; 

참고

코부레이션 비갑개 경감치료로 알레르기 비염을 치료할 수 있다. Coblation turbinate reduction treatment

알레르기 비염이 유발되기 시작하는 소아청소년의 나이는 유발 인자에 따라 다르다-Ⅰ.

알레르기 비염이 유발되기 시작하는 소아청소년의 나이는 유발 인자에 따라 다르다-Ⅱ.

다음은 알레르기 비염부비동염 재발에 관한 인터넷 소아청소년 건강상담 질의응답의 예 입니다.

Q&A. 알레르기 비염부비동염 재발.

Q.

몇 번 아이 두통 때문에 문의 드렸던 6세 아이의 엄마입니다아이가 5일간 새벽녘이나 잠이 깰 때 머리가 아프다고 하여 소아청소년과에서 맥박도 재고 안과에서 안압도 쟀지만 다 정상으로 나왔었어요.

그런데 그런 뒤에 아이가 잠에서 깰 때 보니 한 쪽 코가 막히고 코 속 살이(속살이부어있었어요그래서 소아청소년과 선생님은 휴가 중이라 이비인후과에 가 보았더니 글쎄 그만 그 사이에 축농증이라네요.

소아청소년과에서 약을 그동안 기침 때문에 항생제 오그멘틴 듀오랑 코르티코스테로이드제 신티손을 계속 먹어 왔는데 먹는 도중에 머리가 아팠었거든요그런데 약을 떼자 머리는 안 아파왔고 약 뗀지 3일 만에 코가 이상하여 가보니 콧속에 노란 코가 가득 찼다고 축농증이라고 하네요.

어떻게 이리 빨리 재발을 할 수 있는지요약을 먹는 중에도 감기가 오면 바로 재발하는 건가요그동안 3주 정도는 코가 깨끗했었거든요. 3개월 1주간이나 부비동염 치료를 했는데 약 뗀지 3일 만에 다시 축농증이라니 기가 막혀서요그리고 이비인후과에서 자디텐이라는 약 때문에 아이가 축농증이 된 것 같다고 해요그 약이 코를 못 나오게 꽉 잡아주니까 배출이 안 돼서 그런 거라고요.

우리 아이는 부비동염 약을 떼고 자디텐이라는 예방약만 날마다 두 번 먹고 있었거든요소아청소년과 선생님말씀을 따르자니 그렇고 이비인후과에만 다니자니 아이전반적인 건강이 불안하고어떻게 하면 좋지요게다가 이비인후과에서 준 약이 설파제와 소아용 루리드현탁액정과 비충혈제거제인 슈….(이름이 잘 생각 안 나서에요.

전에 다 먹어봤던 약이라 효과가 있을지 해서요어떻게 하면 좋겠습니까소아청소년과 선생님 휴가가 끝나면 다시 소아청소년과로 가야할까요?

A.

다음은 코 막힘과 가래알레르기 비염우유 알레르기기관지천식에 관한 인터넷 소아청소년 건강상담 질의응답의 예 입니다.

Q&A. 코 막힘과 가래, 알레르기 비염,

우유 알레르기기관지천식

Q.

안녕하세요저의 아이는 태어난 지 80일 된 여아입니다태어날 때 몸무게는 3.2kg, 키는 47cm였는데현재는 정확하진 않지만 몸무게가 6kg정도키는 약 60cm 정도 됩니다직장관계로 모유수유를 5주 정도했습니다.

그런데 태어난 지 한 달 정도부터 약간 코가 막히는 듯싶더니 점점 정도가 심해져서 지금은 안고 있으면 가래 끓는 소리가 나고 저녁으로는 가끔 기침도 합니다열은 없고요.

또한, 코가 막혀서 우유를 먹을 때는 심하게 짜증을 내며 울면서 먹을 때도 있습니다코가 막혀서 그러는지 변을 보려고 그러는지 잘 분간이 가지 않을 때도 있습니다먹는 양은 적당히 먹는 편이구요변도 거의 정확히 약간 묽게 하루 두 번 정도 봅니다.

잠은 낮에는 잘 잘 때도 있고 조금밖에 자지 않을 때도 있지만, 저녁에는 두 차례 정도 우유를 먹는 시간을 제외하곤 잘 자는 편입니다.

그런데 걱정이 되어서 70일 되는 무렵에 소아청소년과에 갔더니 감기가 심한 편은 아니라고 하며 약을 3일분을 처방하여 주었습니다.

그래도 별 차도가 없기에 다시 이비인후과에 가보았는데 또 심한 편은 아니라며 그냥 목과 코를 치료해주고 매일 다녀보라고 해서 이틀을 갔는데 차도가 없습니다.

물론 짧은 기간에 차도가 있기를 바라는 게 무리라는 걸 알지만그래도 다시 소아청소년과 에 다니면서 꾸준히 치료를 받아볼까 합니다.

이렇게 여기저기 다니는 게 좋지 않다는 걸 알면서도 어디가 좋을지 판단이 서질 않는군요.

그냥 놔두어도 저절로 낫는 병일 수도 있을 것도 같고더 심해져서 큰 병이 될 것도 같아서 안절부절못합니다.

사연이 너무 길어져서 죄송하고요조언 부탁드립니다.

A.

다음은 아데노이드 적제수술알레르기 비염에 관한 인터넷 소아청소년 건강상담 질의응답의 예 입니다.

Q&A. 아데노이드 적제수술알레르기 비염

Q.

A.

정아님

안녕하세요좋은 질문해 주셔서 감사합니다.

자녀의 나이성별과거 병력가족 병력진찰소견임상검사 등의 정보를 많이 알수록 답변을 드리는데 도움이 됩니다주신 정보를 토대로 해서 답변을 드리겠습니다.

Q.

어려서부터 감기에 걸리면 숨쉬기가 힘듭니다.

A.

감기는 비강인두 등 상기도에 국한되어 생기는 바이러스성 감염병이고 코가 약간 막혀서 숨쉬기가 좀 곤란할 수는 있지만 자녀가 겪었던 것처럼 숨쉬기가 힘들 정도로 코가 막히지 않는 것이 보통입니다.

감기와 알레르기 비염 및또는 감기와 천식 등을 앓았던 것 같습니다.

특히 야간 유발 천식 및또는 감기알레르기 비염천식 등이 함께 있었기 때문에 그렇게 숨쉬기에 곤란을 당했던 것 같습니다.

거기다가 아데노이드 비대가 있었을 것입니다.

감기알레르기 비염기관지 천식아데노이드 비대 등이 함께 있었기 때문에 호흡곤란이 심했던 것 같습니다.

Q.

평상시에도 약간의 코골이가 있고요.

A.

Q.

감기에 걸렸을 때는 특히밤에 잠을 잘 때는 숨 쉬는 소리가 어찌나 힘겨운지 그 리듬(?)에 같이 숨차할 때가 많습니다.

A.

위에서 설명 드린 바와 같이 감기 알레르기 비염 아데노이드 비대 및또는 천식으로 이런 증상 징후가 생기는 것 같습니다.

천식은 아토피 피부염과 알레르기 비염의 병력이 있는 아이들에게는 거의 다 생길 수 있다고 생각하면 대개 맞습니다.

소아청소년과 전문의와 상의하셔서 알부테롤제 등 기관지 확장제프레드니손제 등 기 관지 염증 소염제로 천식을 며칠 동안 치료해 보시면 호흡곤란과 그 외 증상이 아주 좋아질 것입니다.

그리고 비강 내에 뿌리는 코르티코스테로이드제 코 분무와 경구용 항히스타민제로 알레르기 비염을 치료하면 치료효과가 많이 좋아질 것입니다.

감기 치료에 특효약은 없습니다.

알레르기 질환을 예방하는 치료도 해주세요.

Q.

의사선생님께서는 아데노이드가 비대해서 수술로 제거(?)해 주어야 할 것 같다는 말씀을 하십니다소아청소년과 선생님께서는 성장하면서 작아질 수도 있으니 그냥 지켜보자고 하시구요전 환절기(가을겨울)가 두렵습니다.

A.

Q.

가끔씩 멀미가 난다고 하는 걸 보면 두통도 심한 것 같고요이비인후과에 가면 코가 자꾸 뒤로 넘어간다고 축농증도 있다고 하시고.

A.

아토피 체질이고자녀와 같이 알레르기 비염 등이 있는 아이들의 얼굴이 아데노이드 얼굴형(아데노이드 안모)일 수도 있고부정교합 등 치열이 고르지 않을 수도 있고(있으며알레르기 샤이너 등의 증상 징후가 생길 수 있습니다여러 가지 이유로 멀미도(잘 하고(잘하고), 모든 것에 오관이 더 예민하게 반응하는 편입니다.

비강 점막층이 알레르기 비염으로 붓고 그로 인해서 부비동 속과 비강 속을 연결하는 자연 통로가 쉽게 막힙니다따라서 축농증이 잘 생기게 됩니다비강 속의 비강 분비물이 인두가 있는 쪽으로 쉽게 넘어가서 축농증이 생기는 것은 아닙니다.

Q.

이제 겨우 몸무게가 19kg입니다숨쉬기 힘들어 가는(힘들어하는걸 보면 당장이라도 수술해 주고 싶은 마음뿐입니다.

A.

다음은 기관지천식알레르기 비염에 관한 인터넷 소아청소년 건강상담 질의응답의 예 입니다.

Q&A. 기관지천식알레르기 비염

Q.

A.

안녕하세요좋은 질문해 주셔서 감사합니다.

자녀의 나이성별과거 병력가족 병력진찰소견임상검사 등의 정보를 많이 알수록 답변을 드리는데 도움이 됩니다주신 정보를 토대로 해서 답변을 드리겠습니다.

제 생각으로는 자녀가 알레르기 비염과 천식을 동시에 앓고 있는 것 같습니다그리고 축농증도 있었을 것입니다왜 그렇게 생각하는지 좀 더 자세히 설명해 드리겠습니다.

Q.

제가 상담할 아이는 만6세 된 남자아이로 2년 전에 강가에서 좀 춥게 놀다가 밤에 갑자기 숨소리가 이상해서 다음날 병원에 갔더니 천식이라는 진단을 받고 자디텐이라는 알레르기예방약을 처방받았습니다.

A.

천식을 앓는 환아들은 천식이 유발될 수 있는 유전인자 소질을 지니고 태어납니다.

즉 천식은 일종의 유전병입니다그런 아이들이 찬 공기를 마실 때 흡입한 찬 공기로 천식발작이 유발될 수 있습니다.

이런 천식을 찬 공기 유발성 기관지 천식(한 냉 공기 유발성 천식)이라고도 합니다.

Q.

약 1년간 자디텐과 히스토불린이라는 주사를 맞다가 제가 임의로 그만 중도에 그만 두었습니다.

A.

자디텐과 히스토불린의 두 가지 약물의 원명을 잘 몰라 그 약물에 대해서 말씀드릴 수 없습니다그러나 천식을 예방하는데 제가 가장 많이 쓰는 약물은 크로몰린(Cromolyn Sodium, Intal)제 기도 내 분무나 크로몰린제 흡인용 HFA입니다.

요즘에는 천식을 치료도 하고( 예방하기 위해 코르티코스테로이드제 분무나 흡입용 코르티코스테로이드제 HFA를 많이 씁니다.

Q.

제 아이는 1년에 서너 번 정도 환절기에 감기와 같이 천식증세가 나타나는 것 같습니다환절기가 되면 알러지성 비염으로 아침이면 재채기와 코가 많이 나옵니다.

A.

기관지 천식과 알레르기 비염은 기온의 변화나 감기 등 상기도 바이러스 감염 등으로 잘 유발될 수 있습니다역시 알레르기 비염을 예방하기 위해 크로몰린(Nasal Cromolyn)제 비(분무를 비강 속에 뿌릴 수 있습니다.

Q.

제가 다니는 소아청소년과 선생님께서는 이 정도는 가벼운 알러지라 그때그때 치료를 하면 된다고 하시고 저도 그러는 것이 좋다고 생각됩니다.

A.

천식을 간헐 천식경도 지속 천식중등도 지속중증 지속 천식 등으로 분류합니다.

자녀에게는 간헐 천식이 있는 것 같습니다.

이 정도의 천식은 그때그때 천식 발작이 유발되지 않게 예방하고 그때그때 유발된 천식 발작을 약물로 적절히 치료해 주면 천식이 잘 컨트롤됩니다.

그러나 경도 지속 천식이 중등도 지속 천식 또는 중증 지속 천식 발작으로 유발될 때는 급성으로 발작된 천식을 치료하고흡인용 크로몰린(인탈) HFA이나 그 이외 다른 약물로 천식을 예방해야 합니다.

그리고 천식 발작이 급성으로 유발되면 경구용 알부테롤(Albuterol) 시럽(5cc=albuterol 2mg)을 매 6시간마다 필요에 따라 경구로 복용하고 프레드니손(Prednisone)제 시럽이나 프레드니솔론(Prednisolone)제 시럽을 체중 매 kg당 1~2mg을 1일 분량으로 계산하고 그 1일 분량을, 2~3회분으로 나누어 3~7일 동안 치료할 수 있습니다참고로 말씀드립니다.

Q.

그런데 이번에는 약을 먹는데도 가래소리가 밤마다 나아지지가 않아 빨리 낫게 할 생각으로 종합병원 호흡기 알러지과를 갔더니선생님께서 폐와 코의 x선을 찍으라고 하시고 축농증과 폐렴이 있고 천식증세가 있다고 하시며 축농증은 6주 정도 항생제를 먹어야 된다고 하시고 그날 8가지나 되는 약을 처방해 주셨습니다(열이나 축농증증세는 없었음).

A.

Q.

그리고 가슴 x선 촬영 시 숨을 내쉴 때 찍은 것 같은데 결과는 같은지요폐렴을 앓은 적은 없었습니다.

A.

폐렴이 조금 있을 때 X선 사진 검사상에 거의 나타나지 않을 수 있습니다그와 반대로 X선 사진 검사상 폐렴이 있는 것이 나타나도 아무 증상 징후가 없는 경우 있습니다.

이런 폐렴을 보행성 폐렴(Walking pneumonia)이라고 합니다.

X선 사진 검사를 하지 않고 폐렴을 증상·징후·검진 등을 참작하여 임상적으로 진단하는 경우가 더 많이 있습니다.

소아청소년과에서 진찰 진단을 계속 받으시고 계속 치료하시기 바랍니다.

 알레르기 비염,  천식천식에 대한 백문 백답을 여러 번 꼭 읽어보시기 바랍니다. [부모도 반의사가 되어야 한다소아가정간호백과]-제 18권 소아청소년 이비인후 질환– 부비동염 등을 참고하시기 바랍니다.

질문이 더 있으면 다시 연락해 주시기 바랍니다감사합니다이상원 드림

다음은 코골이 구강호흡에 관한 인터넷 소아청소년 건강상담 질의응답의 예 입니다.

Q&A. 코골이구강호흡

Q.

A.

tonsills_enlarged_1s.jpg

사진 114. 알레르기 비염이 있는 아이들의 편도와 아데노이드는 비정상적으로 많이 커져 있을 수 있다.

Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

 

Environmental control treatment, antigen avoidance treatment, drug treatment, drug treatments for allergic rhinitis

Allergic Rhinitis Environmental Control Treatment and Antigen Avoidance Treatment

antigens-1.jpg

Figure 27. Fortunately, not everyone develops allergic diseases, and only a few do. You have to take a closer look and deal with it. Prevention and treatment of allergic diseases is to avoid and eliminate antigens. Copyright ⓒ 2011 John Sangwon Lee, M.D. FAAP

• You should avoid eating foods (antigens) that can cause allergic rhinitis or other types of allergic diseases as much as possible.

• To newborns or infants born to siblings of biological parents with allergic diseases or atopic constitution, instead of feeding artificial nutrition containing milk, milk protein, or soy protein, if possible, breastfeeding or feeding hypoallergenic artificial nutrition Prevent rhinitis from occurring in advance and properly treat allergic rhinitis that has already occurred.

• To prevent allergic rhinitis and other types of allergic diseases, avoid foods such as milk, eggs, nuts, and chocolate that can cause allergic rhinitis and other types of allergic diseases.

• Do not keep pets such as dogs, cats and birds in the house and avoid contact with them.

• When keeping a pet in the house for unavoidable reasons, avoid contact with or inhalation of the animal’s fur, saliva, dander, feathers, etc.

Screen Shot 2013-06-27 at 2.47.40 PM.png

Photos Do not keep pets such as birds and dogs in the house Copyright ⓒ 2013 John Sangwon Lee, M.D., FAAP

    Screen Shot 2013-06-27.png

Photo golden rod Copyright ⓒ 2013 John Sangwon Lee, M.D., FAAP

• Do not grow flowers or trees in the house where children with atopic constitution or allergic rhinitis live.

• Mold and mold grow in humid places, so control the humidity in the house to prevent mold or mold from growing.

• Use washable and reusable carpets instead of fixed carpets, as stationary carpets can collect more house dust and allow more house dust mites (house dust mites) to grow.

• Wash the curtains often.

• Keep the inside of the house clean and prevent the growth of house dust mites (house dust mites).

• If possible, no other items other than bedding should be placed in the bedroom of children with allergic rhinitis or atopic constitution.

• Cover the bed mattress and spring box with plastic covers to prevent the growth of house dust mites (house dust mites).

• During spring, when flowers are in full bloom, make sure to close the windows to prevent pollen and mold from entering the house from outside.

• When planting or mowing plants, pollen or mold can be inhaled into the respiratory tract and can cause allergic rhinitis, allergic conjunctivitis, or asthma. It is difficult to completely avoid such antigenic contact, but avoid contact as much as possible.

• Mowing the lawn as needed, wearing a mask and dust-repellent glasses.

• If possible, avoid going to areas with regweed weeds during regweed season, when regweed blooms are abundant.

• Do not wear clothes made from animal or bird feathers, and never use feathers or fur on pillows or blankets.

• Reduce house dust mites (house dust mites), etc. with HEPA air filters.

• Get rid of cockroaches.

• For general treatment of other allergic diseases, refer to each section. see p.00 General Treatment of Allergic Disorders. See  How to Avoid and Eliminate Household Allergens. Drug treatment of allergic rhinitis

    allergymedication.jpg

Figure 119. Pharmacological action, mast cell and histamine secretion relationship for drug treatment of allergic rhinitis and treatment of each type of allergic rhinitis. REFERENCES-FISONS

 Allergic rhinitis is treated with oral first- or second-generation antihistamines

. • When an antigen-antibody abnormal reaction occurs, histamine granules may be secreted from mast cells and basophils to organs or regions of each system of the body. • The histamine granule, IgE, cytokines, leukotriene, and other biochemical substances in the body act in combination, which can cause allergic rhinitis or anaphylactic reaction.

• There are normally receptors for histamine in cells scattered in various tissues of each system in the body.

• A histamine antagonist, commonly referred to as antihistamine, is a group of drugs that prevent allergic diseases by blocking histamine granules secreted from mast cells from binding to receptors.

• Treat symptomatic signs of allergic rhinitis with antihistamines based on this physiological basis.

• Treatment of allergic rhinitis with antihistamines may improve the symptoms of several types of allergic rhinitis, but does not cure allergic rhinitis (see Figure 119).

• Also, when antihistamines are used to treat allergic rhinitis, the therapeutic effect is often not immediately apparent.

• Antihistamines include first-generation antihistamines and second-generation antihistamines.

• Antihistamines such as Periactin, Chlor-trimeton, Benadryl, and Pyribenzamine, which have been widely used in clinical practice in the past, are first-generation antihistamines.

• You can treat allergic rhinitis by choosing only one type of first-generation antihistamine from among the first-generation antihistamines.

• When treating allergic rhinitis with first-generation antihistamines, therapeutic effects are shown, but side effects such as sedative and hypnotic effects may also occur.

• So these days, allergic rhinitis is mainly treated with second-generation antihistamines.

o Claritin,

o Astemizole,

o Cetirizine,

o Sofenadine (Fexofenadine),

o Loratadine is a second-generation antihistamine.

• When treating allergic rhinitis with second-generation antihistamines, the therapeutic effect is good, the sedative effect is small, and the hypnotic effect may be small. • When allergic rhinitis was treated with first-generation antihistamines, the symptoms of runny nose, sneezing, itchy nose, and watery symptoms almost disappeared.

• However, second-generation antihistamines show very little decongestion effect on the nasal mucosa. This is a disadvantage when treating allergic rhinitis with second-generation histamines.

    nasalcrome_nasal_spray_s.jpg

Photo 121. Allergic rhinitis can be treated with corticosteroid nasal sprays (nasal sprays), such as bansenaze, Beclomethasone, Budesonide, or Fluticasone, which are sprayed into the nasal mucosa. . Used with permission from Schering Corporation Kenilworth, NJ 07033, Department of Pediatric and Family Medicine, USA

    steroid_nasal_spray_1s.jpg

Picture 120. Corticosteroid nasal sprays (nose sprays) such as Beclomethasone, Budesonide, or Fluticasone can be used to treat allergic rhinitis. Used with permission from Schering Corporation Kenilworth, NJ 07033, Department of Pediatric and Family Medicine, USA

• For that reason, some doctors treat allergic rhinitis with first-generation antihistamines in the evening and second-generation antihistamines during the day.

• Comprehensive allergens sometimes containing components of second-generation antihistamines and nasal mucosal decongestants

• In some cases, treatment with salt medications (eg Claritin-D).

  drug_tablets_2s.jpg

Photo 122. Allergic rhinitis can be treated with tablets or syrups of second-generation antihistamines such as Astemizole, Cetirizine, Fexofenadine, or Loratadine. Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

  drugs_syrup_1s.jpg

Photo 123. Allergic rhinitis can be treated with tablets or syrups of second-generation antihistamines such as Astemizole, Cetirizine, Fexofenadine, or Loratadine. Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

• No matter what type of first-generation or second-generation antihistamine is being treated, side effects may occur during treatment with that antihistamine, and the side effects depend on the type of antihistamine

. • When treated with first-generation antihistamines for allergic rhinitis or other allergic diseases, side effects such as drowsiness, difficulty concentrating, and dry saliva may occur. However, these side effects are less common when treated with second-generation antihistamines.

• When allergic rhinitis is treated with antihistamines, it can be treated well with one type of antihistamine.

• Sometimes, simultaneous treatment with two types of antihistamines is needed for a better treatment effect.

• Depending on the symptoms and severity of allergic rhinitis, one or two of several types of first-generation antihistamines can be selected for treatment.

• When treating allergic rhinitis with first-generation antihistamines, the first-generation antihistamines are no longer effective after starting treatment. Sometimes there is no need for treatment.

• When treating allergic rhinitis with one type of antihistamine, if the therapeutic effect is good, you can continue treatment with that drug if necessary.

• When treated with another type of antihistamine, the therapeutic effect may be very good for a while, but if you continue treatment with that antihistamine for a long period of time, the therapeutic effect may gradually decrease or may be completely absent.

• Therefore, there are cases where treatment is switched to another type of antihistamine. In other words, long-term treatment with antihistamines can lead to resistance to antihistamines.

• Even when treating allergic rhinitis with antihistamines, it is the ideal treatment principle to select and treat the appropriate antihistamine according to the doctor’s prescription.

• If you treat allergic rhinitis with Loratadine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allegra), Desloratadine (Clarinex), or other second-generation antihistamines, the treatment is effective and the hypnotic side effect that induces sleep does not occur. It is common not to treat allergic rhinitis with generational antihistamines.

Allergic rhinitis can be treated with the following second-generation antihistamines:

1. Claritin/Loratadine,

2. Claritin-D,

3. Zyrtec (Zertec, Zyrtec Tablet, Zyrtec, Zyrtec/Cetirizine),

4. Allegra (Fexofenadine),

5. Desloratadine/clarinex

6. XYZAL ORAL SOLUTION

7. Other second-generation antihistamines

• This type of second-generation antihistamine has less sedative pharmacological action than treatment with the first-generation antihistamine and causes very few symptoms such as drowsiness.

• These days, it is mainly used to treat mild allergic rhinitis.

• Claritin-D is also a comprehensive treatment for allergic rhinitis, which is a combination of a second-generation antihistamine and Sudafed.

Allergic rhinitis can be treated with alpha-adrenergic agonists.

• Pseudoephedrine is a type of alpha-adrenergic agonist.

• Sudafed is a commercial drug for pseudoephedrine and is an alpha-adrenergic agonist. • If you treat allergic rhinitis with Sudape, the nasal congestion caused by congestion of the nasal mucosa is greatly improved.

• These types of drugs are called nasal mucosal decongestants.

• Nasal mucosal decongestants include oral tablets (tablets) and liquid syrups.

• There are also sprays that can be treated by spraying directly into the nasal passages;

• There are also nasal drops that can be dropped into the nasal passages as drops.

• Some medications contain only nasal mucosal decongestants.

• Comprehensive nasal mucosal decongestants are also available that are formulated with a blend of antihistamines and nasal mucosal decongestants.

• Oral pseudoephedrine, commonly used these days, is a type of nasal mucosal decongestant.

• The drug does not contain an antihistamine component.

• When treated with the drug, there is no antihistamine pharmacological action, only the nasal mucosal decongestant pharmacological action.

• Nasal mucosal decongestants such as oral pseudoephedrine temporarily constrict the capillaries in the nasal mucosa to reduce runny nose and have a pharmacological action to temporarily relieve congestion in the nasal mucosa and pierce the nasal airways.

• Allergic rhinitis can be treated symptomatically with Sudafed and can be treated symptomatically with a combination of antihistamine and Sudafed.

A combination of first-generation antihistamines and alpha-adrenergic agonists can be treated.

• Periactin, Chlor-trimeton, Benadryl, and Pyribenzamine are first-generation antihistamines.

• Only one first-generation antihistamine can be used to treat allergic rhinitis.

• There is also a comprehensive treatment for allergic rhinitis made using first-generation antihistamines and nasal mucosal decongestants. For example

• o Rondec,

o Activated;

o Naldecon,

o Novafed,

o Triaminic,

o Dimetapp is a comprehensive treatment for allergic rhinitis.

• You can treat allergic rhinitis by choosing one of the comprehensive allergic rhinitis medications listed above.

• There may be only one type of antihistamine in the ingredients of the “allergy drug” used to treat allergic rhinitis, or a mixture of antihistamine and nasal mucosal decongestant.

• When you have a cold, medicines that relieve the symptoms of a cold may contain these types of antihistamines and nasal decongestants.

• That’s why it is sometimes used to treat colds with a comprehensive drug to treat allergic rhinitis.

• It is important to note that allergic rhinitis or colds should be treated according to the doctor’s prescription with this type of drug.

• This type of cold medicine should not be used to treat colds, especially in children under 2-4 years of age.

Allergic rhinitis can be treated with nasal drops or nasal sprays that can relieve congestion of the nasal mucosa.

• Afrin/oxymetazoline nasal spray or neosynephrine nasal spray has a pharmacological action that strongly relieves congestion in the nasal mucosa. In the United States, it is a treatment for allergic rhinitis that can be purchased at a pharmacy without a doctor’s prescription.

• Nasal drops (nasal drops) can be dropped into the nasal passages or nasal sprays can be sprayed into the nasal passages to relieve congestion of the nasal mucosa.

• This treatment method can quickly clear the nasal mucosal congested nasal congestion caused by allergic rhinitis.

• Neosynephrine is available as a nasal spray and as a nasal drop.

• There are nasal sprays and nasal drops (nasal drops) for Afrin.

• Nasal mucosal congestion can be temporarily relieved by dropping nasal drops directly onto the mucous membrane of the nasal cavity or treating with nasal sprays.

• Depending on the type of drug, the nasal mucosal decongestion effect may last for 6 to 12 hours, and nasal congestion may temporarily improve due to allergic rhinitis.

• Continued treatment with these drugs for more than 3 to 5 days may damage the nasal mucosa and may cause other side effects.

• Nasal sprays, such as Afrin or neosynephrine, can be purchased from US pharmacies without a doctor’s prescription.

• However, when buying and treating a strong nasal mucosal decongestant, you must use it according to your doctor’s prescription.

  intal-action-1s.jpg

Figure 124. Sodium Cromolyn pharmacological action. Nasalcrom is a trading name for sodium cromolyn. The component of sodium cromolyn is Cromolyn sodium. a-ragweed, house dust mites (house dust mites), food allergens (antigens), b-Allergen stimulates mast cells (mast cells) containing histamine, c-Nasalchrome prevents the secretion of histamine granules in mast cells from mast cells. If not treated with d-drug, allergic rhinitis may be induced when histamine granules are secreted within the mast cells. e-antihistamines block this process. f-corticosteroids are used to treat allergic rhinitis in the nasal mucosa after this procedure has been completed. REFERENCES-FISONS Pharmaceuticals

The mast cell stabilizer, Cromolyn, can be used to treat allergic rhinitis.

• Cromolyn is a mast cell stabilizer and has a pharmacological action that prevents the release of histamine granules in the mast cells (see Figure 124, see Figure 125).

• Asthma prophylaxis can also be done with Sodium Cromolyn.

• If Cromolyn nasal spray is sprayed into the nasal cavity, the induction of allergic rhinitis can be prevented and the already existing allergic rhinitis can be treated.

• Cromolyn nasal spray is sprayed into the nasal cavity for convenient treatment and good prevention. Cromolyn nasal spray in the form of a spray continues to be effective for prophylaxis even after continued use for several weeks to several months.

• Side effects of cromolyn are very rare.

• You can buy it at US pharmacies without a prescription, but the disadvantage is that the drug is expensive.

Allergic rhinitis can be treated with corticosteroid nasal sprays.

• It is a trend these days to treat mild allergic rhinitis first with second-generation antihistamines and to treat moderate or severe allergic rhinitis with corticosteroid nasal spray first.

• o Beclomethasone nasal spray;

o Budesonide nasal spray;

o Allergic rhinitis can be treated by directly spraying nasal sprays of corticosteroids such as triamcinolone nasal sprays into the nasal passages.

• Beclomethasone nasal spray and Budesonide nasal spray are available in powdered nasal sprays and liquid nasal sprays that can be administered intranasally.

• A nasal spray of any kind of corticosteroid is administered by spraying it into both nasal passages 1 to 2 times a day according to the doctor’s prescription.

• Depending on the effectiveness of treatment, allergic rhinitis can be treated for several weeks or months as directed by your doctor.

• In general, when treating allergic rhinitis with nasal spray with corticosteroids, the therapeutic effect usually starts to appear about 12 hours after starting treatment.

• Side effects such as nasal bleeding, increased intraocular pressure, glaucoma, and kidney growth retardation may occur.

• However, it is not uncommon for these side effects to occur after several weeks of continued treatment.

• In particular, when treating allergic rhinitis with corticosteroid nasal spray, it should be treated according to the doctor’s prescription.

When severe allergic rhinitis is not treated with medication, it can be treated with oral corticosteroids or intramuscular depot-corticosteroids for several days.

It can be treated with leukotriene-receptor antagonists.

• Montelukast sodium and Singulair are leukotriene receptor antagonists.

• Treatment with this antagonist can definitely improve the symptoms of allergic rhinitis.

• A recent study found that people treated with Singulair were more likely to commit suicide. You should talk to your doctor about any side effects when you are treated with this medicine.

Anticholinergics can treat allergic rhinitis

• Allergic rhinitis can be treated by spraying a nasal spray made of Ipratropium bromide/Nasal atrovent 0.03% into the nasal passages.

• When you have a lot of clear runny noses, this drug has a good therapeutic effect. H₁ receptor antagonist Pantanase nasal spray/Olopatadine can be used to treat seasonal allergic rhinitis in children 12 years of age or older.

Antihistamines and corticosteroids can be used simultaneously to treat allergic rhinitis.

• Treatment of severe allergic rhinitis that is not well treated with oral antihistamines or nasal sprays with corticosteroids can be effective when treated with oral antihistamines and nasal sprays with corticosteroids at the same time.

Allergic rhinitis can be treated with antigen immunotherapy.

nasalcrome_nasal_spray_s.jpg

Picture 125. The nasal root can be used to prevent allergic rhinitis with cromolyn nasal spray. Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

• Antigen immunotherapy is called “immunotherapy” or “immunotherapy” (see Immunotherapy).

• Moderate allergic rhinitis or severe allergic rhinitis that is not well treated with appropriate treatment for allergic rhinitis

• Severe allergic rhinitis requiring treatment with systemic corticosteroids

• Severe allergic rhinitis that cannot be cured with adequate treatment with appropriate corticosteroids.

• When sinusitis and or asthma and allergic rhinitis are present at the same time,

• Items 1-4 Allergic rhinitis can be treated with antigen immunotherapy.

• Antigens can be purified and extracted purely from cat or dog hair or dander, pollen from plants, or house dust mites (house dust mites) that can cause allergic rhinitis.

• Depending on the result of the skin reaction that occurs when these purified and extracted various antigens are brought into contact with or injected into the skin layer of children with allergic rhinitis or other allergic diseases, what type of allergic disease the child has It can be determined whether it is caused by an antigen of

• Antigen immunotherapy can be administered to children with allergic rhinitis by subcutaneously injecting a very small amount of the purified antigen found in the skin reaction test result with the tested antigen.

• Immunotherapy is initially initiated with a minimal amount of antigen and gradually increased to the maintenance immunotherapeutic dose.

• After increasing to the maintenance immunotherapy dose, it is normal to start immunotherapy with the maintenance immunotherapy dose for 2 to 6 weeks. Treatment with such antigen-immunotherapy reduces the symptoms of allergic rhinitis by one-third.

• Antigen immunotherapy, immunotherapy, or immunotherapy is called immunotherapy to prevent allergic rhinitis from occurring anymore.

• Antigen immunotherapy appears to be the ideal treatment for allergic rhinitis in theory, but it is not the first choice treatment for several reasons for treating allergic rhinitis.

• As described before, the symptoms of allergic rhinitis are not well treated, or the symptoms are so severe that you cannot sleep at school or go to school or It is common to treat allergic rhinitis with antigen-immunotherapy when attention deficit occurs while studying at home, and when it interferes with daily life.

• However, allergic rhinitis in children before 3 years of age is usually not treated with antigen-immunotherapy.

• Studies have shown that allergic rhinitis in infants, school-age, and adolescent children aged 4-14 years is significantly less likely to cause asthma when treated with antigen-immunotherapy.

• When treated with antigen immunotherapy, systemic side effects can occur in 5-10% of cases, and some side effects can be life-threatening. Another disadvantage is that the cost of treatment is considerable.

• Antigen immunotherapy is usually done by injection into the skin layer, but in the West, sublingual antigen immunotherapy is sometimes done by putting an antigen under the tongue.

• A recent study found that treating allergic rhinitis with immunotherapy can reduce treatment costs. In particular, these days, allergic rhinitis can be treated with sublingual (sublingual) allergic immunotherapy, which can significantly reduce treatment costs (source; Pediatrics News December 2008).

Drugs commonly used to treat allergic rhinitis in the United States 미국에서 흔히 쓰는 알레르기 비염 치료 약물

trade name Adult Dose   Pediatric Dose Side Effects  Note
비강 내 코티코스테로이드 분무제 Intranasal corticosteroids
Beclomethasone dipropionate (Beconase, Vancenase) 42 μg in both nasal passages 2 to 4 times a day  

42 μg in both nasal passages 2 a day

Localized nasal bleeding, nasal irritation May cause short-term growth retardation
Budesonide (Rhinocort Aqua) 64 μg in both nasal passages twice daily, or 128 μg once daily 64 μg once a day Localized nasal bleeding, nasal irritation At the beginning of treatment, start with a small dose and increase the dose gradually.
Flunisolide (Nasalide, Nasarel) 50 μg in both nasal passages 2 or 3 times a day 25 μg in both nasal passages 3 times a day Localized nasal bleeding, nasal irritation
Fluticasone propionate (Flonase) 100 ㎍ once a day into both nasal passages 100 ㎍ once a day into both nasal passages Localized nasal bleeding, nasal irritation Adults can be treated by spraying 50 ㎍ once a day into both nasal passages. If the therapeutic effect is good, it is used whenever necessary and does not affect growth in pediatric treatment.
Mometasone furoate monohydrate (Nasonex) 100 ㎍ once a day into both nasal passages  

50 ㎍ once a day into both nasal passages

Localized nasal bleeding, nasal irritation No effect on growth in pediatric treatment
Triamcinolone acetonide ( Nasacort AQ) 110 ㎍ once a day into both nasal passages 10 ㎍ once a day into both nasal passages Localized nasal bleeding, nasal irritation no smell
Dexamethasone(Dexacort phospate in turbinaire) Adults: twice a day, intranasally 6-12 years old 1-2 times a day, in the nasal cavity Localized nasal bleeding, nasal irritation
경구용 코티코스테로이드제 Oral corticosteroids
Prednisone (Deltasone, Orasone, Meticorten) 20mg once a day for 5 days 1 mg per kg of body weight once a day as a single dose emotional changes, etc. Used only to treat severe allergic rhinitis
항 히스타민제 Antihistamines
Cetirizine HCl (Zyrtec) 5-10mg per day 5-10mg per day mild sedative sleep syrup form. It can be used before or after the onset of symptoms of allergic rhinitis.
Desloratadine (Clarinex) 5mg per day 5 mg daily dose for children 2 or 12 years of age or older Almost no sedative sleep Treated before or after the onset of symptoms of allergic rhinitis. The therapeutic dose should be according to the drug company
Fexofenadine HCl (Allegra) 180mg or 60mg twice daily 30mg twice daily or 60mg once daily Little to no sedative sleep Treated before or after the onset of symptoms of allergic rhinitis. The therapeutic dose should be according to the drug company
Loratadine (Claritine) 10mg once a day 5mg once a day Little to no sedative sleep Syrup, over-the-counter
Nasal mucosal decongestants
Pseudoephedrine(sudafed) according to the instructions of the pharmaceutical company 15mg 4 times a day  nervousness, insomnia, etc.  There are several types of allergic rhinitis drugs that combine pseudoephedrine and antihistamines.
류코트라이인 수용체 길항제 Leukoriene-receptor antagonists
Montelukast sodium (Singulair) Take 10 mg once a day 2-5 years old 4mg once a day, 6-14 years old 5mg once a day Almost none Patients with asthma should take it in the evening.
항 콜린 작동제 Anticholinergics
Ipratropium bromide ( Nasal Atrovent 0.03%) 42 μg in both nasal passages 3 times a day 21 μg in both nasal passages 3 times a day dryness, nasal bleeding It is mainly treated when there is a lot of clear runny nose
비 스테로이드 비강 분무제
Cromolyn sodium (Nasal cromolyn) 10.4mg in both nasal passages 3 to 6 times a day 6 years old or older 10.4mg in both nasal passages 3 to 6 times a day safe Can live without a doctor’s prescription, treatment begins to take effect for at least 2 weeks
비강 분무용 항히스민제와 충혈 완화제Antihistamine/ Decongestant Nasal sprays
azelastine(Astelin) Treated according to the dosage provided by the pharmaceutical company  Treated according to the dosage provided by the pharmaceutical company  Use according to a doctor’s prescription, only when symptomatic
phenylephrine(nasal mucosa layer decongestant) )(Neo-Synephrine) Treated according to the dosage provided by the pharmaceutical company  Treated according to the dosage provided by the pharmaceutical company  Treatment should not be continued for more than 3 days Can be used over-the-counter without a doctor’s prescription, can be treated every 4 hours
oxymetazoline( nasal mucosa layer decongestant) )(Afrin) Treated according to the dosage provided by the pharmaceutical company  Treated according to the dosage provided by the pharmaceutical company  Treatment should not be continued for more than 3 days Can be used over-the-counter without a doctor’s prescription, can be treated every 4 hours
경구용 항히스타민제와 비강 점막층 충혈 완화제 Antihistamine/Decongestant, oral medications
triprolidine/pseudoephedrine (Actifed) Treated according to the dosage provided by the pharmaceutical company  Treated according to the dosage provided by the pharmaceutical company  May be sleepy or have insomnia only prescribed by a doctor
chlorpheniramine/phenylpropanolamine (Contact) Treated according to the dosage provided by the pharmaceutical company  Treated according to the dosage provided by the pharmaceutical company  Taken before or after symptoms develop May cause sleepiness or insomnia, as prescribed by a doctor
brompheniramine/phenylpropanolamine(Dristan) Treated according to the dosage provided by the pharmaceutical company  Treated according to the dosage provided by the pharmaceutical company  Taken before or after symptoms develop May cause sleepiness or insomnia, as prescribed by a doctor
chlorpheniramine/pseudoephedrine(Sudafed-Plus) Treated according to the dosage provided by the pharmaceutical company Treated according to the dosage provided by the pharmaceutical company Taken before or after symptoms develop May cause sleepiness or insomnia, as prescribed by a doctor
loratadine/pseudoephedrine(Claritin-D) Treated according to the dosage provided by the pharmaceutical company Treated according to the dosage provided by the pharmaceutical company Taken before or after symptoms develop May cause sleepiness or insomnia, as prescribed by a doctor
경구용 항히스타민제 Antihistamine, oral medications
clemastine fumerate(Tavista) Treated according to the dosage provided by the pharmaceutical company Treated according to the dosage provided by the pharmaceutical company Taken before or after symptoms develop Has a lot of sedative sleep effects, can be bought and used without a doctor’s prescription
diphenhydramine(Benadryl) Treated according to the dosage provided by the pharmaceutical company Treated according to the dosage provided by the pharmaceutical company Taken before or after symptoms develop Has a lot of sedative sleep effects, can be bought and used without a doctor’s prescription
chlorpheniramine(Allerest) Treated according to the dosage provided by the pharmaceutical company Treated according to the dosage provided by the pharmaceutical company Taken before or after symptoms develop Has a lot of sedative sleep effects, can be bought and used without a doctor’s prescription
dexbrompheniramine(Drixoral) Treated according to the dosage provided by the pharmaceutical company Treated according to the dosage provided by the pharmaceutical company Taken before or after symptoms develop Has a lot of sedative sleep effects, can be bought and used without a doctor’s prescription

Reference ; 

Reference

• As needed, you may obtain it without a doctor’s prescription in the United States.

• In any country in the world, refer to the scientific name of the drug instead of the trade name to obtain detailed information about the drug not listed in this table.

• In particular, it would be helpful to search for scientific names of drugs on the Internet, such as Google. Allergic rhinitis can be treated with coblation turbinate alleviation treatment.

Coblation turbinate reduction treatment

• Chronic rhinitis can lead to congestion of the nasal mucosa and blockage of the nasal airways.

• Allergic rhinitis can also cause irritation and inflammation of the turbinate and thickening of the turbinate as another cause.

• It is a surgical treatment method that reduces the volume of the swollen and inflamed turbinate without damaging the nasal tissue.

• When a part of the nasal airway is blocked due to allergic rhinitis and all medical treatments are not effective, this method can be used. (Source – Pediatric News, July 2007.)

• Ask your child’s pediatrician if there are any discrepancies with the information already mentioned.

The age of children and adolescents at which allergic rhinitis begins depends on the triggering factors

I.

• The age at which allergic rhinitis first occurs depends on the triggering factor of allergic rhinitis.

• Allergic rhinitis can be induced in 20-30% of children and adolescents (0-18 years old), and the incidence is increasing. • Allergic rhinitis is painful and expensive to treat.

• Children with allergic rhinitis are prone to complications such as sinusitis, nasal polyps, otitis media, sleep problems, and asthma.

• Milk, eggs, flour foods, cockroaches, cats, dogs, and house dust mites (house dust mites) are well known as major triggers of allergic rhinitis.

• It can be caused by allergic rhinitis such as sleep disturbance, obstructive sleep apnea, lack of concentration, learning difficulties, and decreased productivity.

The age of children and adolescents at which allergic rhinitis begins depends on the triggering factors-

Ⅱ.

• Allergic rhinitis can occur even before 1 year of age, but the general theory is that real allergic rhinitis does not occur before 1 year of age.

• The reason is that the main role of the antibody in inducing allergic rhinitis is the IgE antibody, and the IgE antibody develops later than the IgG, IgA, and IgM antibodies.

• Pollen-induced allergic rhinitis usually takes about 3 years from exposure to pollen, so it is not common for pollen allergic rhinitis to occur before 3 years of age.

• Perennial rhinitis (allergic rhinitis with symptoms year-round) caused by house dust mites (house dust mites) is less common before age 9.

• Allergic rhinitis caused by milk or food made from milk accounts for about 0.3%.

• The incidence of allergic rhinitis in children with atopic constitution is more than 0.3%.

• Asthma can be induced in 50% of children under 2 years of age with allergic rhinitis. But it happens much more than that.

The following is an example of a Q&A on health counseling for children and adolescents on the Internet about “recurring allergic rhinitis and sinusitis”.

Q&A. Allergic rhinitis, recurrent sinusitis.

Q. I am a mother of a 6-year-old child who has contacted me several times because of a child’s headache.

She said the child had a headache at dawn or when she woke up for 5 days, so she took a pulse at the pediatrician and intraocular pressure at the ophthalmologist, but everything came out normal. But then, when the child woke up, she found that one of her noses was blocked and her nose was swollen.

So, the pediatrician and her teacher were on vacation, so I went to the ENT, and in the meantime, I had sinusitis. She has been taking the antibiotic Augmentin Duo and the corticosteroid synthysone because she coughed during her meds at the pediatrician and she had a headache while taking it. However, when she took the medicine, her head did not hurt, and three days after taking the medicine, her nose was strange, and when she went, it was said that her nose was full of yellow nose. How could she have a relapse so quickly? If I catch a cold while taking the medicine, will it immediately recur?

During that time, my nose was clean for about 3 weeks. She was treated for sinusitis for 3 months and 1 week, and after 3 days of taking it, she has sinusitis again.

And she said that the otolaryngologist thinks the child has sinusitis because of a drug called Zadi Ten. It’s because the drug is holding the nose so tight that it can’t be expelled.

My child took the sinusitis medication and only took the preventive medicine called Zaditen twice a day. By the way, she only goes to the otolaryngology department, and her child’s overall health is unstable. How can I do it? Besides, the medicines given by the otolaryngologist are sulfa drugs, lulide suspension for children, and a nasal decongestant, Shu…. (I can’t remember the name). I’ve been taking all the drugs before, so I was wondering if it would work.

What would you like to do? Pediatrics teacher, should I go back to the Pediatrics Department after the vacation is over?

A. • Good morning.

• Thanks for asking a good question.

• Thank you for providing detailed information such as your child’s age, gender, past medical history, and examination findings. I can understand to some extent my mother who is worried about me. • In the meantime, a famous doctor has personally examined, diagnosed, and treated, so I am concerned about whether I can give you some helpful (helpful) advice.

• If I am a regular pediatrician who treats my son, I think I can try the following treatment. • As mentioned before, your child seems to have an atopic constitution.

• Most of the children with the atopic constitution

• allergic rhinitis;

• Sinusitis;

• croup,

• asthma,

• atopic dermatitis;

• allergic conjunctivitis;

• headache,

• dizziness;

• Pseudoanemia;

• Allergy Shiner,

• milk allergy;

• Tension Fatigue Syndrome;

• insect allergy;

• Many other allergic conditions and their symptoms are relatively common.

• In fact, most of the children and adolescents and adults who suffer from these allergic diseases without knowing it are very common in their daily lives without even knowing they have such allergic diseases.

• I am also one of those people who suffered a lot from such problems before coming to the United States.

• Unfortunately, there is no specific drug that can cure most allergic diseases, so we have to work hard to prevent further allergic diseases.

• Don’t worry if you take good preventive treatment for allergic diseases, and if necessary, you will not have such a big problem.

• There are many good medications available these days to prevent such allergic conditions.

• And there are fewer side effects during treatment, and allergic diseases are treated well.

• I would like to point out that there are many causes of sinusitis. Also, unpredictably, sinusitis can recur.

• Although it is common for most school-age children to get eight colds a year, the study found that some children get as many as 22 colds a year.

• When you catch a cold, the virus that caused the cold mainly infects the nasal mucosa and pharyngeal mucosa, and usually causes cold viral infections in the mucous membranes of the sinuses.

• In this case, the common cold can heal naturally and the viral sinusitis can heal naturally.

• If you have a secondary bacterial infection of viral sinusitis caused by a cold, you have bacterial sinusitis. At this time, symptoms are more severe than those of a cold alone, and the runny nose is thick, yellow, and sometimes bluish.

• You may have a headache, fatigue, fever, and tenderness in the area with sinusitis.

• However, if you have bacterial sinusitis, you may have very few symptoms at times.

• As you know, the diagnosis of sinusitis is often made by referring to the symptomatic signs, past medical history, and current medical history, so it is often difficult for doctors to make a definitive diagnosis.

• In general, there are more cases of diagnosing and treating sinusitis without performing a sinus X-ray, sinus CT scan, or MRI, and without a bacteriological examination.

• Most children with allergic rhinitis, even when they do not have a cold, may also have swelling of the mucous membranes in the nasal passages as well as the mucous membranes in the sinuses.

• Occasionally, fungal sinusitis can develop when bacteria, viruses, or fungi enter the sinuses.

• Depending on the bacteria that caused the sinusitis, the age of the child with the sinusitis and the presence of allergic rhinitis, acute or chronic sinusitis, or other conditions, the symptoms, severity, and treatment prognosis of sinusitis may vary. Very different.

• If you have frequent sinusitis, sometimes you need to know if your immune system is normal or abnormal, or if the cilia in the nasal mucosa and upper and lower respiratory tract are normal.

• With this complex knowledge in mind, it is very rare that sinusitis (sinusitis) cannot be cured even with adequate treatment with antibiotics and other medications, and the sinusitis must be treated surgically.

• When treated with antibiotics, etc., it is usually treated for 10-14 days, sometimes for a long period of time, such as 6 weeks.

• Even with such treatment, it sometimes recurs. And there are times when it doesn’t work. Even if you take preventive treatment to prevent it from reoccurring, it may happen again.

• If it seems that children are suffering from sinusitis, as described above, as sinusitis is related to allergies, immune function abnormalities, ciliary function abnormalities, and growth and development problems, it is ideal to first be screened, diagnosed and treated at the Department of Pediatrics.

• However, in some cases, you can receive treatment from a pediatric allergist, an otolaryngologist, etc. in addition to the pediatric department. • In case of untreated sinusitis, several specialists, such as an otolaryngologist, pediatric allergy and immunology specialist, pediatric infectious disease specialist, and pediatric respiratory specialist, sometimes consult each other for treatment.

• For such treatment, if possible, it is the most ideal treatment method to refer to another specialist, such as an otolaryngologist, according to the judgment of a regular pediatrician, and to consult with the specialist for treatment.

• When receiving treatment from one medical team of multiple specialists, you can listen to the opinions of each specialist and treat in the most appropriate way. However, when receiving team treatment in this way, medical expenses are quite high, and social and national medical policy support and conditions for team treatment must be provided.

• In general, when treating acute sinusitis, a bacteriological test is not performed with a sample collected from the nasal cavity, that is, a runny nose. However, if you have severe sinusitis or incurable sinusitis, a bacteriological test can be performed.

• Although it’s often said that it’s not worthwhile to routinely do a bacterial culture from a nasal runny nose to see what kind of bacteria is causing the sinusitis, it is sometimes used to find out what kind of bacteria is causing the sinusitis and kill the bacteria. It is sometimes ideal to treat sinusitis by choosing the most appropriate antibiotic.

• Sinusitis can be treated with antibiotics such as Septra or Augmentin, which are sulfa drugs, and antihistamines, nasal mucosal capillary constrictors, or corticosteroid nasal spray without bacteriological testing.

• Sometimes you need to know if your white blood cells, upper respiratory tract function, and immune system function are normal.

• If you have allergic rhinitis, sinusitis, or asthma, it is very important to prevent such allergic diseases by avoiding exposure to foods such as milk, polluted environments, house dust mites (house dust mites), stress, pets, drugs, and smoking. It’s important.

• It can be treated and prevented with second-generation antihistamines such as Claritin-Loratadine, mast cell stabilizer Cromolyn sodium nasal spray or anti-inflammatory corticosteroid nasal spray, and treated with appropriate antibiotics.

• When performing these treatments, as mentioned before, it is appropriate to first receive a checkup, diagnosis and treatment from a pediatrician, and if necessary, you can consult with another specialist for treatment.

• When it comes to diagnosis and treatment, it is up to the judgment of the child’s regular pediatrician to determine the drug, type, dose, and duration of use for treatment.

• Read everything here and you’ll get a lot of questions and answers.

• In particular, please read about sinusitis, asthma, allergic rhinitis, and factors and antigens that can trigger allergies.

• Re-emphasize that parents must actively participate in the effective treatment of allergic diseases.

• If the problem persists, please consult a pediatrician and discuss the problem.

• If you have any further questions, please feel free to contact us. Thank you. Lee Sang-wonl.

The following is an example of Internet pediatric health consultation Q&A regarding “stuffy nose and sputum, allergic rhinitis, milk allergy, bronchial asthma”.

Q&A. stuffy nose and phlegm, allergic rhinitis, Milk allergy, bronchial asthma

Q. Good morning? My child is an 80-day old girl. When she was born, she weighed 3.2 kg and was 47 cm tall, although this is not exact now, but she weighs about 6 kg and is about 60 cm tall. She has been breastfeeding for about 5 weeks due to work.

However, since about a month after she was born, she felt that her nose was a bit stuffy, and she got worse and worse, and now she has a buzzing sound when holding her and sometimes coughs in the evening. There is no heat. Also, when she drinks milk because of her stuffy nose, she gets very annoyed and sometimes cries while eating. Sometimes it’s hard to tell if it’s because of a stuffy nose or to have a bowel movement. I eat in moderation.

The stool is almost exactly slightly watery, twice a day. Sometimes I sleep well during the day and sometimes I only sleep a little, but in the evening, I usually sleep well, except for a couple of times when I drink milk. But she was worried, and when she turned 70, she went to the pediatrician. She said that she did not have a bad cold, and prescribed a three-day supply of her medicine. Still, she didn’t get much better, so she went to the otolaryngologist again, and she said it wasn’t too bad, and she just treated her neck and nose and told her to go every day, but there was no improvement after two days. Of course, she knows it’s unreasonable to hope for a short-lived remission, but she’s still willing to go back to the pediatrics and get treatment.

So, she knows it’s not good to go here and there, but she can’t decide where to go. I feel restless because it may be a disease that will heal on its own if I leave it alone, or it will get worse and become a serious disease. Sorry for the long story. Please advise.

A. • Mr. Oh Geum-sang

• Good morning. Thanks for the nice question.

• The more information you have, such as your child’s age, gender, past medical history, family history, examination findings, and clinical tests, the more helpful it is to give you an answer. We will give you an answer based on the information you provided.

• You must be very worried.

• I would like to start by saying that there can be many problems with diagnosing and treating diseases on the Internet.

• If you have such symptoms, you should differentially diagnose your baby for colds, pneumonia, congenital malformations of the nose, laryngeal tract softening, allergic rhinitis and asthma.

• If any of the biological parents’ siblings have allergic rhinitis, weak bronchial tubes, asthma, or a history of allergic diseases such as atopic dermatitis, it is suspected that the baby has allergic rhinitis or bronchial asthma.

• Note that some doctors believe that allergic rhinitis or asthma does not develop at this age. Refer to  ‘The age at which allergic rhinitis begins to occur depends on the type of antigen and the triggering factor’.

• The diagnosis should be differentiated from cold, acute rhinitis, otitis media, sinusitis, congenital wheezing, bronchiolitis, pneumonia or other diseases.

• If your nose is stuffy due to chronic allergic rhinitis or you are breathing with boiling sputum, it is recommended to treat your baby with a hypoallergenic formula. In particular, if an infant who is about 2 months old suffers from such symptoms, it is recommended to first see a pediatrician for diagnosis and treatment.

• Bronchial asthma, allergic rhinitis, and milk allergy in this book. 『Parents Should Become Anti-Doctors – Encyclopedia of Pediatric and Family Nursing』-Vol. 6 Neonatal Diseases-Congenital wheezing. Volume 8 (Volume 8) Respiratory Diseases in Children and Adolescents – Cold, bronchiolitis (bronchitis), etc. will be of great help.

• After you have been diagnosed with allergic rhinitis and bronchial asthma, if you ask about treatment methods, we will give you a detailed answer.

• Please visit the Department of Pediatrics for further diagnosis and consultation.

• And if you have more questions, please contact us. Thank you. Lee Sang-won.

The following is an example of Internet pediatric health consultation Q&A regarding “Adenoidectomy, Allergic Rhinitis”.

Q&A. Adenoidectomy, allergic rhinitis

Q. • Hello, Director. Our eldest child is a 6-year-old boy. When you catch a cold from a young age, it is difficult to breathe. There is also a bit of snoring as usual. When I have a cold, especially when I sleep at night, the sound of breathing is so difficult that I often catch my breath with the rhythm (?).

• So, I went to the general hospital and took an x-ray. The doctor says that the adenoids are enlarged and need to be surgically removed (?).

• The pediatrician says it can get smaller as it grows, so let’s just wait and see. I am afraid of all the changing seasons (autumn and winter). If you see that you sometimes get motion sickness, it seems like you have a severe headache. If you go to the otolaryngologist, they say that you have sinusitis because your nose keeps moving backwards. Now it weighs only 19 kg.

• When I see that I have trouble breathing, I just want to have surgery right away. Last winter, my tonsils had a severe bacterial infection, so I could hardly eat, blisters spread all over my lips, and I went into dehydration within a week. The director was in a hurry so I used it without fear. I would like to ask for the opinion of the director. Have a nice day every day.

A. Ahn Jung

Good morning. Thanks for the nice question. The more information you know about your child’s age, gender, past medical history, family history, examination findings, and clinical tests, the more helpful it is to give you an answer. We will give you an answer based on the information you provided.

Q. When you catch a cold from a young age, it is difficult to breathe.

A. A cold is a viral infection that is confined to the upper respiratory tract, such as the nasal passages and pharynx, and although it may be difficult to breathe due to a slightly blocked nose, it is usually not so much that it is difficult to breathe, as children experience. It seems that you have suffered from colds and allergic rhinitis, or colds and asthma. In particular, it seems that it was difficult to breathe because of night-induced asthma and/or cold, allergic rhinitis, asthma, etc. In addition, there must have been enlarged adenoids. It seems that breathing difficulties were severe because there were colds, allergic rhinitis, bronchial asthma, and adenoid hypertrophy.

Q. There is also a bit of snoring as usual.

A. • The nasal passages in most snoring children can be narrowed due to allergic rhinitis.

• And there are enlarged adenoids and enlarged tonsils, which can make the upper airway narrower.

• If the adenoids become very enlarged, it can make it difficult to suck air through the nostrils – through the nasal passages – into the pharynx and into the lower respiratory tract, and thus difficulty breathing. Sometimes obstructive during sleep

• Apnea may also occur.

• A scan of your sinuses, nose, and adenoids can show how large your adenoids are and can tell you if you have sinusitis.

• Many children with enlarged adenoids and allergic rhinitis also have sinusitis.

• At the same time as treating allergic rhinitis, if you have sinusitis, treat it with appropriate antibiotics for 2 to 6 weeks, and if you have difficulty breathing or obstructive sleep apnea due to enlarged adenoids, I think it is good to have adenoidectomy surgery.

• Ask a regular pediatrician to get advice from an otolaryngologist, and listen to the otolaryngologist’s opinion.

• If your regular pediatrician and otolaryngologist agree that it is best to treat with adenoid resection, perform adenoid resection. However, if the treatment does not work even after taking allergic environmental control treatment and active medical treatment with drugs, consider adenoidectomy surgery.

Q. When I have a cold, especially when I sleep at night, the sound of breathing is so difficult that I often get out of breath with the rhythm (?).

A. As described above, these symptoms appear to be caused by a cold + allergic rhinitis + enlarged adenoids and/or asthma. If you think that asthma can almost always occur in children with a history of atopic dermatitis and allergic rhinitis, you are usually right. After consulting a pediatrician and treating asthma with bronchodilators such as albuterol and anti-inflammatory drugs such as prednisone for a few days, shortness of breath and other symptoms will be greatly improved. And if you treat allergic rhinitis with nasal sprays of corticosteroids and oral antihistamines, the therapeutic effect will be much better. There is no specific medicine for the treatment of colds. Please also provide treatment to prevent allergic diseases.

Q. The doctor says that the adenoids are enlarged and need to be surgically removed (?). The pediatrician says it can get smaller as it grows, so let’s just watch it. I am afraid of all the changing seasons (autumn and winter).

A. • There are many children in the United States who suffer from almost the same health problems. This is because respiratory diseases such as colds and bronchial asthma are more likely to occur when the changing seasons come.

• Cromolyn nasal spray can be sprayed into the nasal cavity for a long period of time (weeks to months) to prevent allergic rhinitis. Cromolyn nasal spray is a mast cell stabilizer. This drug has few side effects and has a good therapeutic effect in preventing allergic rhinitis.

• In the United States, it is a drug that can be bought without a doctor’s prescription, but it is only used once to prevent allergic rhinitis.

• It is a must-try drug.

• Other nasal sprays of corticosteroids can be used to treat allergic rhinitis, and oral second-generation (second-generation) antihistamines such as Claritin can be used to treat allergic rhinitis.

Q. If you see that you sometimes get motion sickness, it seems like you have a severe headache. If you go to the otolaryngologist, they say that you have sinusitis because your nose keeps moving backwards. A. Children with atopic constitution and allergic rhinitis may have an adenoid face shape (adenoid face), uneven teeth

such as malocclusion, and symptoms such as allergy shiner.

For various reasons, I am good at motion sickness (well), and my five senses tend to be more sensitive to everything. The nasal mucosa swells with allergic rhinitis, which easily blocks the natural passage between the sinuses and the nasal passages. Therefore, sinusitis is well developed. The sinus does not occur because nasal secretions from the nasal passages easily pass to the side of the pharynx.

Q. Now it weighs only 19 kg. When I see that it is getting difficult (suffering) to breathe, I just want to have surgery right away.

A. • About 50 percent of your weight.

• If the upper airway is blocked, such as by enlarged adenoids, they may feel more fatigued because they have difficulty breathing (and cannot sleep well (because they don’t) at night), and some children complain of drowsiness during the day. Sometimes I don’t eat well. They may also develop hyperactivity and/or lack of concentration.

• The conclusion is as follows.

• You may have allergic rhinitis, sinusitis, enlarged adenoids, enlarged tonsils, or bronchial asthma. When this happens, the term allergy marching is also used. Almost (about) 7-15% of children with these allergies.

• Symptoms vary widely in the severity of symptoms. Don’t worry (don’t worry), talk to your allergist, pediatrician, and otolaryngologist and get treatment from them. Then you will be able to grow it in good health.

• [www.drleepediatrics.com – Vol. 8 Respiratory Diseases in Children and Adolescents – Colds.  Asthma,  Allergic rhinitis,  Food allergy. Vol. 17 (Vol. 17) Skin diseases in children and adolescents – atopic dermatitis. Please refer to Volume 18 (Vol. 18) Children and Adolescents Otolaryngeal Diseases-Sinusitis, Adenoid and Tonsil Hypertrophy, Adenoid and Redundant Surgery, etc. Please go to the Department of Pediatrics again to undergo screening, diagnosis, treatment, and consultation. If you have any more questions, please contact us again. Thank you. Lee Sang-won.

The following is an example of Q&A on health counseling for children and adolescents on the Internet regarding “bronchial asthma and allergic rhinitis”.

Q&A. Bronchial asthma, allergic rhinitis

Q. • Good morning? I came across your website by chance and came across a lot of useful information. The child I will be consulting with is a 6-year-old boy who was playing in the river two years ago and suddenly had a strange breathing sound at night, so I went to the hospital the next day. He was diagnosed with asthma and was prescribed an allergy prevention drug called Zaditen. After about a year of taking the injections of Zaditor and histobulin, I stopped arbitrarily. My child seems to have asthma symptoms like a cold about three or four times a year during the changing seasons. In the changing season, allergic rhinitis causes a lot of sneezing and sneezing in the morning.

The pediatrician I attend said that it’s a mild allergy, so you can treat it at any time, and I think it’s good to do the same. But this time, even though I was taking medicine, the sound of phlegm did not get better every night, so I went to the respiratory allergy department at a general hospital to get better quickly. The teacher told me to take x-rays of my lungs and nose, I had sinusitis, pneumonia, and I had asthma symptoms, and I had to take antibiotics for about 6 weeks for sinusitis.

• Until the day before, the local pediatrician didn’t say anything seriously, but suddenly I was diagnosed with this kind of diagnosis, and my heart sank. I don’t seem to have any symptoms of sinusitis. I’m sorry to hear that, but it’s hard to believe. The otolaryngologist I often go to says that when children get rhinitis (rhinitis), they appear like sinusitis on x-rays and advises not to do x-rays for children. Teacher, I have a lot of negative thoughts about medicine because my child often goes to the hospital.

• I want to take the least amount of medication, so I would like to ask the teacher for advice on whether I have a wrong idea. And it looks like it was taken when exhaling during the x-ray, is the result the same? I never had pneumonia.

A. Good morning. Thanks for the nice question. The more information you know about your child’s age, gender, past medical history, family history, examination findings, and clinical tests, the more helpful it is to give you an answer. We will give you an answer based on the information you provided. My guess is that your child has both allergic rhinitis and asthma. And there must have been sinusitis. Let me explain in more detail why we think so.

Q. The child I will be consulting with is a 6-year-old boy who was playing in the river two years ago and suddenly had a strange breathing sound at night, so I went to the hospital the next day. He was diagnosed with asthma and was prescribed an allergy prevention drug called Zaditen.

A. Children with asthma are born with a genetic predisposition to trigger asthma. In other words, asthma is a kind of genetic disease. When such children breathe cold air, the cold air they inhale can trigger asthma attacks. This type of asthma is also called cold air-induced bronchial asthma (cold air-induced asthma).

Q. After about a year of taking the injections of Zaditor and histobulin, I stopped arbitrarily.

A. I am not familiar with the original names of these two drugs, Zaditen and Histobulin, so I cannot tell you about them. However, the drugs I use the most to prevent asthma are cromolyn sodium (Intal) intratracheal spray or HFA for cromolyn inhalation. Nowadays, corticosteroid spray or inhaled corticosteroid HFA is often used to treat asthma (and prevent it).

Q. My child seems to have asthma symptoms like a cold about three or four times a year during the changing seasons. In the changing season, allergic rhinitis causes a lot of sneezing and sneezing in the morning

. A. Bronchial asthma and allergic rhinitis can be easily triggered by changes in temperature or upper respiratory tract viral infections such as colds. Also, to prevent allergic rhinitis, a nasal spray made of Nasal Cromolyn can be sprayed into the nasal passages.

Q. The pediatrician I attend said that it’s a mild allergy, so you can treat it at any time, and I think it’s good to do the same.

A. Asthma is classified as intermittent asthma, mild persistent asthma, moderately persistent asthma, and severe persistent asthma. Your child appears to have intermittent asthma. Asthma of this level can be controlled well by preventing occasional asthma attacks from triggering and by appropriately treating the triggered asthma attacks with medications. However, when mild persistent asthma is caused by attacks of moderate or severe persistent asthma, acutely onset asthma should be treated, and asthma prevented with inhaled cromolyn (Intal) HFA or other medications. And if asthma attack is triggered acutely, oral albuterol syrup (5cc=albuterol 2mg) is taken orally every 6 hours as needed, and Prednisone syrup or Prednisolone syrup is administered by weight. 1~2mg per kg is calculated as a daily dose, and the daily dose can be divided into 2~3 doses for 3~7 days. I’ll give you a reference.

Q. But this time, the sound of phlegm did not get better every night even though I was taking medicine, so I went to the respiratory allergy department at the general hospital to get better quickly. He told me that I had to take antibiotics for about 6 weeks and prescribed 8 kinds of drugs that day (there was no fever or sinus symptoms).

A. • Children with asthma are also prone to allergic rhinitis, and children with allergic rhinitis are also prone to asthma. You can also get sinusitis and otitis media. Unfortunately, it’s almost right to have these three bottles as standard. In addition, the adenoids may be abnormally large. The tonsils may also be greatly enlarged. You may also have costs in your nasal passages or sinuses.

• For this reason, sometimes hospitals do x-rays of the nose, sinuses, and upper airways.

• For some reason, when a facial X-ray is taken, an abnormality that already exists in the sinuses can be discovered incidentally, and in some cases, sinus abnormalities are discovered on the X-ray examination, even though there are no symptoms of sinusitis, and sinusitis is diagnosed for the first time.

• You may have symptoms of sinusitis, but the results of a sinus x-ray may be normal. These words are somewhat contradictory and contradictory.

• Sinus CT scans are more often diagnosed these days than sinus x-rays. Clinically, if you look into the nasal passages or nasal endoscopes of a child who has nasal congestion, allergy shiner, runny nose, and coughing, a thick, yellowish runny nose can be found. • If these symptoms persist for more than 10 days, sinusitis can be clinically diagnosed and treatment can be started.

• Acute sinusitis is usually treated with antibiotics such as Amoxicillin or Augmentin for 2-6 weeks. This treatment is very common. Don’t worry. Nasal Cromolyn nasal spray or nasal spray containing corticosteroids is used in the nasal cavity for a month or two for better treatment.

Q. And the chest x-ray looks like it was taken while exhaling, is the result the same? I never had pneumonia.

A. When there is a small amount of pneumonia, it may rarely show up on an X-ray examination. Conversely, there are cases when an X-ray shows pneumonia, but there are no symptoms. This type of pneumonia is called walking pneumonia. There are more cases in which pneumonia is diagnosed clinically by considering symptoms, signs, and examination without X-ray examination. Please continue to receive diagnosis and treatment from the Department of Pediatrics. Please be sure to read the FAQ several times on allergic rhinitis, asthma, and asthma. [Parents should also become anti-doctors – Encyclopedia of Pediatric and Family Nursing] – Volume 18 Children’s and Adolescent Otolaryngology – Sinusitis, etc. If you have any more questions, please contact us again. Thank you. Lee Sang-won.

The following is an example of a Q&A for health counseling for children and adolescents on the Internet about “snoring mouth breathing”.

Q&A. snoring, mouth breathing

Q. • Good morning? My name is Jinkyung Kim and I live in Melbourne, Australia.

• My 8-year-old son, Dongmin, has been snoring at her for the last couple of months.

• I wanted to inquire about him at least once because it was a pity to see him sleeping from the side. I don’t know why I suddenly started snoring, but I would appreciate it if you could tell me in detail how to fix my snoring habit. For reference, Dongmin almost always had a stuffy nose due to allergies, and occasionally used nasal spray to relieve symptoms. So he got into the habit of sleeping with his mouth open. I don’t know if those things have anything to do with snoring.

• I know you are busy, but I would appreciate your reply.

• Well then, have a nice day. in Melbourne.

A. • Hello, Kim Sookja. Thanks for asking.

• Good question.

• The more information you have, such as your child’s age, gender, past medical history, family history, examination findings, and clinical tests, the more helpful it is to give you an answer.

• We will give you an answer based on the information you provide. You seem to have allergic rhinitis, which causes the nasal mucosa to swell and the nasal mucosa to become congested, which leads to a stuffy nose and stuffy nose, which makes you open your mouth and breathe.

• Breathing with your mouth open is called gaping or mouth breathing in English.

• When allergic rhinitis is chronic, it is normal for the adenoids to become swollen and enlarged and the tonsils to become swollen and enlarged.

• At this time, anatomical changes occur in the nasal cavity, adenoids, tonsils, and soft palate, leading to narrowing of the upper airway and snoring. At this time, treatment to stop snoring should focus on treating allergic rhinitis and restoring the structural change of the upper airway caused by chronic allergic rhinitis to its original state. Learn more about snoring in the following information.

• Surprisingly, many children and adults suffer from severe snoring while sleeping. Some children snore every night when they sleep, and some children snore occasionally.

•There are many differences in the degree of snoring (snoring). Sometimes the cause of snoring can be known for sure, and often not. In order to better understand the causes and treatment methods, it is necessary to learn more about the anatomy of the upper respiratory tract here.

• The airway from both nostrils to the larynx is called the upper airway. The upper airways include the nasal passages, sinuses, adenoids, tonsils, and pharynx.

• Sometimes called the laryngeal and lower airways. When part of the upper airway is blocked for some reason, breathing difficulties may occur and snoring may occur.

• There are many causes of blockage of part of the upper airway. Part of the upper airway may be temporarily blocked due to birth defects of the upper airway from birth or acquired anatomical problems such as enlarged adenoids.

• There are more cases of snoring because a part of the upper airway part is temporarily blocked due to acquired tonsil enlargement or adenoid enlargement than snoring because part of the upper airway part is blocked due to a congenital anomaly. • There are several causes of enlarged tonsils and enlarged adenoids.

• The most common cause is an infectious or allergic disease of the upper respiratory tract. • In children who have atopic constitution or a past or present history of allergic diseases such as bronchial asthma and atopic dermatitis, enlarged tonsils and/or adenoids may be caused by allergic diseases and snoring.

• An enlarged tonsil and/or an enlarged adenoid may cause a narrowing of the upper airway and a snoring sound when the posterior nostrils, soft palate, posterior wall of the pharynx, and tongue vibrate abnormally with each breath. Changing the position of your child’s head or neck while snoring may add less or more blockage to the partially blocked upper airways, which may result in less, louder, or no snoring.

• The first thing to do is to see a pediatrician to find out what’s causing the snoring. If the tonsils and/or adenoids are abnormally enlarged and snoring, it is necessary to determine whether the enlargement is caused by an infectious disease, allergy, or other cause. If it is enlarged due to an infectious disease, it is necessary to find out what infectious disease caused the enlargement and treat it according to the cause.

• The part of the airway from both nostrils to the larynx is called the upper airway. The upper airways include the nasal cavity, sinuses, adenoids, tonsils, soft palate, uvula, pharynx, root of the tongue, and posterior pharynx.

• The larynx and lower airways, the trachea and bronchial airways, are called the airways. When a part of the upper airway is partially blocked for some reason, difficulty breathing can occur, which can lead to snoring. There are several causes of blockage in the upper airways.

    tonsills_enlarged_1s.jpg

Picture 114. The tonsils and adenoids in children with allergic rhinitis may be abnormally large. Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

• Congenital anomalies in the upper airways from birth, enlarged tonsils, and/or acquired abnormal enlargement of the adenoids can cause temporary blockage of parts of the upper airways and cause snoring. Most of the causes of snoring are congenital anomalies, which are acquired rather than caused by blockage of a part of the upper airway, or an enlarged adenoid and other abnormalities in the upper airway interact to produce a snoring sound as if in an orchestral ensemble is

• There are several causes of enlarged tonsils and enlarged adenoids. The most common causes are infectious or allergic diseases of the upper respiratory tract.

• Children with atopic constitution or a past or present history of allergic diseases such as asthma and atopic dermatitis may develop allergic rhinitis, enlarged tonsils, or enlarged adenoids, which may block part of the upper airway and cause snoring.

• An enlarged tonsil and/or an enlarged adenoid may cause a narrowing of part of the upper airway and a snoring sound when the soft palate, posterior nasal cavity, posterior pharyngeal wall, and tongue vibrate abnormally with each breath.

• When the position of the head or neck is changed in children who sleep while snoring, the part of the upper airway that was temporarily blocked may open wider and sometimes more block.

• So, if the position of the head or neck is changed, the snoring may be louder or less loud, and the snoring sound may be lower (lower), louder, continuous, and may stop.

• If your child snores, the first thing to do is to see a pediatrician to determine what is causing the snoring. • If the tonsils and/or adenoids are abnormally enlarged and snoring, the cause of the enlargedness should be determined. That is, it is necessary to determine whether the tonsils and/or adenoids are enlarged due to an infectious disease, an allergic disease, or other causes.

• If it is enlarged due to an infectious disease, it is necessary to find out what kind of pathogen the enlargement was caused by the infectious disease and treat it according to the cause.

• If it is enlarged due to an infectious disease, it is necessary to find out what kind of pathogenic infectious disease the enlargement is and treat it according to the cause.

• If hypertrophy is caused by allergic disease, it is necessary to find out which allergen was causing the hypertrophy, to remove or avoid the allergen, to treat it, or to treat the allergy properly with allergy medication or other methods.

• If the upper airway is severely blocked, you may wake up suddenly from sleep, and you may not be able to get enough sleep. If these symptoms persist for a long time, they can lead to growth and development delays, school study and learning difficulties, high blood pressure, daytime sleepiness, hyperactivity disorder and/or attention deficit disorder and heart problems (pulmonary heart disease).

• Obstructive sleep apnea may also occur. Enlarged adenoids and/or tonsils may block part of the upper airway and cause snoring to be treated with adenoidectomy and/or tonsillectomy. Please visit again if you have more questions. Thank you. Lee Sang-won.

Recent medications for allergic rhinitis

• Second-generation antihistamines, such as Fexofenadine (Allegra), Loratadine (Claritin), and Cetirizine (Zyrtec), are non-sedative histamines and do not have a sedative effect during treatment with these antihistamines.

• Azelastine (Astelin) has antihistamine and anti-inflammatory properties, and is a treatment for allergic rhinitis by spraying it into the nasal cavity.

• Corticosteroids such as Beclomethasone, Budesonide (Rhinocort Aqua), Dexamethasone, Flunisolide, Fluticasone propionate, Mometasone furoate, and Triamcinolone acetonide. Nasal spray is a nasal spray for allergic rhinitis.

• Noncorticosteroid nasal spray has anti-inflammatory properties.

• Topical allergic rhinitis drugs used to treat allergic rhinitis by spraying into the nasal passages with nasal spray. • Atrovent nasal spray is a nasal mucosal capillary decongestant.

• Cromolyn sodium nasal spray is a mast cell stabilizer and has anti-inflammatory (anti-inflammatory) action.

• Depending on the age and severity of allergic rhinitis, treatment of allergic rhinitis by selecting one or two of the above-described treatments for allergic rhinitis is very effective.

출처 및 참조 문헌

  • www.drleepediatrics.com 제1권 소아청소년 응급 의료
  • www.drleepediatrics.com 제2권 소아청소년 예방
  • www.drleepediatrics.com 제3권 소아청소년 성장 발육 육아
  • www.drleepediatrics.com 제4권 모유,모유수유, 이유
  • www.drleepediatrics.com 제5권 인공영양, 우유, 이유식, 비타민, 미네랄, 단백질, 탄수화물, 지방
  • www.drleepediatrics.com 제6권 신생아 성장 발육 육아 질병
  • www.drleepediatrics.com제7권 소아청소년 감염병
  • www.drleepediatrics.com제8권 소아청소년 호흡기 질환
  • www.drleepediatrics.com제9권 소아청소년 소화기 질환
  • www.drleepediatrics.com제10권. 소아청소년 신장 비뇨 생식기 질환
  • www.drleepediatrics.com제11권. 소아청소년 심장 혈관계 질환
  •  www.drleepediatrics.com제12권. 소아청소년 신경 정신 질환, 행동 수면 문제
  • www.drleepediatrics.com제13권. 소아청소년 혈액, 림프, 종양 질환
  • www.drleepediatrics.com제14권. 소아청소년 내분비, 유전, 염색체, 대사, 희귀병
  • www.drleepediatrics.com제15권. 소아청소년 알레르기, 자가 면역질환
  • www.drleepediatrics.com제16권. 소아청소년 정형외과 질환
  • www.drleepediatrics.com제17권. 소아청소년 피부 질환
  • www.drleepediatrics.com제18권. 소아청소년 이비인후(귀 코 인두 후두) 질환
  • www.drleepediatrics.com제19권. 소아청소년  안과 (눈)질환
  • www.drleepediatrics.com 제20권 소아청소년 이 (치아)질환
  • www.drleepediatrics.com 제21권 소아청소년 가정 학교 간호
  • www.drleepediatrics.com 제22권 아들 딸 이렇게 사랑해 키우세요
  • www.drleepediatrics.com 제23권 사춘기 아이들의 성장 발육 질병
  • www.drleepediatrics.com 제24권 소아청소년 성교육
  • www.drleepediatrics.com 제25권 임신, 분만, 출산, 신생아 돌보기
  • Red book 29th-31st edition 2021
  • Nelson Text Book of Pediatrics 19th- 21st Edition
  • The Johns Hopkins Hospital, The Harriet Lane Handbook, 22nd edition
  • 응급환자관리 정담미디어
  • Pediatric Nutritional Handbook American Academy of Pediatrics
  • 소아가정간호백과부모도 반의사가 되어야 한다이상원 저
  • The pregnancy Bible. By Joan stone, MD. Keith Eddleman, MD
  • Neonatology Jeffrey J. Pomerance, C. Joan Richardson
  • Preparation for Birth. Beverly Savage and Dianna Smith
  • 임신에서 신생아 돌보기까지이상원
  • Breastfeeding. by Ruth Lawrence and Robert Lawrence
  • Sources and references on Growth, Development, Cares, and Diseases of Newborn Infants
  • Emergency Medical Service for Children, By Ross Lab. May 1989. p.10
  • Emergency care, Harvey Grant and Robert Murray
  • Emergency Care Transportation of Sick and Injured American Academy of Orthopaedic Surgeons
  • Emergency Pediatrics A Guide to Ambulatory Care, Roger M. Barkin, Peter Rosen
  • Quick Reference To Pediatric Emergencies, Delmer J. Pascoe, M.D., Moses Grossman, M.D. with 26 contributors
  • Neonatal resuscitation Ameican academy of pediatrics
  • Pediatric Nutritional Handbook American Academy of Pediatrics
  • Pediatric Resuscitation Pediatric Clinics of North America, Stephen M. Schexnayder, M.D.
  • Pediatric Critical Care, Pediatric Clinics of North America, James P. Orlowski, M.D.
  • Preparation for Birth. Beverly Savage and Dianna Smith
  • Infectious disease of children, Saul Krugman, Samuel L Katz, Ann A.
  • 4권 모유모유수유이유 참조문헌 및 출처
  • 5권 인공영양우유, 이유, 비타민, 단백질지방 탄수 화물 참조문헌 및 출처
  • 6권 신생아 성장발육 양호 질병 참조문헌 및 출처
  • 소아과학 대한교과서

Copyright ⓒ 2014 John Sangwon Lee, MD., FAAP

부모도 반의사가 되어야 한다”-내용은 여러분들의 의사로부터 얻은 정보와 진료를 대신할 수 없습니다.

“The information contained in this publication should not be used as a substitute for the medical care and advice of your doctor. There may be variations in treatment that your doctor may recommend based on individual facts and circumstances.

“Parental education is the best medicine.